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. 2019 Dec;26(18):1921-1928.
doi: 10.1177/2047487319859450. Epub 2019 Jun 20.

Exercise training intensity determination in cardiovascular rehabilitation: Should the guidelines be reconsidered?

Dominique Hansen  1   2   3 , Kim Bonné  2 , Toon Alders  2 , Ann Hermans  2 , Katrien Copermans  2 , Hans Swinnen  2 , Vincent Maris  1 , Thomas Jansegers  1 , Wout Mathijs  1 , Laura Haenen  1 , Johan Vaes  2 , Emmanuela Govaerts  2 , Veerle Reenaers  2 , Ines Frederix  2   3   4 , Paul Dendale  2   3
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Exercise training intensity determination in cardiovascular rehabilitation: Should the guidelines be reconsidered?

Dominique Hansen et al. Eur J Prev Cardiol. 2019 Dec.

Abstract

Aims: In the rehabilitation of cardiovascular disease patients a correct determination of the endurance-type exercise intensity is important to generate health benefits and preserve medical safety. It remains to be assessed whether the guideline-based exercise intensity domains are internally consistent and agree with physiological responses to exercise in cardiovascular disease patients.

Methods: A total of 272 cardiovascular disease patients without pacemaker executed a maximal cardiopulmonary exercise test on bike (peak respiratory gas exchange ratio >1.09), to assess peak heart rate (HRpeak), oxygen uptake (VO2peak) and cycling power output (Wpeak). The first and second ventilatory threshold (VT1 and VT2, respectively) was determined and extrapolated to %VO2peak, %HRpeak, %heart rate reserve (%HRR) and %Wpeak for comparison with guideline-based exercise intensity domains.

Results: VT1 was noted at 62 ± 10% VO2peak, 75 ± 10% HRpeak, 42 ± 14% HRR and 47 ± 11% Wpeak, corresponding to the high intensity exercise domain (for %VO2peak and %HRpeak) or low intensity exercise domain (for %Wpeak and %HRR). VT2 was noted at 84 ± 9% VO2peak, 88 ± 8% HRpeak, 74 ± 15% HRR and 76 ± 11% Wpeak, corresponding to the high intensity exercise domain (for %HRR and %Wpeak) or very hard exercise domain (for %HRpeak and %VO2peak). At best (when using %Wpeak) in only 63% and 72% of all patients VT1 and VT2, respectively, corresponded to the same guideline-based exercise intensity domain, but this dropped to about 48% and 52% at worst (when using %HRR and %HRpeak, respectively). In particular, the patient's VO2peak related to differently elicited guideline-based exercise intensity domains (P < 0.05).

Conclusion: The guideline-based exercise intensity domains for cardiovascular disease patients seem inconsistent, thus reiterating the need for adjustment.

Keywords: Cardiovascular rehabilitation; exercise intensity; guidelines.

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