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Randomized Controlled Trial
. 2024 Oct;60(5):878-888.
doi: 10.23736/S1973-9087.24.08364-3. Epub 2024 Jul 29.

Impact of eccentric cycling in coronary rehabilitation program: a pragmatic randomized controlled trial versus conventional rehabilitation

Delphine Besson  1   2 , Amadou-Khalilou Sow  3 , Isabelle Fournel  3 , Anaïs Gouteron  2   4 , Aurélie Gudjoncik  2 , Jean M Casillas  1   2   4 , Paul Ornetti  1   3   5 , Davy Laroche  6   4
Affiliations
Randomized Controlled Trial

Impact of eccentric cycling in coronary rehabilitation program: a pragmatic randomized controlled trial versus conventional rehabilitation

Delphine Besson et al. Eur J Phys Rehabil Med. 2024 Oct.

Abstract

Background: This randomized controlled trial examined the feasibility of adding eccentric exercise to a conventional cardiac rehabilitation program (CCRP) for coronary heart disease patients.

Methods: Ninety-three patients were randomly assigned to either the MIX group (eccentric ergometer + CCRP) or the CON group (concentric ergometer + CCRP) for 7 weeks. Training effectiveness was assessed based on "good responders" showing improved functional capacities, such as 6-minute walk test (6MWT) distance and maximal voluntary contraction of the plantar flexors (ankle MVC). Safety was monitored with a visual analog scale for muscle soreness, perceived exertion, and heart rate during training.

Results: The proportion of good responders was similar between groups (26% in MIX, 29% in CON, P=0.744). Both groups improved in 6MWT (CON: 12.6%, MIX: 16.14%) and ankle MVC (CON: 15.5%, MIX: 11.30%), with no significant differences. Exercise tolerance did not differ significantly between the groups, but perceived effort was significantly lower in the MIX group (P<0.0001) compared to the CON group.

Conclusions: Integrating eccentric exercise into cardiac rehabilitation is safe and well-tolerated. Nevertheless, this study did not find significant advantages over conventional programs for coronary heart disease patients. Further research should explore specific patient groups or conditions where eccentric exercise may be more beneficial, emphasizing personalized prescriptions and gradual workload progression for better cardiac rehabilitation outcomes.

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Conflict of interest statement

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—Study design of the two months’ rehabilitation program with different evaluations between the initial and final conventional cardiopulmonary exercise test (CPET). CON: concentric; ECC: eccentric; 6MWT: 6-Minute Walking Test. *Concentric ergometer (rowing machine, treadmill…), strengthening exercises and therapeutic patient education.
Figure 2
Figure 2
—Flow chart of the ENERGETIC study.
Figure 3
Figure 3
—Evolution of power during training (bars) and relative evolution of heart rate between end exercise and rest (line) during the 7 weeks of training for concentric and concentric/eccentric (MIX) group. *Significant differences (P<0.001) between MIX and CON groups.
Figure 4
Figure 4
—Mean and standard deviation of rate of perceived exertion (RPE) with Borg Scale (A) and number of pain >4 with Visual Analogic Scale (VAS; B) during the seven weeks of training between concentric and concentric/eccentric group. *Significant differences (P<0.05).
See this image and copyright information in PMC

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