Effectiveness and Safety of Four Aerobic Exercise Intensity Prescription Techniques in Rehabilitation Training for Patients with Coronary Heart Disease

Tao Chen, Huiying Zhu, Qingyuan Su, Tao Chen, Huiying Zhu, Qingyuan Su

Abstract

Methods: A retrospective study was conducted on all patients with CHD who were admitted to CR and completed cardiopulmonary exercise tests (CPET) in Guangdong Hospital of traditional Chinese medicine. According to the risk stratification method of CHD, all participants were divided into three groups: low, moderate, and high risk. The training target heart rates (HRt) of each participant were calculated according to the formula of heart-rate-reserve (HRR), maximum-heart-rate (MHR), target-heart-rate (THR), and anaerobic threshold (AT) method provided in the guideline. Among them, the HRR method using the maximum-heart-rate obtained by the age formula was named "HRR method A," and that using the actual measured peak heart rate was named "HRR method B." For the three groups, the effectiveness and safety indexes at the target-heart-rate zone set by the different formulas above are counted and compared using CPET data.

Results: A total of 324 patients were included in the analysis. There was no significant difference between the target-heart-rate set by the HRR method A and AT method among the three groups (P > 0.05). The mean value of HRt set by other methods was lower than the AT heart rate (P < 0.05). The HRt set by the THR method was close to the AT, while that set by the MHR method was the lowest. The frequency of patients whose HRt was set by the MHR method was lower than the AT one, which was the highest. None of the participants had serious adverse events. There were no risks of ECG abnormalities in the low- and moderate-risk groups. The HRR method A had the highest incidence of various risks of ECG abnormalities, while the MHR method had the lowest one, and the safety of the THR method is close to that of the AT method (P < 0.05).

Conclusion: The heart rate calculated by HRR method A is more consistent with the actual AT. All four techniques are safe in low- and moderate-risk patients. In high-risk patients, using HRR method A has certain risks. It is recommended to use the MHR method for safety reasons, but its effectiveness is low. If considering both effectiveness and safety, the THR method can be conservatively selected at the beginning of the CR program.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Copyright © 2022 Tao Chen et al.

References

    1. The writing committee of the report on cardiovascular health and diseases in China, “report on cardiovascular health and diseases in China 2019: an updated summary”. Chinese Circulation Journal . 2020;35(9):833–854.
    1. JCS Joint Working Group. Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012) Circulation Journal: Official Journal of the Japanese Circulation Society . 2014;78(8):2022–2093. doi: 10.1253/circj.cj-66-0094.
    1. Anderson L., Thompson D. R., Oldridge N., et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews . 2016;2016
    1. Piepoli MF., Corra U., Adamopoulos S., et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European association for cardiovascular prevention & Rehabilitation. Endorsed by the committee for practice guidelines of the European society of cardiology. European Journal of Preventive Cardiology . 2014;21(6):664–681. doi: 10.1177/2047487312449597.
    1. Pelliccia A., Sharma S., Gati S., et al. 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal . 2020;42:17–96. doi: 10.1093/eurheartj/ehaa605.
    1. Martin B. J., Arena R., Haykowsky M., et al. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clinic Proceedings . 2013;88(5):455–463. doi: 10.1016/j.mayocp.2013.02.013.
    1. Taylor J. L., Bonikowske A. R., Olson T. P. Optimizing outcomes in cardiac rehabilitation: the importance of exercise intensity. Frontiers in Cardiovascular Medicine . 2021;8 doi: 10.3389/fcvm.2021.734278.734278
    1. Chinese Society of Cardiology. Chinese expert consensus for cardiac rehabilitation and secondary prevention of coronary heart disease. Chinese Journal of Cardiology . 2013;41(4):267–275.
    1. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs . Champaign, UK: Human Kinetics; 2013.
    1. Ding R. J., Lei S. History current situation and countermeasure of cardiac rehabilitation in China. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease . 2021;29:1–5.
    1. Mytinger M., Nelson R. K., Zuhl M. Exercise prescription guidelines for cardiovascular disease patients in the absence of a baseline stress test. Journal of Cardiovascular Development and Disease . 2020;7(2):p. 15. doi: 10.3390/jcdd7020015.
    1. Pavy B., Iliou M. C., Vergès-Patois B., et al. French society of cardiology guidelines for cardiac rehabilitation in adults. Archives of Cardiovascular Diseases . 2012;105(5):309–328. doi: 10.1016/j.acvd.2012.01.010.
    1. O’Neil S., Thomas A., Pettit-Mee R., et al. Exercise prescription techniques in cardiac rehabilitation centers in midwest states. Journal of Clinical Exercise Physiology . 2018;7(1):8–14. doi: 10.31189/2165-6193-7.1.8.
    1. Price K. J., Gordon B. A., Bird S. R., Benson A. C. A review of guidelines for cardiac rehabilitation exercise programmes: is there an international consensus? European Journal of Preventive Cardiology . 2016;23(16):1715–1733. doi: 10.1177/2047487316657669.
    1. American College of Sports Medicine. ACSM’s Exercise Testing and Prescription . Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2017.
    1. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation Programs . Champaign, UK: Human Kinetics; 2021.
    1. Chinese Society of Cardiology. Chinese expert consensus on exercise therapy for patients with coronary heart disease. Chinese Journal of Cardiology . 2015;43:575–588.
    1. Cardiovascular Committee of Chinese Association of Rehabilitation Medicine. Chinese Guideline for Cardiac Rehabilitation and Secondary Prevention . Beijing, China: Peking University Medical Press; 2018.
    1. Foster C., Porcari J. P. The risks of exercise training. Journal of Cardiopulmonary Rehabilitation . 2001;21(6):347–352. doi: 10.1097/00008483-200111000-00002.
    1. Franklin B. A. Cardiovascular events associated with exercise. The risk-protection paradox. Journal of Cardiopulmonary Rehabilitation . 2005;25(4):189–195. doi: 10.1097/00008483-200507000-00001.
    1. Lavie C. J., Thomas R. J., Squires R. W., Allison T. G., Milani R. V. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clinic Proceedings . 2009;84(4):373–383. doi: 10.4065/84.4.373.
    1. Dahabreh I. J., Paulus J. K. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. The Journal of the American Medical Association . 2011;305(12):p. 1225. doi: 10.1001/jama.2011.336.
    1. Scheinowitz M., Harpaz D. Safety of cardiac rehabilitation in a medically supervised, community based program. Cardiology . 2005;103(3):113–117. doi: 10.1159/000083433.
    1. Pavy B., Iliou M. C., Meurin P., Tabet J. Y., Corone S. Safety of exercise training for cardiac patients: results of the French registry of conplications during cardiac rehabilitation. Archives of Internal Medicine . 2006;166(21):p. 2329. doi: 10.1001/archinte.166.21.2329.
    1. Scottish Intercollegiate Guidelines Network. Cardiac Rehabilitation: A National Clinical Guideline . Edinburgh, Scottish: Scottish Intercollegiate Guidelines Network; 2016.

Source: PubMed

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