Characterising the application of the "progressive overload" principle of exercise training within cardiac rehabilitation: a United Kingdom-based community programme.

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

Abstract

Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation (CR) programmes for improving cardiorespiratory fitness (CRF) in patients with a history of cardiac disease in the United Kingdom (UK). Through an observational study, we aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity (% heart rate reserve) during the cardiovascular (CV) exercise training component (%HRR-CV), CV training duration; estimated changes in cardiorespiratory fitness (change in estimated metabolic equivalents (METs)); session rating of perceived exertion (sRPE), sRPE training load (sRPE-TL), and exercise training impulse (TRIMP) were evaluated. Thirty cardiac patients (83% male; age (SD) 67.0 (10.0) years; body mass index (SD) 28.3 (4.6) kg/m-2) were recruited to an 8-week programme (16 sessions in total). Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). The study concluded that the key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity (%HRR-CV and sRPE). Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.

Citation

KHUSHHAL, A., NICHOLS, S., CARROLL, S., ABT, G. and INGLE, L. 2020. Characterising the application of the "progressive overload" principle of exercise training within cardiac rehabilitation: a United Kingdom-based community programme. PLoS ONE (online), 15(8), article number e0237197. Available from: https://doi.org/10.1371/journal.pone.0237197

• Journal Article Type: Article
• Acceptance Date: Jul 21, 2020
• Online Publication Date: Aug 13, 2020
• Publication Date: Aug 31, 2020
• Deposit Date: Nov 29, 2023
• Publicly Available Date: Nov 29, 2023
• Journal: PLoS ONE
• Print ISSN: 1932-6203
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 8
• Article Number: e0237197
• DOI: https://doi.org/10.1371/journal.pone.0237197
• Keywords: Cardiac rehabilitation; Exercise therapy; Physical therapy; Progressive overload
• Public URL: https://rgu-repository.worktribe.com/output/2079709