Short-term and Long-term Feasibility, Safety, and Efficacy of High-Intensity Interval Training in Cardiac Rehabilitation: The FITR Heart Study Randomized Clinical Trial
Open accessAbstract
Importance: High-intensity interval training (HIIT) is recognized as a potent stimulus for improving cardiorespiratory fitness (volume of oxygen consumption [VO2] peak) in patients with coronary artery disease (CAD). However, the feasibility, safety, and long-term effects of HIIT in this population are unclear. Objective: To compare HIIT with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and efficacy of improving VO2 peak in patients with CAD. Design, Setting, and Participants: In this single-center randomized clinical trial, participants underwent 4 weeks of supervised training in a private hospital cardiac rehabilitation program, with subsequent home-based training and follow-up over 12 months. A total of 96 participants with angiographically proven CAD aged 18 to 80 years were enrolled, and 93 participants were medically cleared for participation following a cardiopulmonary exercise test. Data were collected from May 2016 to December 2018, and data were analyzed from December 2018 to August 2019. Interventions: A 4 × 4-minute HIIT program or a 40-minute MICT program (usual care). Patients completed 3 sessions per week (2 supervised and 1 home-based session) for 4 weeks and 3 home-based sessions per week thereafter for 48 weeks. Main Outcomes and Measures: The primary outcome was change in VO2 peak during the cardiopulmonary exercise test from baseline to 4 weeks. Further testing occurred at 3, 6, and 12 months. Secondary outcomes were feasibility, safety, adherence, cardiovascular risk factors, and quality of life. Results: Of 93 randomized participants, 78 (84%) were male, the mean (SD) age was 65 (8) years, and 46 were randomized to HIIT and 47 to MICT. A total of 86 participants completed testing at 4 weeks for the primary outcome, including 43 in the HIIT group and 43 in the MICT group; 69 completed testing at 12 months for VO2 peak, including 32 in the HIIT group and 37 in the MICT group. After 4 weeks, HIIT improved VO2 peak by 10% compared with 4% in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [3.4] mL/kg/min; MICT, 1.2 [3.4] mL/kg/min; P = .02). After 12 months, there were similar improvements from baseline between groups, with a 10% improvement in the HIIT group and a 7% improvement in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [4.5] mL/kg/min; MICT, 1.8 [4.3] mL/kg/min; P = .30). Both groups had high feasibility scores and low rates of withdrawal due to serious adverse events (3 participants in the HIIT group and 1 participant in the MICT group). One event occurred following exercise (hypotension) in the HIIT group. Over 12 months, both home-based HIIT and MICT had low rates of adherence (HIIT, 18 of 34 [53%]; MICT, 15 of 37 [41%]; P = .35) compared with the supervised stage (HIIT, 39 of 44 [91%]; MICT, 39 of 43 [91%]; P > .99). Conclusions and Relevance: In this randomized clinical trial, a 4-week HIIT program improved VO2 peak compared with MICT in patients with CAD attending cardiac rehabilitation. However, improvements in VO2 peak at 12 months were similar for both groups. HIIT was feasible and safe, with similar adherence to MICT over 12-month follow-up. These findings support inclusion of HIIT in cardiac rehabilitation programs as an adjunct or alternative modality to moderate-intensity exercise. Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001292561.
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High-intensity interval training has proven safe in the cardiac rehabilitation setting.
“HIIT has proven safe in the cardiac rehabilitation setting 68,69”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [68]
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Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
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“During a 12 ‐ month follow ‐ up, MICT participants were more likely to complete training (Taylor et al., 2020).”
- Authors
- Taylor, J. L., Holland, D. J., Keating, S. E., Leveritt, M. D., Gomersall, S. R., Rowlands, A. V., Bailey, T. G., & Coombes, J. S.
- Affiliations
- The University of Queensland (AU)
- University of Leicester (GB)
- Corresponding author
- Taylor, Jenna L.
- ORCID
- Venue
- JAMA Cardiology
- Publisher
- American Medical Association (AMA)
- Published
- 2020-12-01
- Volume
- 5
- Issue
- 12
- Pages
- 1382
- ISSN
- 2380-6583 (ISSN-L)
- PMC
- PMC7489382
- OpenAlex
- W3082757702
- Cited by
- 148
- References
- 21
- Citations by year
- 2026: 27 · 2025: 36 · 2024: 25 · 2023: 22 · 2022: 21 · 2021: 16 · 2020: 1
- FWCI
- 16.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research
- University of Queensland
- Medical Research Council
- National Health and Medical Research Council (1122190)
- NIHR Leicester Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- high-intensity interval training, cardiac rehabilitation, coronary artery disease, moderate-intensity continuous training, peak oxygen uptake, cardiorespiratory fitness, home-based exercise training, exercise adherence, exercise safety, quality of life, cardiovascular risk factors, long-term training effects, supervised exercise
- MeSH terms
- Cardiac Rehabilitation, High-Intensity Interval Training, Adolescent, Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Feasibility Studies, Female, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Young Adult
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