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CLINICAL STUDIES: EXERCISE

Differential effects of high-frequency versus low-frequency exercise training in rehabilitation of patients with coronary artery disease

Wybe Nieuwland, MD^*, Marike A. Berkhuysen, PhD , Dirk J. van Veldhuisen, MD, PhD, FACC^*, Johan Brügemann, MD, PhD^*, Martin L. J. Landsman, MD, PhD^*, Eric van Sonderen, PhD, K. I. Lie, MD, PhD^||, Harry J. G. M. Crijns, MD, PhD^* and Piet Rispens, MD, PhD

^* Department of Cardiology/Thoraxcenter, University Hospital Groningen, Groningen, Netherlands
Department Human Movement Sciences, University of Groningen, Groningen, Netherlands
Emory Heartwise Risk Reduction Program, Emory University, Atlanta, Georgia, USA
Northern Center for Health Care Sciences, University of Groningen, Groningen, Netherlands
^|| Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands. %

Manuscript received April 9, 1999; revised manuscript received January 18, 2000, accepted March 6, 2000.

Reprint requests and correspondence: Dr. D. J. van Veldhuisen, Department of Cardiology/Thoraxcenter, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
d.j.van.veldhuisen{at}thorax.azg.nl

OBJECTIVES

We sought to study the influence of frequency of exercise training during cardiac rehabilitation on functional capacity (i.e., peak oxygen consumption [VO₂] and ventilatory anaerobic threshold [VAT]) and quality of life (QoL).

BACKGROUND

Although the value of cardiac rehabilitation is now well established, the influence of the different program characteristics on outcome has received little attention, and the effect of frequency of exercise training is unclear. Functional capacity is regularly evaluated by peak VO₂ but parameters of submaximal exercise capacity such as VAT should also be considered because submaximal exercise capacity is especially important in daily living.

METHODS

Patients with coronary artery disease (n = 130, 114 men; mean age 52 ± 9 years) were randomized to either a high- or low-frequency program of six weeks (10 or 2 exercise sessions per week of 2 h, respectively). Functional capacity and QoL were assessed before and after cardiac rehabilitation. Global costs were also compared.

RESULTS

Compared with baseline, mean exercise capacity increased in both programs: for high- and low-frequency, respectively: peak VO₂ = 15% and 12%, Wmax = 18% and 12%, VAT = 35% and 12% (all p < 0.001). However, when the programs were compared, only VAT increased significantly more during the high-frequency program (p = 0.002). During the high-frequency program, QoL increased slightly more, and more individuals improved in subjective physical functioning (p = 0.014). We observed superiority of the high-frequency program, especially in younger patients. Mean costs were estimated at 4,455 and 2,273 Euro, respectively, for the high- and low-frequency programs.

CONCLUSIONS

High-frequency exercise training is more effective in terms of VAT and QoL, but peak VO₂ improves equally in both programs. Younger patients seem to benefit more from the high-frequency training.

Abbreviations and Acronyms   HR = heart rate   peak VO2 = peak oxygen consumption   QoL = quality of life   RER = respiratory exchange ratio   VAT = ventilatory anaerobic threshold   Wmax = peak workload

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