第四組Topic最終版

HIIT verserse MCT in coronary artery disease

1. Comparison of Effect Between High Intensity and Traditional Training in CAD Phase II Patient 報告學生 ： 吳柏璋 吳昱嫻 張瀠予 黃思潔 指導老師 ： 陳姵妏 陳安妮 老師 Intensity: The Higher the Better? 9 0% 7 5% 6 % % HRmax %VO 2res Interval Continuous BP EKG RPE AT 50W 80W 2 W 50 % 15mins 30mins

2. Phase II Cardiac Rehab Comparison of Effect Between High Intensity and Traditional Training in CAD Phase II Patient Moderate Continuous Training( MCT ) High Intensity Interval Training( HIIT ) Risk? More effect? Intensity: The Higher the Better? 2

3. Outline Introduction–High Intensity Interval Training 1 Principle – Aerobic Exercise Training on CAD 2 Comparison–Effect between HIIT & MCT 3 Application– HIIT Prescription 5 Conclusion 6 References 7 Thinking 4 3

4. Origin of HIIT Introduction 1979 Recent years Number of HIT studies in high risk pts 1977 10 wk program of interval +MCT on healthy subjects → O2max increase   1972 High workloads for 60s with 30s rest intervals → can maintain twice as long 4 Weston, et al.2014 HIIT on Myocardiac Infarction patients → reduce myocardial ischemia

5. Concept of HIIT Introduction Warm-up Cool-down Training stage rest rest rest High intensity induce m itochondrial biogenesis Gibala,et al. 2012 5 4mins 85-95% HRpeak 4mins 85-95% HRpeak 4mins 85-95 % HRpeak 4mins 85-95 % HRpeak 3mins 60-70% HRpeak 3mins 3mins 60-70% HRpeak 60-70% HRpeak

6. HIIT Mechanism Introduction Laursen , et al. 2010 MCT HIIT 6

7. Introduction A-V O 2 diff. Skeletal muscle Mitochondria ↑ SV Preload Afterload Rate of venous return Cardiac contractility ↑ Muscle Contraction Pump ↑ HIIT Mechanism http://www.bengreenfieldfitness.com/2013/03/best-ways-to-build-endurance-2/ http ://img09.deviantart.net/20ff/i/2011/321/b/9/run_homer_run_by_linggarlitoz-d4gfs6h.png O2peak=Stroke volume( SV )X HR X A-V O2 diff.   7

8. HIIT Benefits Total exercise time↓ Improve more O2peak than MCT   Helgerud , et al.2007 CAD: every 3.5 ml/kg/min O2peak↑, Mortality rate10-25% ↓   Keteyian , et al. 2008 After burn effect ： decrease more fat Endothelium and skeletal muscle mitochondrial function↑ Introduction Interesting Gibala , et al. 2012 林常德 , 2002 8

9. General Principle of Aerobic Exercise Training of CAD Principle Cardiopulmonary test O2peak   A naerobic threshold(AT) HR peak http://www.amplemed.com.tw/prod_page/hpcosmos/quasar/files/stacks_image_1238.jpg 9

10. Principle Cardiopulmonary test Fitness Level Percent Max Heart Rate Percent O2 max Low 50 28 60 42 66 50 Moderate 70 56 74 60 77 65 High 81 70 85 75 88 80 Very High 90 83 92 85 100 100 Fitness Level Percent Max Heart Rate Low 50 28 60 42 66 50 Moderate 70 56 74 60 77 65 High 81 70 85 75 88 80 Very High 90 83 92 85 100 100 Decide Intensity General Principle of Aerobic Exercise Training of CAD 10 ACSM’s,2013

11. General Principle of Aerobic Exercise Training of CAD Principle Decide Intensity Warm-up Cool-down 60-80%HRpeak Training stage Time Continuous ： Cardiopulmonary test 11

12. Principle Interval ： General Principle of Aerobic Exercise Training of CAD Warm-up Cool-down Training stage rest rest rest Cardiopulmonary test Decide Intensity Time 12

13. Effects Between HIIT and MCT Author Title Moholdt , et al. 2009 Aerobic interval training versus continuous moderate after coronary artery bypass surgery -A randomized study of cardiovascular effects and quality of life Keteyian , et al. 2014 Greater Improvements in Cardiorespiratory Fitness Using Higher-Intensity Interval Training in the Standard Cardiac Rehabilitation Setting Conraads , et al. 2015 Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: The SAINTEX -CAD study Comparison 13

14. Methods Subjects: 59 subjects CABG 4-16week post-op Interventions: Treadmill walking Comparison Warm up-8mins 4mins 3mins Cool down 5mins 90 % HRmax 70 % HR max 38 mins 46 mins 70 % HR max High intensity interval training Moderate continuous training 14 O2peak 27.1 ± 4.5 (7.74 MET) Age 60.2 ± 6.9 GenderM /F 24/4 27.1 ± 4.5 (7.74 MET) Age 60.2 ± 6.9 GenderM /F 24/4

15. Frequency: 5 days/week for 4weeks Home exercise: same intensity & duration 3-4 times/week to 6 months Outcome measures: Primary : O2peak Secondary: HR recovery , quality of life, left ventricular function , work economy, blood markers of disease , resting HR   Comparison 15 Methods

16. AIT MCT BL (n = 28) 4w (n = 28) 6m (n = 23) BL (n = 31) 4w (n = 31) 6m (n = 25) Maximal exercise test O2 peak (mL·kg −1 ·min −1 ) 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 Perceived exertion 8.3 ± 1.5 8.2 ± 1.3 7.9 ± 1.3 8.1 ± 1.5 7.6 ± 1.9 7.1 ± 1.8 RER at O2 peak 1.13 ±0.07 1.14 ±0.07 1.15 ±0.08 1.13 ±0.06 1.13 ±0.08 1.15 ±0.09 Heart rate recovery (1 min) 19.6 ± 6.8 22.5 ± 7.6 25.5 ± 8.6 20.3 ± 9.4 25.4 ± 8.4 24.6 ± 7.7 Quality of life- Emotional domain 5.7 ± 0.7 6.2 ± 0.5 6.1 ± 0.6 5.5 ± 1.1 6.0 ± 0.7 5.9 ± 0.7 Physical domain 5.3 ± 0.7 6.2 ± 0.4 6.2 ± 0.7 5.4 ± 1.0 6.0 ± 0.6 6.1 ± 0.6 Social domain 5.6 ± 0.6 6.5 ± 0.4 6.5 ± 0.6 5.4 ± 1.3 6.3 ± 0.7 6.3 ± 0.6 AIT MCT BL (n = 28) 4w (n = 28) 6m (n = 23) BL (n = 31) 4w (n = 31) 6m (n = 25) Maximal exercise test 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 Perceived exertion 8.3 ± 1.5 8.2 ± 1.3 7.9 ± 1.3 8.1 ± 1.5 7.6 ± 1.9 7.1 ± 1.8 1.13 ±0.07 1.14 ±0.07 1.15 ±0.08 1.13 ±0.06 1.13 ±0.08 1.15 ±0.09 Heart rate recovery (1 min) 19.6 ± 6.8 22.5 ± 7.6 25.5 ± 8.6 20.3 ± 9.4 25.4 ± 8.4 24.6 ± 7.7 Quality of life- Emotional domain 5.7 ± 0.7 6.2 ± 0.5 6.1 ± 0.6 5.5 ± 1.1 6.0 ± 0.7 5.9 ± 0.7 Physical domain 5.3 ± 0.7 6.2 ± 0.4 6.2 ± 0.7 5.4 ± 1.0 6.0 ± 0.6 6.1 ± 0.6 Social domain 5.6 ± 0.6 6.5 ± 0.4 6.5 ± 0.6 5.4 ± 1.3 6.3 ± 0.7 6.3 ± 0.6 Results Table II. Cardiorespiratory variables, quality of life, and blood markers at baseline (BL), 4w, and 6m 3.3 1.8 2.3 1.0 Comparison O2 peak (mL·kg −1 ·min −1 ) 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 O 2 peak↑ Exercise capacity↑   significant differences No significant differences > HRrecovery Heart Function↑ 16 5.1 mL/kg/min 3.3 mL /kg/min Heart rate recovery (1 min) 19.6 ± 6.8 22.5 ± 7.6 25.5 ± 8.6 20.3 ± 9.4 25.4 ± 8.4 24.6 ± 7.7 2.9 3.0 5.1 -0.8 No significant differences 5.9beat/min 4.3beat/min

17. Effects Between HIIT and MCT Author Title Moholdt , et al. 2009 Aerobic interval training versus continuous moderate after coronary artery bypass surgery -A randomized study of cardiovascular effects and quality of life Keteyian , et al. 2014 Greater Improvements in Cardiorespiratory Fitness Using Higher-Intensity Interval Training in the Standard Cardiac Rehabilitation Setting Conraads , et al. 2015 Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: The SAINTEX -CAD study Comparison 17

18. Subjects: 39 subjects between 18-75 y/o CAD(include CABG, PCI, MI) Interventions: Treadmill walking High intensity interval training Moderate continuous training Warm up-8mins 4mins 3mins Cool down 4mins 60~70%HRR 80~90%HRR 40 mins 40 mins 60~80% HR reserve Cool down 5mins Training 30mins Warm up-5mins Comparison 18 Methods O2peak 22.4 ± 4.2 (6.4MET) Age 60 ± 7 GenderM /F 11/4 22.4 ± 4.2 (6.4MET) Age 60 ± 7 GenderM /F 11/4

19. Frequency: 3 days/week for 10 weeks Encouraged to attend 45-minute educational sessions offered 2 days/week during CR Outcome measures: Rest & submaximal exercise HRrest , SBP/DBP, O2 AT Exercise response HR recovery 1min , VE-CO 2 , HRmax , RPE, BP   Comparison 19 Methods

20. 20 HIIT (n = 15), Mean ± SD MCT (n = 13), Mean ± SD Parameter Baseline Followup Baseline Followup Rest Heart rate, bpm 67 ± 13 66 ± 13 68 ± 12 64 ± 10 Systolic blood pressure, mmHg 126 ± 18 117 ± 15 116 ± 24 118 ± 14 Diastolic blood pressure, mmHg 78 ± 9 71 ± 11 74 ± 12 74 ± 9 Submaximal Exercise Heart rate at stage 2 of exercise test, bpm 98 ± 15 90 ± 21 95 ± 17 87 ± 16 Oxygen uptake at ventilatory -derived anaerobic threshold mL · kg − 1 · min − 1 14.1 ± 2.5 17.1 ± 4.3 14.2 ± 1.9 14.9 ± 2.7 mL · min − 1 1315 ± 421 1546 ± 494 1303 ± 370 1366 ± 448 3.0 ± 2.8 mL /kg/min; 21% 0.7 ± 2.2 mL /kg/min; 5% No significant differences Table 2 Cardiorespiratory Responses at Rest and During Submaximal Exercise at Baseline and Followup Comparison AT ↑ endurance↑ significant differences Results

21. HIIT (n = 15), Mean ± SD MCT(n = 13), Mean ± SD Parameter Baseline Followup Baseline Followup Peak heart rate, bpm 145 ± 17 151 ± 17 138 ± 24 135 ± 26 Peak systolic blood pressure, mmHg 162 ± 17 169 ± 16 179 ± 29 164 ± 32 Peak diastolic blood pressure, mmHg 79 ± 9 75 ± 13 78 ± 13 78 ± 12 Peak oxygen uptake mL · kg − 1 · min − 1 22.4 ± 4.2 26.0 ± 5.9 a 21.8 ± 4.0 23.5 ± 4.6 L · min − 1 2025 ± 544 2309 ± 598 1982 ± 574 2119 ± 624 Change in heart rate from peak exercise to minute 1 of recovery, bpm − 25 ± 10 − 25 ± 9 − 28 ± 16 − 29 ± 16 Table 3 Cardiorespiratory Responses to Exercise at Baseline and Followup 3.6 ± 3.1 mL /kg/min, 16% 1.7 ± 1.7 mL /kg/min, 8% Comparison O 2 peak↑ Exercise capacity↑   No significant differences > No significant differences 21 Results

22. Effects Between HIIT and MCT Author Title Moholdt , et al. 2009 Aerobic interval training versus continuous moderate after coronary artery bypass surgery -A randomized study of cardiovascular effects and quality of life Keteyian , et al. 2014 Greater Improvements in Cardiorespiratory Fitness Using Higher-Intensity Interval Training in the Standard Cardiac Rehabilitation Setting Conraads , et al. 2015 Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: The SAINTEX -CAD study Comparison 22

23. Subjects: 174 subjects, 4~12 weeks following AMI, PCI or CABG Interventions: Bicycle only High intensity interval training Moderate continuous training 47 mins 65-75 % HR peak Cool down 5mins Training 37mins Warm up-5mins Warm up-10mins 4mins 3mins 50~70 % HR peak 90-95 % HR peak 38 mins Comparison 23 Methods O2peak 23.5 ± 5.7 (6.4 MET) Age 57 ± 8.8 GenderM /F 91/9 23.5 ± 5.7 (6.4 MET) Age 57 ± 8.8 GenderM /F 91/9

24. Frequency: Frequency:3 days/week 12weeks Outcome measures: Anthropometric measurements Cardiopulmonary exercise test( O 2 peak ) Flow-mediated dilation by brachial artery ultrasound scanning Quality of life   Comparison 24 Methods

25. AIT (n=85) ACT (n=89) Parameter 0 weeks 6 weeks 12 weeks 0 weeks 6 weeks 12 weeks O2 (ml/min) 1965 ± 503 2232 ± 548 2395 ± 560 1887 ± 473 2116 ± 527 2238 ± 550 O2/kg (ml/kg/min) 23.5 ± 5.7 26.7 ± 6.7 28.6 ± 6.9 22.4 ± 5.6 25.2 ± 6.2 26.8 ± 6.7 HR ( bpm ) 134 ± 21.0 140 ± 19.0 145 ± 18.2 129 ± 21.1 134 ± 22.3 138 ± 21.5 Workload (Watt) 154 ± 38.8 177 ± 44.9 192 ± 46.9 145 ± 41.0 169 ± 47.9 180 ± 46.6 RER 1.26 ± 0.12 1.27 ± 0.12 1.28 ± 0.11 1.26 ± 0.11 1.26 ± 0.09 1.27 ± 0.09 O2 pulse 14.8 ± 3.6 16.0 ± 3.5 16.6 ± 3.5 14.7 ± 2.9 15.9 ± 3.3 16.2 ± 3.2 AIT (n=85) ACT (n=89) Parameter 0 weeks 6 weeks 12 weeks 0 weeks 6 weeks 12 weeks 1965 ± 503 2232 ± 548 2395 ± 560 1887 ± 473 2116 ± 527 2238 ± 550 23.5 ± 5.7 26.7 ± 6.7 28.6 ± 6.9 22.4 ± 5.6 25.2 ± 6.2 26.8 ± 6.7 HR ( bpm ) 134 ± 21.0 140 ± 19.0 145 ± 18.2 129 ± 21.1 134 ± 22.3 138 ± 21.5 Workload (Watt) 154 ± 38.8 177 ± 44.9 192 ± 46.9 145 ± 41.0 169 ± 47.9 180 ± 46.6 RER 1.26 ± 0.12 1.27 ± 0.12 1.28 ± 0.11 1.26 ± 0.11 1.26 ± 0.09 1.27 ± 0.09 O2 pulse 14.8 ± 3.6 16.0 ± 3.5 16.6 ± 3.5 14.7 ± 2.9 15.9 ± 3.3 16.2 ± 3.2 Table 2 Peak exercise capacity parameters at baseline, after 6 and after 12 weeks of AIT or ACT. 5.1 mL/kg/min 4.4 mL/kg/min 3.2 1.9 2.8 1.6 AIT = aerobic interval training ACT = aerobic continuous training; Comparison O 2 peak↑ Exercise capacity↑   No significant differences > 25 Results

26. AIT (n = 76) ACT (n = 84) Parameter 0 weeks 6 weeks 12 weeks 0 weeks 6 weeks 12 weeks Resting diameter (mm) 3.96 ± 0.56 4.00 ± 0.56 4.00 ± 0.50 3.93 ± 0.56 3.95 ± 0.58 3.99 ± 0.65 FMD (%) 5.26 ± 3.02 6.33 ± 3.22 6.47 ± 2.79 5.61 ± 2.36 6.46 ± 2.87 6.68 ± 3.09 NMD (%) 22.6 ± 6.57 22.5 ± 6.55 22.2 ± 7.19 22.1 ± 7.30 21.2 ± 7.77 22.1 ± 6.92 Table 3 Endothelial function parameters at baseline, after 6 and after 12 weeks of AIT or ACT. Comparison Vascular function ↑ 26 Results No significant differences

27. Comparison Thinking Exclusion criteria Subjects’ Selection Time Effect ； Safety 27

28. Considerations of HIIT Through Exclusion Rognmo et al. ,2004 Moholdt et al., 2009 Keteyian et al. , 2014 Conraads et al. , 2015 CABG <12months <4weeks < 4week <4weeks MI <3months nil < 3week <4weeks PCI < 12months nil < 3weeks <4weeks LVEF (%) <40% nil < 40% < 40% Others LM CAD Unstable angina Heart failure Inability to exercise Drug abuse. Fail of a run-in period unstable with symptoms and medication 28 Comparison

29. Comparison Thinking Moholdt et al. 2009 Keteyian et al. 2014 Conraad et al. 2015 O2peak 27.1 ± 4.5 (7.7 MET) 22.4 ± 4.2 (6.4 MET) 23.5 ± 5.7 (6.7 MET) Age 60.2 ± 6.9 60 ± 7 57 ± 8.8 HIIT group Gender(M/F) 24/4 11/4 91/9 Training time 4weeks  6months 10weeks 12weeks Moholdt et al. 2009 Keteyian et al. 2014 Conraad et al. 2015 27.1 ± 4.5 (7.7 MET) 22.4 ± 4.2 (6.4 MET) 23.5 ± 5.7 (6.7 MET) Age 60.2 ± 6.9 60 ± 7 57 ± 8.8 HIIT group Gender(M/F) 24/4 11/4 91/9 Training time 4weeks  6months 10weeks 12weeks 29

30. Comparison Moholdt , et al. 2009 Keteyian , et al. 2014 Conraads , et al . 2015 O2peak ↑ HIIT> MCT   S ignificant differences No significant differences No significant differences 30 HRrecovery No significant differences No significant differences Vascular Adaption No significant differences No significant differences Safety There are no cardiac accidents in studies. Thinking

31. how to prescribe HIIT ? Application ACSM 吳英黛 31

32. A HIIT protocal Mezzani 2012 Application 32

33. Conclusion HIIT Effect? Risk? More O2peak Lower Mortality   Safe way Conflict : Lower capacity patients For higher c apacity patient It’s an another option. Intensity: The Higher the Better? 33

34. 1.American college of sports medicine. ACSM's guidelines for exercise testing and prescription. Philadelphia. LWW . 9th ed , 2013. 2.Conraads VM , Pattyn N, De Maeyer C, Beckers PJ , Coeckelberghs E, Cornelissen VA, et al. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX -CAD study. Int J Cardiol 2015;179:203–210. 3.Currie KD , Dubberley JB , McKelvie RS, MacDonald MJ. Low-volume, high-intensity interval training in patients with CAD. Med Sci Sports Exerc 2013;45:1436–1442. 4.Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol 2012; 590:1077-1084. 5.Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 2007;39:665-671. 6.Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS , Forman DE, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation 2013;127:652-662 . 34 References

35. 35 References 7.Keteyian SJ , Brawner CA, Savage PD, Ehrman JK , Schairer J, Divine G, et al. Peak aerobic capacity predicts prognosis in patients with coronary heart disease. Am Heart J 2008;156:292–300. 8.Keteyian SJ , Hibner BA, Bronsteen K, Kerrigan D, Aldred HA, Reasons LM, et al. Greater improvement in cardiorespiratory fitness using higher- inten - sity interval training in the standard cardiac rehabilitation setting. J Cardiopulm Rehabil Prev 2014;34:98–105. 9.Laursen PB . Training for intense exercise performance: high-intensity or high-volume training? Scand J Med Sci Sports 2010;20 Suppl 2:1-10 10.Liou K, Ho S, Fildes J, Ooi Sy . High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters. Heart Lung Circ 2016;25:166–174. 11.Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, et al. Aerobic Exercise Intensity Assessment and Prescription in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2012;32:327-350. 12.Moholdt TT, Amundsen BH , Rustad LA, Wahba A, Lovo KT , Gullikstad LR , et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J 2009;158:1031-1037.

36. 13.Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation A randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J 2009;158:734-741. 14.Rognmo O, Hetland E, Helgerud J, Hoff J, Slordahl S. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. European Journal of Cardiovascular Prevention & Rehabilitation 2004;11:216–22. 15.Weston KS, Wisloff U, Coombes , JS . High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. J Sports Med 2014;48:1227–1234. 16. 吳英黛 編著，呼吸循環系統物理治療基礎實務。台北。金名圖書有限公司。第二版。 2010 。 17. 林正常 總校閱   。運動生理學。台北市：藝軒出版。 2002 。 36 References

37. Thanks For Your Listening 37

38. 38 Q&A

39. Guideline HIIT MCT Application 39

40. Discussion VO2peak? 血管功能 個案挑選是否都使用能力較佳的患者 個案是否適用 是否能接受其他併發 症 40

41. Contraindication of HIIT Unstable Angina Uncompensated HF Recent MI(<4weeks) Recent CABG or PCI(<12m.) Heart disease( Valvular , congenital, ischaemic , hypertrophy cardiomyopathy) Complex ventricular arrhythmia or 2~3 ∘AVB Severe COPD, CVD, or uncontrolled peripheral vascular disease Uncontrolled DM Hypertensive patient with blood pressure >180/110 Severe neuropathy Weston, 2014 41

42. FITT principle -A healthy adult should exercise at moderate aerobic exercise 3-5 days/week ACSM ‘s2014 -CAD: ACSM’s suggest CVD outpatients should join exercise training 4~7 days/week. -For exercise limitation patient, conduct multiple times of short time exercise everyday Frequency Type Time Intensity General Principle of Aerobic Exercise Training of CAD Principle 42

43. FITT principle ACSM ‘s 2014 Rate of perceived exertion VO 2 Reserve =VO 2peak -VO 2rest (3.5) x%VO 2 R= x%VO 2 R +VO 2rest (3.5) %VO 2peak % HRmax HRR = HRmax-HRrest Karvonen Intensity: Light Moderate High Very high VO 2rest VO 2 R VO2peak Frequency Type Time Intensity General Principle of Aerobic Exercise Training of CAD 43

44. FITT principle ACSM ‘s 2014 Fitness Level Percent Max Heart Rate Percent VO2 max Low 50 28 60 42 66 50 Moderate 70 56 74 60 77 65 High 81 70 85 75 88 80 Very High 90 83 92 85 100 100 Frequency Type Time Intensity General Principle of Aerobic Exercise Training of CAD 44

45. FITT principle Frequency Type Time Intensity ACSM ‘s 2014 Warm up 5-10mins Training stage 20-30mins Cool down 5-10mins ACSM ’ s protocal  warm-up:training stage=1:2 Warm up 5-10mins Higher intensity Cool down 5-10mins Rest intensity Higher intensity Rest intensity General Principle of Aerobic Exercise Training of CAD 45

46. General Principle of Aerobic Exercise Training of CAD FITT principle ACSM ‘s 吳英黛 - Treadmill Arm ergometer Rower Stair climber Bicycle Elliptical Frequency Type Time Intensity 46

47. Findings Author Title Currie, et al. 2013 Low-volume, high-intensity interval training in patients with CAD. 47

48. Methods Subjects: 22 subjects with recent CAD : MI, PCI Interventions: Treadmill walking Progress Week1~4 Week5~8 Week9~12 HIT 89% pre-PPO 102% pre-PPO 110% pre-PPO END 30mins 40mins 50mins Warm up-10~15mins 1mins 共 10 次 1mins 1mins Rest:10%PPO 51%~65% PPO High intensity interval training END Warm up10~15mins Cool down 10~15mins Cool down 10~15mins Training90-110%PPO 48

49. Methods Frequency: 2 supervised session/week for 12 weeks Protocol based on peak power output Outcome measures : Cardiorespiratory fitness supervised graded exercise test VO2peak VO2 AT Hrpeak Rest BP Brachial artery assessments FMD test Preocclusion EDD Peak reactive hyperemia blood flow 49

50. Result 3.6 mL/kg/min 4.6 mL/kg/min 2.1 mL/kg/min 3.3 mL/kg/min 50

51. Result decrease decrease 51

52. Baseline of patient’s capacity in HIIT group Moholdt.2009 Keteyian ,2014 Conraads et al. (2015) VO2peak 27.1 ± 4.5 22.4 ± 4.2 23.5 ± 5.7 Age 60.2 ± 6.9 60 ± 7 57 ± 8.8 GenderM /F 24/4 11/4 91/9 BMI 26.0 ± 6.2 30.4 ± 5.6 28 ± Risk factors DM 4 DM HTN HTN58 DM20 52

53. Safety There are no cardiac accidents in studies Comparison Summary HIIT V.S MCT Cardio fitness&mortality VO2peak ↑ ： HIIT > MCT Heart Function HRrecovery Vascular Adaption Blood pressure, FMD % 53

54. HIIT MCT Change in peak VO2 of > 2 mL/kg/min: HIIT: 67% MCT: 33% Comparison 54 Results

55. AIT MCT BL (n = 28) 4w (n = 28) 6m (n = 23) BL (n = 31) 4w (n = 31) 6m (n = 25) Maximal exercise test O2 peak (mL·kg −1 ·min −1 ) 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 Perceived exertion 8.3 ± 1.5 8.2 ± 1.3 7.9 ± 1.3 8.1 ± 1.5 7.6 ± 1.9 7.1 ± 1.8 RER at O2 peak 1.13 ±0.07 1.14 ±0.07 1.15 ±0.08 1.13 ±0.06 1.13 ±0.08 1.15 ±0.09 Heart rate recovery (1 min) 19.6 ± 6.8 22.5 ± 7.6 25.5 ± 8.6 20.3 ± 9.4 25.4 ± 8.4 24.6 ± 7.7 Quality of life- Emotional domain 5.7 ± 0.7 6.2 ± 0.5 6.1 ± 0.6 5.5 ± 1.1 6.0 ± 0.7 5.9 ± 0.7 Physical domain 5.3 ± 0.7 6.2 ± 0.4 6.2 ± 0.7 5.4 ± 1.0 6.0 ± 0.6 6.1 ± 0.6 Social domain 5.6 ± 0.6 6.5 ± 0.4 6.5 ± 0.6 5.4 ± 1.3 6.3 ± 0.7 6.3 ± 0.6 AIT MCT BL (n = 28) 4w (n = 28) 6m (n = 23) BL (n = 31) 4w (n = 31) 6m (n = 25) Maximal exercise test 27.1 ± 4.5 30.4 ± 5.5 32.2 ± 7.0 26.2 ± 5.2 28.5 ± 5.6 29.5 ± 6.7 Perceived exertion 8.3 ± 1.5 8.2 ± 1.3 7.9 ± 1.3 8.1 ± 1.5 7.6 ± 1.9 7.1 ± 1.8 1.13 ±0.07 1.14 ±0.07 1.15 ±0.08 1.13 ±0.06 1.13 ±0.08 1.15 ±0.09 Heart rate recovery (1 min) 19.6 ± 6.8 22.5 ± 7.6 25.5 ± 8.6 20.3 ± 9.4 25.4 ± 8.4 24.6 ± 7.7 Quality of life- Emotional domain 5.7 ± 0.7 6.2 ± 0.5 6.1 ± 0.6 5.5 ± 1.1 6.0 ± 0.7 5.9 ± 0.7 Physical domain 5.3 ± 0.7 6.2 ± 0.4 6.2 ± 0.7 5.4 ± 1.0 6.0 ± 0.6 6.1 ± 0.6 Social domain 5.6 ± 0.6 6.5 ± 0.4 6.5 ± 0.6 5.4 ± 1.3 6.3 ± 0.7 6.3 ± 0.6 Results Table II. Cardiorespiratory variables, quality of life, and blood markers at baseline (BL), 4w, and 6m 5.1 mL/kg/min 3.3 mL /kg/min 3.3 1.8 2.3 1.0 5.9beat/min 4.3beat/min Comparison O 2 peak↑ Exercise capacity↑   2.9 3.0 5.1 -0.8 significant differences No significant differences No significant differences > HRrecovery Heart Function↑ 55