Vol 26, No 2 (2019)
Original articles — Clinical cardiology
Published online: 2018-05-08

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Mechanical efficiency of high versus moderate intensity aerobic exercise in coronary heart disease patients: A randomized clinical trial

Koldobika Villelabeitia-Jaureguizar1, Davinia Vicente-Campos2, Alejandro Berenguel Senen3, Verónica Hernández Jiménez4, Lorena Ruiz Bautista4, María Elvira Barrios Garrido-Lestache4, Jose López Chicharro5
Pubmed: 29745970
Cardiol J 2019;26(2):130-137.


Background: Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. A decreased ME, could represent an increased energy cost during exercise and may, therefore, be limited in terms of physical activity. This study aimed to compare the influence of two different exercise protocols: moderate continuous training (MCT) versus high intensity interval training (HIIT), as part of a cardiac rehabilitation program on ME values among coronary patients. 

Methods: One hundred and ten coronary patients were assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise tests in a cycle ergometer were performed to obtain VO2peak. Net energy expenditure (EE) and ME were obtained at intensities corresponding to the first (VT1) and second (VT2) ventilatory thresholds, and at VO2peak.

Results: Both exercise programs significantly increase VO2peak with a higher increase in the HIIT group (2.96 ± 2.33 mL/kg/min vs. 3.88 ± 2.40 mL/kg/min, for patients of the MCT and HIIT groups, respectively, p < 0.001). The ME at VO2peak and VT2 only significantly increased in the HIIT group. At VT1, ME significantly increased in both groups, with a greater increase in the HIIT group (2.20 ± ± 6.25% vs. 5.52 ± 5.53%, for patients of the MCT and HIIT groups, respectively, p < 0.001). 

Conclusions: The application of HIIT to patients with chronic ischemic heart disease of low risk re- sulted in a greater improvement in VO2peak and in ME at VT1, than when MCT was applied. Moreover, only the application of HIIT brought about a significant increase in ME at VT2 and at VO2peak. 

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  1. Layec G, Haseler LJ, Hoff J, et al. Evidence that a higher ATP cost of muscular contraction contributes to the lower mechanical efficiency associated with COPD: preliminary findings. Am J Physiol Regul Integr Comp Physiol. 2011; 300(5): R1142–R1147.
  2. Jabbour G, Iancu HD. Mechanical efficiency improvement in relation to metabolic changes in sedentary obese adults. BMJ Open Sport Exerc Med. 2015; 1(1): e000044.
  3. Jabbour G, Iancu HD, Mauriège P, et al. High-intensity interval training improves performance in young and older individuals by increasing mechanical efficiency. Physiol Rep. 2017; 5(7): e13232.
  4. Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016; 67(1): CD001800.
  5. Hambrecht R, Niebauer J, Fiehn E, et al. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol. 1995; 25(6): 1239–1249.
  6. Ito S, Mizoguchi T, Saeki T. Review of High-intensity Interval Training in Cardiac Rehabilitation. Intern Med. 2016; 55(17): 2329–2336.
  7. Villelabeitia-Jaureguizar K, Vicente-Campos D, Senen AB, et al. Effects of high-intensity interval versus continuous exercise training on post-exercise heart rate recovery in coronary heart-disease patients. Int J Cardiol. 2017; 244: 17–23.
  8. Jaureguizar KV, Vicente-Campos D, Bautista LR, et al. Effect of high-intensity interval versus continuous exercise training on functional capacity and quality of life in patients with coronary artery disease: a RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev. 2016; 36(2): 96–105.
  9. Kyröläinen H, Avela J, McBride JM, et al. Effects of power training on mechanical efficiency in jumping. Eur J Appl Physiol. 2004; 91(2-3): 155–159.
  10. Gillen JB, Gibala MJ. Is high-intensity interval training a time-efficient exercise strategy to improve health and fitness? Appl Physiol Nutr Metab. 2014; 39(3): 409–412.
  11. Skinner JS, McLellan TM, McLellan TH. The transition from aerobic to anaerobic metabolism. Res Q Exerc Sport. 1980; 51(1): 234–248.
  12. Garby L, Astrup A. The relationship between the respiratory quotient and the energy equivalent of oxygen during simultaneous glucose and lipid oxidation and lipogenesis. Acta Physiol Scand. 1987; 129(3): 443–444.
  13. Lafortuna CL, Proietti M, Agosti F, et al. The energy cost of cycling in young obese women. Eur J Appl Physiol. 2006; 97(1): 16–25.
  14. Meyer K, Samek L, Schwaibold M, et al. Interval training in patients with severe chronic heart failure: analysis and recommendations for exercise procedures. Med Sci Sports Exerc. 1997; 29(3): 306–312.
  15. Berry MJ, Storsteen JA, Woodard CM. Effects of body mass on exercise efficiency and VO2 during steady-state cycling. Med Sci Sports Exerc. 1993; 25(9): 1031–1037.
  16. Cotes JE. Relationships of oxygen consumption, ventilation and cardiac frequency to body weight during standardized submaximal exercise in normal subjects. Ergonomics. 1969; 12(3): 415–427.
  17. Bonne TC, Doucende G, Flück D, et al. Phlebotomy eliminates the maximal cardiac output response to six weeks of exercise training. Am J Physiol Regul Integr Comp Physiol. 2014; 306(10): R752–R760.
  18. Hoppeler H, Howald H, Conley K, et al. Endurance training in humans: aerobic capacity and structure of skeletal muscle. J Appl Physiol (1985). 1985; 59(2): 320–327.
  19. Coyle EF, Sidossis LS, Horowitz JF, et al. Cycling efficiency is related to the percentage of type I muscle fibers. Med Sci Sports Exerc. 1992; 24(7): 782–788.
  20. Grassi B, Rossiter HB, Zoladz JA. Skeletal muscle fatigue and decreased efficiency: two sides of the same coin? Exerc Sport Sci Rev. 2015; 43(2): 75–83.
  21. Høydal K, Helgerud J, Karlsen T, et al. Patients with coronary artery- or chronic obstructive pulmonary disease walk with mechanical inefficiency. Scand Cardiovasc J. 2009; 41(6): 405–410.
  22. Warburton DER, McKenzie DC, Haykowsky MJ, et al. Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol. 2005; 95(9): 1080–1084.
  23. Currie KD, Dubberley JB, McKelvie RS, et al. Low-volume, high-intensity interval training in patients with CAD. Med Sci Sports Exerc. 2013; 45(8): 1436–1442.
  24. Keteyian SJ, Hibner BA, Bronsteen K, et al. Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. J Cardiopulm Rehabil Prev. 2014; 34(2): 98–105.
  25. Rognmo Ø, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. 2012; 126(12): 1436–1440.
  26. Moholdt T, Aamot IL, Granøien I, et al. Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study. Clin Rehabil. 2012; 26(1): 33–44.