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
Professor Sean Carroll S.Carroll@hull.ac.uk
Professor of Sport, Health and Exercise Science
Dr Grant Abt G.Abt@hull.ac.uk
Reader (Associate Professor) of Sport and Exercise Physiology, Department for Sport, Health and Exercise Science
Professor Lee Ingle L.Ingle@hull.ac.uk
Background: In recent years, criticism of the percentage range approach for individualised exercise prescription has intensified and 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 was to investigate the fidelity of a structured Phase III CR programme, by monitoring and quantifying exercise training intensity.
Design: Observational study.
Methods: 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.
Results: Thirty cardiac patients (83% male; mean age [SD] 67  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.
Conclusion: 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.
Khushhal, A., Nichols, S., Carroll, S., Abt, G., & Ingle, L. (in press). Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: A United Kingdom perspective. PloS one, 14(6), https://doi.org/10.1371/journal.pone.0217654
|Journal Article Type||Article|
|Acceptance Date||May 17, 2019|
|Online Publication Date||Jun 13, 2019|
|Deposit Date||Jun 5, 2019|
|Publicly Available Date||Jul 5, 2019|
|Publisher||Public Library of Science|
|Peer Reviewed||Peer Reviewed|
|Keywords||General Biochemistry, Genetics and Molecular Biology; General Agricultural and Biological Sciences; General Medicine|
Publisher Licence URL
© 2019 Khushhal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.