Combining aerobic interval, inspiratory and resistance trainings induces better cardiac remodelling and exercise capacity in heart failure patients

Abstract

Aim

The aim of this study is to evaluate the effect of a combined program of two or three modalities: aerobic interval training (AIT), inspiratory muscle training (IMT), and resistance training (RT), on cardiac function, exercise capacity and dyspnoea in heart failure (HF). Moreover, this study aims to find the best training exercise that could have additional benefits on measured parameters, thus providing a novel application in cardiac rehabilitation programs.

Methods

60 patients with HF, left ventricle ejection fraction ≤45% and inspiratory muscle weakness were randomly assigned to one of the six following groups (n = 10, for each group): Control, AIT, IMT, RT, AIT + IMT and AIT + IMT + RT (combined group: CT). AIT was performed at 60% of maximum heart rate, IMT at 60% of maximal inspiratory pressure and RT at 60% of 1 repetition maximum. The control group patients had no training at all. The training regimens were performed 3 times per week for 12 weeks.

Results

All groups showed significant positive effects on almost all the measured parameters. However, the combination of IMT to AIT and the addition of RT to IMT and AIT (CT group) were the most powerful modalities and resulted in additional benefits over all training modalities. For example, the improvements (post-training vs pre-training) on ejection fraction was 29% (p < 0.001) and on exercise time 68.5% (p = 0.001) in CT group. However, the improvements for the same parameters were lower in AIT + IMT group (ejection fraction 18% (p < 0.001) and exercise time 62% (p < 0.001)).

Conclusion

The addition of RT to AIT and IMT (CT group) resulted in additional benefits in some of the measured parameters over the double combined group: AIT + IMT and all training modalities, which make the combination of three exercise training the most recommended protocol in cardiac rehabilitation programs and prevention protocols.

Keywords:

• Chronic heart failure
• resistance training
• inspiratory muscle training
• aerobic interval training

ClinicalTrials.gov Identifier or Trial Registration number:

• NCT03538249

Ethics committee:

• Beirut cardiac institute IRB
• OTLY- P- 38F- 16

Acknowledgement

We would like to thank Dr. Ali Salami for performing the statistical analysis of the data presented in this article.

Ethics approved

The Beirut Cardiac Institute committee approved this study. All participants gave written informed consent form before data collection began.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The National Council for Scientific Research (CNRS), Beirut, Lebanon (2015–2018). The Islamic centre Association for Guidance and Higher Education, Beirut, Lebanon (2014–2018).