High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction
Open accessAbstract
Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT ( P =0.45); left ventricular end-diastolic diameter changes compared with RRE were −2.8 mm (−5.2 to −0.4 mm; P =0.02) in HIIT and −1.2 mm (−3.6 to 1.2 mm; P =0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake ( P =0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P =0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. Conclusions: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00917046.
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Only 20% of the HIIT group in that study exercised at the prescribed intensity, making it difficult to draw firm conclusions.
“However, only 20% of the HIIT group in that study exercised at the prescribed intensity, making it difficult to draw firm conclusions.”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [26]
The Results section (Training Intensity Compared With Protocol Targets; page not provided) reports that 51% of HIIT patients exercised below the prescribed intensity, but does not establish that only 20% exercised within the prescribed range. The Discussion describes difficulty achieving the target intensity, and the Conclusions call for further studies, supporting the caution about firm conclusions. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCompared to other studies, the drop-out rate over the five year study period was low, and the adherence to prescribed exercise was relatively high.
“Compared to other studies,25 26 the drop-out rate over the five years study period was low, and the adherence to prescribed exercise was relatively high.”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [26]
The Results section ('Patient Population and Adherence to Intervention'; page unavailable) reports few withdrawals and high adherence to supervised exercise: a median of 35 of 36 sessions in the two training groups. But those figures cover a 12-week intervention, with follow-up to 52 weeks—not a five-year period. The paper therefore supports the comparison only in a shorter-term setting. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOther studies on the effect of exercise on morbidity and mortality include combined lifestyle interventions and populations with diseases and have fewer monitored and relatively short periods of supervised exercise.
“Other studies on the effect of exercise on morbidity and mortality include combined lifestyle interventions24 and populations with diseases25 26 and have fewer monitored and relatively short periods of supervised exercise.26 27”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [26]
The Methods (Patients and Interventions) describe patients with chronic heart failure and a 12-week supervised exercise program; the Results (Patient Population and Adherence to Intervention) report 36 possible supervised sessions for the training groups. The Methods (End Points) show that deaths and hospitalizations were tracked, but the paper does not establish that it had fewer monitored sessions than the studies to which the citing sentence compares it. It also states in the Methods (Statistical Analysis) that it was not powered to assess differences in clinical events. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAlthough high intensity training has now been incorporated in most public health recommendations, the long term effect, feasibility, and safety have recently been questioned.
“Although high intensity training, which HIIT represents, has now been incorporated in most public health recommendations, the long term effect, feasibility, and safety have recently been questioned.26 42 43”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [26]
The Discussion and Conclusions (pages not provided) raise questions about HIIT’s feasibility, durability of benefit, and safety in patients with heart failure: many patients did not reach the prescribed intensity, improvements were not maintained at 52 weeks, and the trial was too small to assess safety. The paper does not establish that high-intensity training is included in most public-health recommendations, and its findings concern patients with heart failure rather than the general public. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOne study in patients with heart failure with reduced ejection fraction observed no difference in cardiovascular disease events between HIIT and MICT groups after 52 weeks of follow-up.
“One study in patients with heart failure with reduced ejection fraction observed no difference in cardiovascular disease events between HIIT and MICT groups after 52 weeks of follow-up.26”
From Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial (2020) · cites this paper as [26]
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Cites
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O. D., et al. (2021) · PubMed · doi:10.1093/eurheartj/ehab670 · Cited by 19,618 · see citing works
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429 · see citing works
O'Connor (2009) · doi:10.1001/jama.2009.454 · Cited by 2,173 · see citing works
Wisløff, U., Støylen, A., Loennechen, J. P., Bruvold, M., Rognmo, Ø., Haram, P. M., Tjønna, A. E., Helgerud, J., Slørdahl, S. A., Lee, S. J., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.675041 · Cited by 1,996 · see citing works
Self-citationExercise-based rehabilitation for heart failure
Taylor, R. S., Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H., Lough, F., Rees, K., Singh, S. J., & Mordi, I. R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003331.pub4 · Cited by 871 · see citing works
Subgroup analyses in randomized trials: risks of subgroup-specific analyses;
Brookes, S. T., Whitely, E., Egger, M., Smith, G. D., Mulheran, P. A., & Peters, T. J. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2003.08.009 · Cited by 775 · see citing works
Rognmo, Ø., Hetland, E. V., Helgerud, J., Hoff, J., & Slørdahl, S. A. (2004) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000131677.96762.0c · Cited by 707 · see citing works
Rognmo, Ø., Moholdt, T., Bakken, H., Hole, T., Mølstad, P., Myhr, N. E., Grimsmo, J., & Wisløff, U. (2012) · Circulation · doi:10.1161/circulationaha.112.123117 · Cited by 511 · see citing works
Self-citationHaykowsky, M. J., Liang, Y., Pechter, D., Jones, L. W., McAlister, F. A., & Clark, A. M. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.055 · Cited by 396 · see citing works
Antiremodeling Effect of Long-Term Exercise Training in Patients With Stable Chronic Heart Failure
Giannuzzi, P., Temporelli, P. L., Corrà, U., & Tavazzi, L. (2003) · Circulation · doi:10.1161/01.cir.0000081780.38477.fa · Cited by 343 · see citing works
Conraads, V. M., Pattyn, N., Maeyer, C. D., Beckers, P. J., Coeckelberghs, E., Cornelissen, V., Denollet, J., Frederix, G., Goetschalckx, K., Hoymans, V. Y., et al. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.10.155 · Cited by 307 · see citing works
Self-citationHaykowsky, M. J., Timmons, M. P., Kruger, C., McNeely, M. L., Taylor, D. A., & Clark, A. M. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.01.303 · Cited by 224 · see citing works
Vanhees, L., Rauch, B., Piepoli, M., van Buuren, F., Takken, T., Borjesson, M., Bjarnason-Wehrens, B., Doherty, P., Dugmore, D., & Halle, M. (2012) · European Journal of Preventive Cardiology · doi:10.1177/2047487312437063 · Cited by 219 · see citing works
Self-citationThorstensen, A., Dalen, H., Amundsen, B. H., Aase, S. A., & Støylen, A. (2009) · European Journal of Echocardiography · doi:10.1093/ejechocard/jep188 · Cited by 134 · see citing works
Self-citationStøylen, A., Conraads, V. M., Halle, M., Linke, A., Prescott, E., & Ellingsen, Ø. (2011) · European Journal of Preventive Cardiology · doi:10.1177/1741826711403252 · Cited by 81 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab368 · Cited by 13,344 · see citing works
Self-citation2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J.-P., Corrado, D., Drezner, J. A., Halle, M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa605 · Cited by 1,958 · see citing works
Self-citationAmbrosetti, M., Abreu, A., Corrà, U., Davos, C. H., Hansen, D., Frederix, I., Iliou, M. C., Pedretti, R. F. E., Schmid, J.-P., Vigorito, C., et al. (2021) · European Journal of Preventive Cardiology · doi:10.1177/2047487320913379 · Cited by 965 · see citing works
Mueller, S., Winzer, E. B., Duvinage, A., Gevaert, A. B., Edelmann, F., Haller, B., Pieske-Kraigher, E., Beckers, P., Bobenko, A., Hommel, J., et al. (2021) · JAMA · doi:10.1001/jama.2020.26812 · Cited by 347 · see citing works
Self-citationIzquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273 · see citing works
Wewege, M. A., Ahn, D., Yu, J., Liou, K., & Keech, A. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.009305 · Cited by 214 · see citing works
Stensvold, D., Viken, H., Steinshamn, S. L., Dalen, H., Støylen, A., Loennechen, J. P., Reitlo, L. S., Zisko, N., Bækkerud, F. H., Tari, A. R., et al. (2020) · BMJ · doi:10.1136/bmj.m3485 · Cited by 154 · see citing works
Self-citationAndreato, L. V., Esteves, J. V., Coimbra, D. R., Moraes, A. J. P., & de Carvalho, T. (2019) · Obesity Reviews · doi:10.1111/obr.12766 · Cited by 131 · see citing works
High-Intensity Interval Training in Cardiac Rehabilitation
Dun, Y., Smith, J. R., Liu, S., & Olson, T. P. (2019) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2019.07.011 · Cited by 118 · see citing works
Williams, C. J., Gurd, B. J., Bonafiglia, J. T., Voisin, S., Li, Z., Harvey, N., Croci, I., Taylor, J. L., Gajanand, T., Ramos, J. S., et al. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00019 · Cited by 117 · see citing works
Self-citationNytrøen, K., Rolid, K., Andreassen, A. K., Yardley, M., Gude, E., Dahle, D. O., Bjørkelund, E., Relbo Authen, A., Grov, I., Philip Wigh, J., et al. (2019) · Circulation · doi:10.1161/circulationaha.118.036747 · Cited by 80 · see citing works
Santos, A., Braaten, K., MacPherson, M., Vasconcellos, D., Vis-Dunbar, M., Lonsdale, C., Lubans, D., & Jung, M. E. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01535-w · Cited by 59 · see citing works
Ko, J.-M., So, W.-Y., & Park, S.-E. (2025) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd12040158 · Cited by 17 · see citing works
GASKILL, S. E., SKINNER, J. S., & QUINDRY, J. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003220 · Cited by 14 · see citing works
- Authors
- Ellingsen, Ø., Halle, M., Conraads, V., Støylen, A., Dalen, H., Delagardelle, C., Larsen, A.-I., Hole, T., Mezzani, A., Van Craenenbroeck, E. M., Videm, V., Beckers, P., Christle, J. W., Winzer, E., Mangner, N., Woitek, F., Höllriegel, R., Pressler, A., Monk-Hansen, T., Snoer, M., Feiereisen, P., Valborgland, T., Kjekshus, J., Hambrecht, R., Gielen, S., Karlsen, T., Prescott, E., & Linke, A.
- Affiliations
- Norwegian University of Science and Technology (NO)
- From St. Olavs Hospital, Trondheim University Hospital, Norway (Ø.E., A.S., H.D., V.V., T.K.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway (Ø.E., H.D., T.K.); Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Klinikum rechts der Isar, Germany (M.H., J.W.C., A.P.); DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart...
- Corresponding author
- Ellingsen, Øyvind
- ORCID
- Ellingsen, Øyvind
- Halle, Martin
- Conraads, Viviane
- Støylen, Asbjørn
- Dalen, Håvard
- Delagardelle, Charles
- Mezzani, Alessandro
- Videm, Vibeke
- Beckers, Paul
- Christle, Jeffrey W.
- Winzer, Ephraim
- Mangner, Norman
- Snoer, Martin
- Feiereisen, Patrick
- Valborgland, Torstein
- Kjekshus, John
- Hambrecht, Rainer
- Gielen, Stephan
- Karlsen, Trine
- Prescott, Eva
- Linke, Axel
- Venue
- Circulation
- Published
- 2017-02-28
- Volume
- 135
- Issue
- 9
- Pages
- 839-849
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC5325251
- OpenAlex
- W2621044226
- Cited by
- 414
- References
- 15
- Citations by year
- 2026: 34 · 2025: 38 · 2024: 36 · 2023: 44 · 2022: 42 · 2021: 45 · 2020: 44 · 2019: 44 · 2018: 50 · 2017: 37
- FWCI
- 70.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Circulation (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion, cc-by-nc-nd)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- Universitetet i Oslo
- Fondazione Salvatore Maugeri
- Universität Leipzig
- Bispebjerg Hospital
- 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 › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- high-intensity interval training, heart failure with reduced ejection fraction, moderate-intensity continuous training, left ventricular remodeling, left ventricular end-diastolic diameter, cardiorespiratory fitness, peak oxygen uptake, exercise training, supervised exercise intervention, exercise adherence, adverse events
- MeSH terms
- High-Intensity Interval Training, Aged, Echocardiography, Exercise Test, Female, Follow-Up Studies, Heart Failure, Heart Rate, Heart Ventricles, Humans, Male, Middle Aged, Quality of Life, Stroke Volume, Exercise Tolerance, Ventricular Remodeling
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