Combined Arm-leg Ergometer Endurance Training Versus Cycle Ergometer Endurance Training in Myocardial Infarction

Effects of Combined Arm-leg Ergometer Endurance Training Versus Cycle Ergometer Endurance Training on Cardiorespiratory Fitness, Exercise Tolerance and Quality of Life in Patients With Post-myocardial Infarction

Myocardial infarction (MI) often leads to reduced cardiorespiratory fitness, poor exercise tolerance, and decreased quality of life. Conventional rehabilitation mainly uses cycle ergometer training but may not adequately improve upper-limb function needed for daily activities. This randomized clinical trial aims to compare the effects of combined arm-leg ergometer endurance training and cycle ergometer training on cardiorespiratory fitness, exercise tolerance, and quality of life in post-MI patients. The study will be conducted in cardiac rehabilitation centers in Pakistan using 40 medically stable post-MI patients divided into two groups. Group A will receive combined arm-leg ergometer training, while Group B will receive cycle ergometer training. Sessions will be conducted 3 times weekly for 6 weeks. Outcomes will be measured using VO₂ peak, 6-minute walk test, and MacNew HRQOL questionnaire, with data analyzed through SPSS version 25.

Study Overview

• Status: Not yet recruiting
• Conditions: Post Myocardial Infarction
• Intervention / Treatment: Device: arm-leg ergometer training; Device: traditional cycle ergometer training

Detailed Description

Myocardial infarction (MI) remains a primary contributor to long-term disability and cardiovascular death. After MI, patients typically experience reduced cardiorespiratory fitness, poor exercise tolerance, and diminished quality of life (QOL). Conventional rehabilitation using cycle ergometer training is well-established in improving VO₂ peak and functional capacity, yet it often neglects upper-limb reconditioning, which plays a crucial role in performing everyday tasks. Emerging evidence suggests that combining arm and leg ergometer endurance training offers a more comprehensive rehabilitation strategy by engaging a greater muscle mass, enhancing systemic oxygen delivery, and improving both upper- and lower-limb functionality. While upper-limb ergometry has demonstrated physiological benefits in COPD, coronary artery disease, and heart failure populations, it remains underutilized in post-MI rehabilitation protocols. The aim of the study is to compare the effects of combined arm leg ergometer endurance training versus cycle ergometer endurance training on cardiorespiratory fitness, exercise tolerance, and quality of life in patients with post-myocardial infarction. This study will be a randomized clinical trial. A non-probability convenience sampling method will be used. The study will be conducted at the Cardiac Rehab Unit, Cardiac Centers, and Hospitals, Pakistan. Patients will be selected according to the inclusion and exclusion criteria.

Data will be collected by three primary outcomes: cardiorespiratory fitness (measured by VO₂ peak), exercise tolerance (6-minute walk test), and quality of life (MacNew HRQOL questionnaire). A total of 40 medically stable post-MI patients will be recruited and randomized into two groups. Group A will participate in Combined Arm-Leg Ergometer Training, while Group B will receive Cycle Ergometer Training. Each session will last 30 minutes with a warm-up and cool-down period, which will be held 3 times per week for 6 weeks. Outcome measures will be taken at baseline and week 6. Data analysis will be done bySPSS version 25.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Muhammad Iqbal Tariq Tariq, Phd*; Phone Number: 333826752; Email: iqbal.tariq@riphah.edu.pk
• Study Contact Backup: Name: Nimra noor Noor, MS-CPPT; Phone Number: 03030684869; Email: nimranoor358@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Males and Females
• Patients with a history of myocardial infarction (MI)
• Medically stable for at least 1 month post-MI
• Age between 40-70 years.
• Willingness and ability to participate in exercise training.
• Medically cleared for exercise by a cardiologist.

Exclusion Criteria:

• Unstable angina or uncontrolled hypertension.
• Orthopedic/neurological limitations affecting participants.
• Arrhythmias
• Fever
• Cognitive impairment or non-consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: arm-leg ergometer ergometer; Group A, undergoing combined arm-leg ergometer training, will participate in exercise sessions three times per week for six weeks. Each session will last between 30 minutes and will include a warm-up and cool-down period. The intensity of the training will be maintained at a moderate level, corresponding to 50-70% of the individuals heart rate reserve or a score of 11-14 on the Borg Rating of Perceived Exertion (RPE) scale, which reflects "light to somewhat hard" exertion. This protocol involves the simultaneous use of both upper and lower limbs, which may elicit a higher cardiovascular demand and greater systemic oxygen consumption	Device: arm-leg ergometer training; Each session will last between 30 minutes and will include a warm-up and cool-down period. The intensity of the training will be maintained at a moderate level, corresponding to 50-70% of the individuals heart rate reserve or a score of 11-14 on the Borg Rating of Perceived Exertion (RPE) scale, which reflects "light to somewhat hard" exertion. This protocol involves the simultaneous use of both upper and lower limbs, which may elicit a higher cardiovascular demand and greater systemic oxygen consumption, thereby potentially enhancing improvements in VO₂ peak and overall cardiovascular efficiency
Experimental: traditional cycle ergometer; traditional cycle ergometer training, will follow the same frequency, intensity, and duration of training as Group A, but the type of exercise will be limited to lower limb cycling on a standard stationary bike. This mode of training targets aerobic endurance primarily through leg muscles, which is the conventional method used in postmyocardial infarction rehabilitation exercise sessions three times per week for 6 weeks	Device: traditional cycle ergometer training; same frequency, intensity, and duration of training as Group A, but the type of exercise will be limited to lower limb cycling on a standard stationary bike. This mode of training targets aerobic endurance primarily through leg muscles, which is the conventional method used in postmyocardial infarction rehabilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cardiorespiratory fitness	measured by VO₂ peak. VO₂ peak is an objective measure of cardiorespiratory fitness, indicating the maximum amount of oxygen the body can utilize during intense exercise. It is typically recorded using a metabolic cart or estimated through submaximal or maximal exercise tests (e.g., using a cycle ergometer or treadmill). The higher the VO₂ peak, the more efficient the cardiovascular and respiratory systems are at transporting oxygen to working muscles	Baseline and after 6 weeks of intervention
exercise tolerance	6-minute walk test. The 6MWT is a widely used functional exercise test to assess submaximal aerobic capacity and endurance. It measures the total distance an individual can walk on a flat surface in 6 minutes. The test is practical, cost-effective, and well-tolerated by cardiac patients. It reflects daily physical functioning and correlates with VO₂ peak in cardiac rehabilitation populations	Baseline and after 6 weeks of intervention
individual quality of life	MacNew HRQOL questionnaire. The MacNew HRQOL questionnaire is a disease-specific, self-reported tool that assesses the emotional, physical, and social functioning of individuals with heart disease. It contains 27 items divided into 3 domains and is scored on a 7-point Likert scale. Higher scores indicate better perceived quality of life. It is validated for post-MI and cardiac rehabilitation populations.	Baseline and after 6 weeks of intervention

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Nimra Noor, MS-CPPT, Riphah International University Lahore(Gulberg)

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: June 8, 2026
• First Submitted That Met QC Criteria: June 8, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Quality of Life; Myocardial infarction; Cycle Ergometer; Arm-Leg Ergometer
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Heart Diseases; Infarction; Necrosis; Myocardial Ischemia; Ischemia; Pathological Conditions, Signs and Symptoms; Myocardial Infarction
• Other Study ID Numbers: REC/RCR & AHS/25/0311

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No