Cardiovascular responses to high-intensity stair climbing in individuals with coronary artery disease

Sydney E Valentino, Emily C Dunford, Jonathan Dubberley, Eva M Lonn, Martin J Gibala, Stuart M Phillips, Maureen J MacDonald, Sydney E Valentino, Emily C Dunford, Jonathan Dubberley, Eva M Lonn, Martin J Gibala, Stuart M Phillips, Maureen J MacDonald

Abstract

Exercise-based cardiac rehabilitation leads to improvements in cardiovascular function in individuals with coronary artery disease. The cardiac effects of coronary artery disease (CAD) can be quantified using clinical echocardiographic measures, such as ejection fraction (EF). Measures of cardiovascular function typically only used in research settings can provide additional information and maybe more sensitive indices to assess changes after exercise-based cardiac rehabilitation. These additional measures include endothelial function (measured by flow-mediated dilation), left ventricular twist, myocardial performance index, and global longitudinal strain. To investigate the cardiovascular response to 12 week of either traditional moderate-intensity (TRAD) or stair climbing-based high-intensity interval (STAIR) exercise-based cardiac rehabilitation using both clinical and additional measures of cardiovascular function in individuals with CAD. Measurements were made at baseline (BL) and after supervised (4wk) and unsupervised (12 week) of training. This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674). Participants were randomized into either TRAD (n = 9, 8M/1F) and STAIR (n = 9, 8M/1F). There was a training-associated increase in one component of left ventricular twist: Cardiac apical rotation (TRAD: BL: 5.6 ± 3.3º, 4 week: 8.0 ± 3.9º, 12 week: 6.2 ± 5.1º and STAIR: BL: 5.1 ± 3.6º, 4 week: 7.4 ± 3.9º, 12 week: 7.8 ± 2.8º, p (time) = 0.03, η2 = 0.20; main effect) and post-hoc analysis revealed a difference between BL and 4 week (p = 0.02). There were no changes in any other clinical or additional measures of cardiovascular function. The small increase in cardiac apical rotation observed after 4 weeks of training may indicate an early change in cardiac function. A larger overall training stimulus may be needed to elicit other cardiovascular function changes.

Keywords: HIIT; cardiac function; cardiac rehabilitation; flow-mediated dilation; stair climbing.

© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.

Figures

FIGURE 1
FIGURE 1
Speckle‐tracking echocardiography analysis of PSAX‐AP and PSAX‐MV images and the subsequent calculation required to obtain LV twist
FIGURE 2
FIGURE 2
Representative image of MPI analysis from Doppler tracings of mitral inflow and LV outflow. A = time between filling periods; B = ejection time (ET). The sum of is isovolumic contraction time (ICT) and isovolumic relaxation time (IRT) can be obtained by the subtraction of B from A. Image is not to scale for the purpose of depicting the analysis graphically
FIGURE 3
FIGURE 3
Individual values overlayed on the box and whisker format of baseline (BL), 4, and 12 week for each of the following: (a) relative flow‐mediated dilation (FMD), (b) peak left ventricular twist, (c) peak basal rotation, and (d) peak apical rotation. *Denotes p < 0.05

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