Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial
Open accessAbstract
Importance: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. Objective: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF. Design, Setting, and Participants: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded. Interventions: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise). Main Outcomes and Measures: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months. Results: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%). Conclusions and Relevance: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF. Trial Registration: ClinicalTrials.gov Identifier: NCT02078947.
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In patients with heart failure with preserved ejection fraction, improvement in exercise capacity was comparable between high-intensity interval training and moderate-intensity continuous training.
“Investigators reported that the improvement in exercise capacity was comparable with MICT vs. HIIT.”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [123]
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“In a recent study, investigators evaluated whether HIIT was associated with greater improvement in exercise capacity among patients with HFpEF compared with MICT or PA counseling [123,124].”
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- Authors
- Mueller, S., Winzer, E. B., Duvinage, A., Gevaert, A. B., Edelmann, F., Haller, B., Pieske-Kraigher, E., Beckers, P., Bobenko, A., Hommel, J., Van de Heyning, C. M., Esefeld, K., von Korn, P., Christle, J. W., Haykowsky, M. J., Linke, A., Wisløff, U., Adams, V., Pieske, B., van Craenenbroeck, E. M., Halle, M., & OptimEx-Clin Study Group
- Affiliations
- TUM Klinikum (DE)
- Herzzentrum Dresden Universitätsklinik (DE)
- University of Antwerp (BE)
- German Centre for Cardiovascular Research (DE)
- Technical University of Munich (DE)
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- University of Alberta (CA)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Halle, Martin
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2021-02-09
- Volume
- 325
- Issue
- 6
- Pages
- 542
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC7873782
- OpenAlex
- W3126541334
- Cited by
- 347
- References
- 39
- Citations by year
- 2026: 65 · 2025: 82 · 2024: 61 · 2023: 61 · 2022: 50 · 2021: 27
- FWCI
- 56.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Funders
- European Commission (602405)
- International Graduate School of Science and Engineering
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- moderate-intensity continuous training, heart failure with preserved ejection fraction, peak oxygen uptake, cardiorespiratory fitness, physical activity guidelines, diastolic function, natriuretic peptides, sedentary patients, endurance exercise, diastolic dysfunction, heart failure with reduced ejection fraction
- MeSH terms
- High-Intensity Interval Training, Aged, Exercise Therapy, Female, Heart Failure, Humans, Male, Oxygen Consumption, Stroke Volume, Exercise, Exercise Tolerance, Practice Guidelines as Topic, Evidence-Based Medicine
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