Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: A United Kingdom perspective

Autor: Simon Nichols, Sean Carroll, Lee Ingle, Grant Abt, Alaa Khushhal
Rok vydání: 2019
Předmět:
Male
medicine.medical_treatment
Drug research and development
Cardiovascular Medicine
030204 cardiovascular system & hematology
Cardiovascular System
Clinical trials
0302 clinical medicine
Heart Rate
Medicine and Health Sciences
Medicine
Public and Occupational Health
Cardiac Rehabilitation
Multidisciplinary
Rehabilitation
Middle Aged
Sports Science
Phase III clinical investigation
Exercise Therapy
Cardiovascular Diseases
Cohort
sports.sport
Female
Exercise prescription
Research Article
medicine.medical_specialty
Science
sports
Cardiology
Patient Advocacy
Rehabilitation Medicine
03 medical and health sciences
Heart rate
Humans
Sports and Exercise Medicine
Exercise physiology
Exercise
Aged
Pharmacology
Circuit training
business.industry
Biology and Life Sciences
Physical Activity
030229 sport sciences
United Kingdom
Research and analysis methods
Health Care
Physical Fitness
Clinical medicine
Exercise Test
Physical therapy
Exercise intensity
Observational study
business
human activities
Zdroj: PLoS ONE
PLoS ONE, Vol 14, Iss 6, p e0217654 (2019)
ISSN: 1932-6203
Popis: Background: In recent years, criticism of the percentage range approach for individualised exercise\ud prescription has intensified and we were concerned that sub-optimal exercise dose (especially\ud intensity) may be in part responsible for the variability in the effectiveness of cardiac rehabilitation\ud (CR) programmes in the United Kingdom (UK). The aim was to investigate the fidelity of a structured\ud Phase III CR programme, by monitoring and quantifying exercise training intensity.\ud Design: Observational study.\ud Methods: The programme comprised 16 sessions over 8 weeks, where patients undertook an\ud interval, circuit training approach within national guidelines for exercise prescription (40-70% heart\ud rate reserve [HRR]). All patients wore an Apple Watch (Series 0 or 2, Watch OS2.0.1, Apple Inc.,\ud California, USA). We compared the mean % heart rate reserve (%HRR) achieved during the\ud cardiovascular training component (%HRR-CV) of a circuit-based programme, with the %HRR during\ud the active recovery phases (%HRR-AR) in a randomly selected cohort of patients attending standard\ud CR. We then compared the mean %HRR-CV achieved with the minimal exercise intensity threshold\ud during supervised exercise (40% HRR) recommended by national governing bodies.\ud Results: Thirty cardiac patients (83% male; mean age [SD] 67 [10] years; BMI 28.3 [4.6] kg∙m-2\ud ) were\ud recruited. We captured 332 individual training sessions. The mean %HRR-CV and %HRR-AR were 37\ud (10) %, and 31 (13) %, respectively. There was weak evidence to support the alternative hypothesis\ud of a difference between the %HRR-CV and 40% HRR. There was very strong evidence to accept the\ud alternative hypothesis that the mean %HRR-AR was lower than the mean %HRR-CV (median\ud standardised effect size 1.1 (95%CI: 0.563 to 1.669) with a moderate to large effect.\ud Conclusion: Mean exercise training intensity was below the lower limit of the minimal training\ud intensity guidelines for a Phase III CR programme. These findings may be in part responsible for\ud previous reports highlighting the significant variability in effectiveness of UK CR services and poor\ud CRF improvements observed from several prior investigations.
Databáze: OpenAIRE