The Acute Physiological Response to High-intensity Interval Exercise in Patients with Coronary ...

115 Pages·2017·2.22 MB·English

The Acute Physiological Response to High-intensity Interval
Exercise in Patients with Coronary Artery Disease
by
Vanessa Dizonno
A thesis submitted in conformity with the requirements
for the degree of Master of Science
Graduate Department of Exercise Sciences
University of Toronto
© Copyright by Vanessa Dizonno (2017)
The acute physiological response to high-intensity interval exercise in
patients with coronary artery disease
Vanessa Dizonno
Master of Science
Graduate Department of Exercise Sciences
University of Toronto
2017
Abstract
High-intensity interval exercise (HIIE) elicits quicker and more substantial improvements in
aerobic capacity compared to moderate-intensity continuous exercise (MICE), but the protocol
that optimizes the physiological stimulus and patient preference is undetermined. Fifteen patients
with coronary artery disease (CAD) underwent physiological assessment during 3 different HIIE
protocols and MICE. The 4x4 protocol elicited a greater physiological stimulus, as indicated by
heart rate (HR), oxygen uptake (VO ), rating of perceived exertion (RPE), and blood pressure
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responses, but was the least preferred HIIE protocol. The 10x1 protocol was most preferred, it
was comparable to MICE, and should be considered a timesaving alternative. TRIP proved to be
a strong physiological stimulus and may be a viable choice opposed to long duration intervals,
for its similar HR response and RPE at a higher VO compared to MICE. These results indicate
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that HIIE is an efficient and well-tolerated exercise prescription for CAD patients.
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Acknowledgments
First and foremost, I would like to thank my supervisor, Dr. Jack Goodman, for his mentorship
and continued support throughout my undergraduate and graduate experience, and I am
extremely grateful for the academic resources and opportunities made available to me. This
thesis project would not have been possible without his expertise and guidance. A special thank
you to Dr. Katharine Currie who has been another academic mentor, and has taught me many of
the skills required of this thesis. I would also like to acknowledge my other committee members,
Dr. Scott Thomas and Dr. Paul Oh, who have contributed valuable insight over the past two
years.
I would like to pay special mention to my family members and friends who have been my
irreplaceable support network, and have provided continuous encouragement throughout my
entire academic career. Thank you to my lab colleagues for allowing me to practice and refine
my skills and assisting during data collection.
Departmental funding and scholarships I received from the university and generous donors
allowed me to focus my efforts on my research and academic success, and I am thankful for this
financial support.
Finally, I appreciate the time and hard work put forth by my study participants, who were a
pleasure to have a part of the study.

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Table of Contents

ACKNOWLEDGMENTS ........................................................................................................................ III

LIST OF TABLES ...................................................................................................................................VII

LIST OF FIGURES ............................................................................................................................... VIII

LIST OF APPENDICES .......................................................................................................................... IX

LIST OF ABBREVIATIONS .................................................................................................................... X

– INTRODUCTION AND RATIONALE ..........................................................................1

1.1. INTRODUCTION ...............................................................................................................................1

1.2. RATIONALE .....................................................................................................................................3

1.3. AIMS................................................................................................................................................4

1.3.1. Primary aim .............................................................................................................................4

1.3.2. Secondary aim .........................................................................................................................4

1.4. EXPERIMENTAL APPROACH .............................................................................................................4

1.5. STUDY HYPOTHESES .......................................................................................................................6

1.5.1. Primary hypothesis ..................................................................................................................6

1.5.2. Secondary hypothesis ..............................................................................................................6

– REVIEW OF LITERATURE ..........................................................................................7

2.1. INTRODUCTION ...............................................................................................................................7

2.2. CHRONIC RESPONSE TO HIGH-INTENSITY INTERVAL TRAINING ......................................................8

2.2.1. Effect of HIIT on maximal aerobic capacity ...........................................................................9

2.2.2. Effect of HIIT on cardiac structure and function ..................................................................12

2.2.3. Effect of HIIT on QoL, adherence and safety ........................................................................14

2.3. ACUTE RESPONSE TO HIGH-INTENSITY INTERVAL EXERCISE ........................................................16

2.3.1. Effect of HIIE on the acute cardiorespiratory response ........................................................16

2.4. HIIE PROTOCOL OPTIMIZATION ....................................................................................................17

2.4.1. Work interval .........................................................................................................................18

2.4.2. Recovery interval ...................................................................................................................18

2.4.3. HIIE optimization summary ..................................................................................................20

2.5. MECHANISMS ................................................................................................................................20

2.5.1. Chronic exercise ....................................................................................................................20

2.5.2. Acute exercise ........................................................................................................................21

2.6. SUMMARY OF REVIEW OF LITERATURE .........................................................................................22
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– METHODOLOGY AND METHODS ..........................................................................23

3.1. STUDY OVERVIEW .........................................................................................................................23

3.2. PARTICIPANTS ...............................................................................................................................23

3.2.1. Participant inclusion and exclusion criteria .........................................................................23

3.2.2. Standard of care ....................................................................................................................23

3.2.3. Recruitment ...........................................................................................................................24

3.3. STUDY VISITS ................................................................................................................................25

3.3.1. Visit 1 – Consent and familiarization ....................................................................................25

3.3.1. Visits 2-5 – Exercise interventions ........................................................................................25

3.4. STUDY MEASURES .........................................................................................................................29

3.4.1. Resting phenotypic characteristics ........................................................................................29

3.4.2. HR, BP, RPE, VO .................................................................................................................29
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3.4.3. Participant exercise preference .............................................................................................30

3.5. DATA AND STATISTICAL ANALYSES .............................................................................................30

3.5.1. Sample size calculation .........................................................................................................30

3.5.2. Data analysis .........................................................................................................................30

3.5.3. Statistical analysis .................................................................................................................31
– THE ACUTE PHYSIOLOGICAL RESPONSE TO HIGH-INTENSITY

INTERVAL EXERCISE IN PATIENTS WITH CORONARY ARTERY DISEASE ........................32

ABSTRACT ............................................................................................................................................32

INTRODUCTION ..................................................................................................................................32

MATERIALS AND METHODS ............................................................................................................33

RESULTS ...............................................................................................................................................38

DISCUSSION .........................................................................................................................................41

CONCLUSION .......................................................................................................................................45

ACKNOWLEDGEMENTS ....................................................................................................................45

– CONCLUSION ...............................................................................................................46

5.1. EXTENDED DISCUSSION ................................................................................................................46

5.1.1. Clinical implications .............................................................................................................47

5.1.2. Patient preferences ................................................................................................................48

5.2. STUDY LIMITATIONS .....................................................................................................................49

5.3. FUTURE DIRECTIONS .....................................................................................................................51

5.4. CONCLUSION .................................................................................................................................52

REFERENCES ..........................................................................................................................................54
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APPENDIX A: RECRUITMENT SCRIPT ............................................................................................67

APPENDIX B: SCREENING FORM .....................................................................................................70

APPENDIX C: RECRUITMENT POSTER ...........................................................................................71

APPENDIX D: CONSENT FORM ..........................................................................................................72

APPENDIX E: BORG RATING OF PERCEIVED EXERTION ........................................................80

APPENDIX F: MEDICAL HISTORY QUESTIONNAIRE .................................................................81

APPENDIX G: EXTENDED TECHNICAL PROTOCOLS .................................................................83

APPENDIX H: PRE-VISIT CHECKLIST .............................................................................................92

APPENDIX I: DATA COLLECTION SHEETS ....................................................................................93

APPENDIX J: HIIE QUESTIONNAIRE .............................................................................................101

APPENDIX K: ADDITIONAL RESULTS ...........................................................................................104

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List of Tables
Table 1. Summary of HIIT studies examining aerobic capacity in patients with CAD.
Table 2. Detailed description of HIIE protocols.
Table 3. Participant characteristics.
Table 4. Detailed description of HIIE protocols for manuscript.
Table 5. Study results.
Table 6. Additional results.
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List of Figures
Figure 1. Intermittent versus continuous exercise training variables, format, and associated
adaptations.
Figure 2. Variables that can be manipulated in a HIIE session.
Figure 3. Familiarization protocol schematic.
Figure 4. 4x4 protocol schematic.
Figure 5. 10x1 protocol schematic.
Figure 6. TRIP schematic.
Figure 7. MICE schematic.
Figure 8. Exercise protocol schematics for manuscript.
Figure 9. VO response to exercise protocols.
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Figure 10. HR response to exercise protocols.
Figure 11. Group average SBP and DBP responses to the exercise protocols.
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List of Appendices
Appendix A: Recruitment Script
Appendix B: Screening Form
Appendix C: Recruitment Poster
Appendix D: Consent Form
Appendix E: Borg Rating of Perceived Exertion
Appendix F: Medical History Questionnaire
Appendix G: Extended Technical Protocols
Appendix H: Pre-visit Checklist
Appendix I: Data Collection Sheets
Appendix J: HIIE Questionnaire
Appendix K: Additional Results
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List of Abbreviations
AT Anaerobic Threshold
AUC Area Under the Curve
BLa Blood Lactate
BMI Body Mass Index
BNP B-type Natriuretic Peptide
BP Blood Pressure
CABG Coronary Artery Bypass Graft
CAD Coronary Artery Disease
CPA Cardiopulmonary Assessment
CR Cardiac Rehabilitation
CRS Cardiac Rehabilitation Supervisor
cTn Cardiac Troponin
CV Cardiovascular
CVD Cardiovascular Disease
DBP Diastolic Blood Pressure
ECG Electrocardiogram
EDV End-Diastolic Volume
EF Ejection Fraction
eNOS Endothelial Nitric Oxide Synthase
ESV End-Systolic Volume
FMD Flow-Mediated Dilation
HF Heart Failure
HIIE High Intensity Interval Exercise
HIIT High Intensity Interval Training
HR Heart Rate
HRpeak Peak Heart Rate
HRR Heart Rate Reserve
KT Knowledge Translation
LV Left Ventricle
MI Myocardial Infarction
MICE Moderate Intensity Continuous Exercise
MICT Moderate Intensity Continuous Training
NO Nitric Oxide
PCI Percutaneous Coronary Intervention
PCr Phosphocreatine
QoL Quality of Life
RCT Randomized Controlled Trial
RPE Rating of Perceived Exertion
RPP Rate Pressure Product
RR Risk Ratio
SIT Sprint Interval Training
TRI Toronto Rehabilitation Institute
TRIP Toronto Rehabilitation Institute Protocol
TTE Time to Exhaustion
TWH Toronto Western Hospital
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