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

Khushhal, Alaa; Nichols, Simon; Carroll, Sean; Abt, Grant; Ingle, Lee

Authors

Alaa Khushhal

Simon Nichols

Sean Carroll

Grant Abt

Lee Ingle



Abstract

In recent years, criticism of the percentage range approach for individualised exercise prescription has intensified. We were concerned that sub-optimal exercise dose (especially intensity) may be in part responsible for the variability in the effectiveness of cardiac rehabilitation (CR) programmes in the United Kingdom (UK). The aim of this observational study was to investigate the fidelity of a structured Phase III CR programme, by monitoring and quantifying exercise training intensity. The programme comprised 16 sessions over 8 weeks, where patients undertook an interval, circuit training approach within national guidelines for exercise prescription (40–70% heart rate reserve [HRR]). All patients wore an Apple Watch (Series 0 or 2, Watch OS2.0.1, Apple Inc., California, USA). We compared the mean % heart rate reserve (%HRR) achieved during the cardiovascular training component (%HRR-CV) of a circuit-based programme, with the %HRR during the active recovery phases (%HRR-AR) in a randomly selected cohort of patients attending standard CR. We then compared the mean %HRR-CV achieved with the minimal exercise intensity threshold during supervised exercise (40% HRR) recommended by national governing bodies. Thirty cardiac patients (83% male; mean age [SD] 67 [10] years; BMI 28.3 [4.6] kg/m-2) were recruited. We captured 332 individual training sessions. The mean %HRR-CV and %HRR-AR were 37 (10) %, and 31 (13) %, respectively. There was weak evidence to support the alternative hypothesis of a difference between the %HRR-CV and 40% HRR. There was very strong evidence to accept the alternative hypothesis that the mean %HRR-AR was lower than the mean %HRR-CV, median standardised effect size 1.1 (95%CI: 0.563 to 1.669), with a moderate to large effect. Mean exercise training intensity was below the lower limit of the minimal training intensity guidelines for a Phase III CR programme. These findings may be in part responsible for previous reports highlighting the significant variability in effectiveness of UK CR services and poor CRF improvements observed from several prior investigations.

Citation

KHUSHHAL, A., NICHOLS, S., CARROLL, S., ABT, G. and INGLE, L. 2019. Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: a United Kingdom perspective. PLoS ONE [online], 14(6), article number e0217654. Available from: https://doi.org/10.1371/journal.pone.0217654

Journal Article Type Article
Acceptance Date May 15, 2019
Online Publication Date Jun 13, 2019
Publication Date Jun 30, 2019
Deposit Date Nov 30, 2023
Publicly Available Date Nov 30, 2023
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 14
Issue 6
Article Number e0217654
DOI https://doi.org/10.1371/journal.pone.0217654
Keywords Cardiac rehabilitation; Cardiovascular fitness; Cardiac patients
Public URL https://rgu-repository.worktribe.com/output/2079544
Additional Information The file accompanying this record contains both the full-text article and the supplementary data.