Sportkardiologie / Sports Cardiology
High Intensity Training in CHD-Patients with Chronic Heart Failure

High Intensity Interval Training in CHD-Patients with Chronic Heart Failure (CHF-HFrEF)

Hochintensives Intervalltraining bei Patienten mit koronarer Herzerkrankung (KHK) mit Herzinsuffizienz (CHF-HFrEF)


Introduction: Applicability and effectiveness of high intensity interval training currently being discussed and investigated as a possible addition to moderate continuous training (MCT) for patients with CHF-HFrEF especially in cardiac rehabilitation (CR). Meanwhile, a prospective multi-centre-RCT and meta-analyses are also available for high intensity interval training.

Method: We conducted a selective literature search until December 2017. This was focussed on studies to evaluate high-intensity interval-training modalities in CR in patients with CHF-HFrEF.

Results: While early (and often small) studies with a great variety in exercise-intensity and -protocol-modalities and following meta-analyses often showed highly significant positive results with regard to the maximum oxygen uptake (VO2peak) and other relevant clinical parameters, current prospective multicentre RCTs show no such significant advantages for high intensity training compared to MCT.

Discussion: High intensity training in CR phase II and III is a equivalent form of exercise for CHF-HFrEF patients showing equivalent improvement of cardiovascular protection factors, clinical CHF-parameters and quality of life compared with MCT. High-intensity interval training may be applied in stable CHF-HFrEF-patients who tolerate MCT well and in whom further improvement in exercise capacity is aimed. Nevertheless, there is still a need for research in a more precise clinical-application and its long-term effects.

KEY WORDS: Cardiac Rehabilitation, Exercise, Endurance Training, Chronic Heart Failure, High Intensity Interval Training


Einführung: Hochdosiertes Ausdauertraining in der Rehabilitation (CR) von Patienten mit Herz-Kreislauferkrankungen werden derzeit als mögliche Addition zum klassischen moderaten kontinuierlichen Ausdauertraining (MCT) diskutiert und erforscht. Aktuell liegen auch erstmalig RCTs und Metaanalysen bei Patienten mit CAD und CHF-HFrEF vor.

Methode: Wir führten eine selektive Literaturrecherche bis Dezember 2017 durch. Das Review widmet sich hochintensivem Intervalltraining bei Patienten mit CHF-HFrEF.

Ergebnisse: Während frühe (oft kleine) Studien mit unterschiedlichen Trainingsintensitäten und -protokollen und folgende Meta-Analysen z. T. hochsignifikant positive Resultate im Hinblick auf die maximale Sauerstoffaufnahme (VO2peak) und weitere klinisch relevante Parameter ergaben, kann ein aktuelles prospektives Multicenter-RCT keine signifikanten Vorteile für hochintensives Intervalltraining im Vergleich zum MCT mehr nachweisen.

Diskussion: Die Anwendung von hochintensivem Intervalltraining stellt bei CHF-HFrEF-Patienten eine in Bezug auf die Verbesserung kardiovaskulärer Schutzfaktoren, klinischer Herzinsuffizienz-Parameter und Lebensqualität dem MCT gleichwertige Trainingsform dar. Hochintensives Intervalltraining kann bei klinisch stabilen CHF-HFrEF-Patienten, die das MCT gut tolerieren, eingesetzt werden, wenn eine weitere Steigerung der Leistungsfähigkeit erzielt werden soll. Dennoch gibt es weiterhin erheblichen Forschungsbedarf, insbesondere zur differenzierteren Anwendung und zu Langzeit-Effekten.

SCHLÜSSELWÖRTER: Kardiologische Rehabilitation, Bewegung, Ausdauertraining, Chronische Herzinsuffizienz, Hochintensives Intervalltraining


The first part of this review describes principles, definition, history and application of interval training in CHD patients with normal/maintained left-ventricular ejection fraction, part two discusses the relevance of high-intensity interval training, including HIIT/AIT (high-intensity interval training/aerobic interval training) in patients with reduced left-ventricular ejection fraction (chronic heart failure, heart failure with reduced ejection fraction, CHF-HFrEF) based on the results of a selective literature search.

Physical exercise is counted among the clinically-proven primary treatment forms for patients with CHF-HFrEF. Described for the first time nearly 40 years ago, the value of training intervention has been repeatedly proven and meanwhile has become a standard therapy form in secondary and tertiary prevention of this prognostically-relevant disease (3, 21, 28, 32, 39).

Improvements in physical work capacity, quality of life, neurohumoral activation and numerous parameters of muscle and vascular physiology including endothelial function have been demonstrated (23, 31, 40, 43). Physical exercise, performed as moderate continiuous training (MCT) is an established component of training intervention in CHF-HFrEF patients and is recommended as standard therapy in guidelines of the leading specialist societies (4, 29, 30, 44).

The interval training method as such as well as high-intensity interval training, which has been applied for many years in ambitious leisure and performance sports, has attracted the attention of scientific studies in cardiovascular diseases since the 1990s thanks to the observed effects on muscle and vascular physiology.

As early as the 1990s, Meyer et al. (22, 24) gained initial experience with interval training in patients with CHF-HFrEF. The interval training protocols (30/60 sec) determined with the steep ramp test (SRT) showed for training between 17 and 35 minutes at 50% peak work an effective exercise (“pedaltime”) of only 5 to 8 minutes. It was shown that hereby low values for the subjective feeling of exertion (RPE-Borg-Skala), a lower rate-pressure product as an expression of cardiac work as well as lower catecholamine levels despite elevated lactate levels were attained (22). The peripheral stimulation was thus higher with concurrently reduced cardiac stress. This principle is advantageous and desirable for chronic diseases like CHF-HFrEF to prevent peripheral deconditioning (“muscle-waste-syndrome“) (23). The significantly better prognosis for CHF-HFrEF patients with eliminated or reduced weight loss was explained by the preservation of muscle mass as a relevant part of body weight. Interval training is characterized by the alternating of exercise and recovery phases.

A precise description of this and HIIT/AIT is given in Part 1 of this review.

To date, studies on interval training in CHF-patients have mostly been performed on patients with reduced ejection fraction (HFrEF).Currently, no study results are available on patients with symptoms of heart failure with preserved ejection fraction (HFpEF). The results especially of the first multicenter RCTs (Ex-DHF and OptimEx) are still outstanding (8, 37). In a pilot study, moderate strength-endurance training brought positive effects in the improvement of diastolic function (7).

High-Intensity Interval Training in Patients with Chronic Heart Failure (CHF) with Reduced Ejection Fraction (HFrEF)

At the beginning of the last decade, Nechwatal et al. studied the effectiveness of interval training with short intensive exercise compared to MCT in HFrEF patients during a 3-week CR. The results showed both training modalities to be equally effective in improving physical work capacity (27). This result was confirmed in another prospective study with significant improvements in maximum work capacity measured in both watts and as VO2peak (6).

Later, a Greek research team examined the effects of interval training in CHF-HFrEF patients using the Meyer protocol with and without additional strength training. No adverse events were observed. In both studies published on this topic, a still significantly higher or about doubled increase in VO2peak was found in a combination of the two training modalities and additive strength training (2, 38). In another randomized study, interval training at 50-80% of the maximum performance determined by STR in the Meyer method was compared with MCT during an 8-week CR Phase II in CHFHFrEF patients. Here, too, no adverse events occurred. The VO2peak improved significantly by 27% in the interval group while it remained unchanged in the MCT group (11).

Great notice was taken of the results of the ”milestone” study, published in 2007 by Wisløff et al., which are still being controversially discussed (31, 43). They show a significantly greater improvement in VO2peak from 13.0±1.6 to 19.0±2.1ml/kg/min in a treadmill AIT (4x4-protocol; 90-95% HRmax) compared to MCT (13.1±1.1 to 14.9±0.9ml/kg/min). Moreover, a significant increase in left-ventricular ejection fraction in the sense of reverse cardiac remodeling only in the AIT group was disclosed for the first time (43). Another prospective study confirmed significant improvements in the VO2peak and other parameters of respiratory efficiency only in the AIT group (41).

While improvement in work capacity is foremost in ambitious leisure and performance sports among athletes, the physical work capacity under everyday conditions is most important for patients with CHF-HFrEF to maintain quality of life, avoid rehospitalization and, where possible, improve the prognosis. High-intensity interval protocols are tolerated by patients with CHF-HFrEF very differently and not always without problems in the authors’ own clinical experience. The protocol used by Wisløff (10 min warm-up at 60-70% of HRmax, 4x4 min intervals at 90-95% of HRmax followed by 4x3 min active recovery at 50-70% of HRmax, duration of the session 38 min) is used in some of the available scientific studies and particularly in current multicenter studies on CHD and CHF (43).

The results of a current meta-regression analysis of 55 training studies (n=7553 patients with CHD and CHF) in CR confirm that the effectiveness of the intervention in CR (on average VO2peak +3.33 mL/kg/min (+17%)) is influenced decisively by training intensity but not by other factors, including training modality. The effects in studies which included CHF patients (VO2peak +3.94 mL/kg/min) were higher than those of CHD patients without included CHF (+2.79mL/kg/min). Training intensity (% VO2peak or % HRmax) higher by 10% was associated on average with greater improvement in VO2peak by 1 mL/kg/min. Despite the large number of patients, no relevant adverse events were reported (40). The results confirm the observations of earlier reviews with respect to the importance of training intensity and duration of the program (especially more than 6 months) in training interventions in CHI patients (1, 19).

The effectiveness of high-intensity interval training compared to MCT in patients with CHF-HFrEF has already been evaluated in two meta-analyses (16, 35). One of these meta-analyses included exclusively studies which compared MCT with interval training, of which in turn, only some contained no other intervention components of CR. In the comparison, high-intensity interval training resulted in a significantly greater increase in VO2peak of +2.14 ml/kg/min, whereas there was no difference with respect to a reverse cardiac remodeling or improvement in left-ventricular ejection fraction at rest (16).

The second meta-analysis included studies on combined interval and strength training, exclusively interval training and exclusively MCT compared to inactive control groups. A combination of strength training and HIIT was superior to high-intensity training alone or MCT with respect to the VO2peak (VO2peak -1.10 ml/kg/min). There was a positive correlation between the weekly energy expenditure and the VO2peak (r=0.48) (35).

Later, the results of another randomized study on combined high-intensity interval training at 100% VO2max and 30 sec passive recovery phases combined with strength training over 12 weeks vs. an inactive control group were published. Significant improvements were observed in VO2max, maximum performance achieved (watts) and 6-minute-walking distance (5).

A study initiated a short time ago is currently investigating the effects of high-intensity interval training on the quality of life in CHF-HFrEF patients, which is often greatly impaired (41).

Table 1 shows a summary of the results of randomized studies in which the effectiveness of high-intensity interval training was compared to MCT in CHF-HFrEF patients. Table 2 shows a summary of the results of current meta-analyses, in which the effectiveness of high-intensity interval training is compared to MCDT in CHF-HFrEF patients.

Results of a current Norwegian study (n=4846) confirm a lower risk of cardiovascular events during aerobic endurance training in CR Phase II and III. During the 7-year observation period, a risk of cardiac arrest of 1:58607 training units (TU) (total 3 cases) was determined in 175,820 TU. One of the 3 cases occurred at moderate training intensity (with lethal outcome, risk 1:129,456 TU) and 2 cases at high training intensity (neither with lethal outcome, risk 1:23,182 TU) (26,33). In one study, a significant reduction in the occurrence of arrhythmias was observed in the Holter-ECG after high-intensity interval training compared to MCT resp. the control groups (20).

The goal of the first and thus far only randomized-prospective multicenter study (SMARTEX-HF) (n=261; LV-EF ≤ 35%) was to examine in larger cohorts the effectiveness of the 4x4-min protocol (90-95% HRmax) (AIT) compared to MCT at 60-70% HFmax or to the usual recommendation of regular exercise (RRE) over 12 weeks. The primary endpoint was the end-diastolic left-ventricular diameter in the context of remodelling; the secondary endpoint was the change in LV-EF, in brain-natriuretic-peptides (BNP), in the quality of life and in VO2peak (9).

Compared to the RRE as control group, the primary endpoint was not achieved by either AIT or MCT (LVEDD-Median: AIT: -2.8 mm vs. RRE (p=0.02), MCT -1.6 mm vs. RRE (p=0.34)). This was true also of the comparison of the two interventions with one another (AIT -1.2 mm vs. MCT (p=0.45)). With respect to the LV-EF, there were no significant differences among the three groups. Both interventions led to a significant increase in the VO2peak. The difference between the training groups, however, was not significant. Compared to RRE, on the other hand, the difference was significant (Median AIT +1.4 ml/kg/min (p=0.02), MCT+1.8 ml/min/kg (p=0.003)). The changes attained could not be stabilized in the 52-week follow-up. As in the SAINTEX-CHD study on CHD patients with preserved LV-function, the authors determined that more than 50% of the patients in the AIT group did not achieve the target intensity in training, whereas 80% of the MCT group trained at higher intensities than targeted (9).

With respect to relevant adverse events, there were no differences during the intervention, however, in the follow-up phase in this high-risk subject collective there was numerically a trend, to more non-lethal and lethal events for AIT (non-lethal vs. lethal: 32 vs. 3; p=0.10) and RRE (26/1) compared to MCT (8/3), but the differences were not significant. The authors conclude that MCT should remain the standard for training intervention in CHF-HFrEF patients, even in a supervised CR setting (9).

In recent years, both numerous investigators and users have reported problems in adhering to the training targets in the 4x4 min protocol (AIT). By contrast, a Franco-Canadian team observed greater acceptance of short HIIT intervals of up to one minute at >85% HRmax and passive recovery in CHFHFrEF patients, with a concurrent significant improvement in VO2peak/wattmax (13,15,25). At present, there does not appear to be a universally-applicable protocol for interval training including AIR/HIIT for all CHF-HFrEF patients.

Which program is suitable is determined primarily by the level of training status, resp. an existing deconditioning, the time at which CR was started, comorbidities and the rhythm (in)stability. Especially shortly after an acute disease or deconditioning and in arrhythmias, training stimuli should be gradually dosed, even for MCT, and reevaluated at shorter intervals. Recommendations of some teams are available applying subjective parameters (rate of perceived exertion (RPE) multiplied by training time, “SessionRPE“) or objective measurements of heart rate and lactate profiles during the ergometric entry examination. Using heart rate as the only parameter to control training is considered inadequate, especially in the possible presence of chronotopic incompetency in CHF-HFrEF (10, 17, 18, 42). These recommendations have as yet, however, not found essential application in everyday clinical practice.

Conclusions on High-Intensity Interval Training Including AIT/HIIT in Patients with CHF-HFrEF

1. High-intensity interval training can be optionally integrated gradually in the training program as part of CR in addition to MCT on an individual basis, taking into account the individual patient’s preferences, physical exercise capacity and other comorbidities to be heeded, especially cardiac arrhythmia, in stable and optimally-treated CHF-HFrEF. HIIT has not to date been associated with a generally higher risk than the generally accepted MCT in stable patients.

2. MCT remains the standard for endurance training of CHFHFrEF patients, high-intensity interval training incl. HIIT/AIT can be prescribed in addition to MCT, if MCT is well-tolerated and a further increase in performance capacity is to be achieved.

3. SMARTEX-HF, the first multicenter RCT study with a 12-month follow-up, indicates that there may possibly be a “too much” or an overdose of physical activity, especially in high-risk collectives like CHF-HFrEF patients.

4. In the context of phase II CR, the target group for AIT/HIIT, especially initially, appears to be small, or more limited than in patients with preserved LV-EF. Studies confirm that many patients cannot meet the targets of high-intensity training, at least at first. This means that in using high-intensity interval training, considerable expenditure is needed for individually-adapted implementation and supervision of training. It appears to be suitable for patients who are more resilient, motivated and able to exert themselves more.

5. In the clinical setting, the postulated time advantage of about 30 min / week is less relevant. High-intensity interval training appears advantageous especially in the context of outpatient CR phase III.

6. (Neutral) one-year data are available only for SMARTEX-HF (for AIT) (9). In general, however, long-term observations which confirm the prognostic role of AIT/HIIT in CHFHFrEF are missing in all other studies or meta-analyses.

7. HIIT/AIT protocols should be examined with more differentiation in future studies, also with a focus on adherence to the defined protocols/energy expenditure, in order to enable differentiated recommendations for specific patient groups among the CHF-HFrEF patients. This could hypothetically increase the adherence (or further adherence) to physical activity. Especially the training status and comorbidities existing prior to CR must be taken into account.

Conflict of Interest
The authors have no conflict of interes.


  1. ADES PA, KETEYIAN SJ, BALADY GJ, HOUSTON-MILLER N, KITZMAN DW,MANCINI DM, RICH MW. Cardiac rehabilitation exercise and selfcarefor chronic heart failure. JACC Heart Fail. 2013; 1: 540-547.
  2. ANAGNOSTAKOU V, CHATZIMICHAIL K, DIMOPOULOS S, KARATZANOS E,PAPAZACHOU O, TASOULIS A, ANASTASIOU-NANA M, ROUSSOS C, NANAS S. Effects of interval cycle training with or without strengthtraining on vascular reactivity in heart failure patients. J CardFail. 2011; 17: 585-591.
  3. AMBROSY AP, CERBIN LP, DEVORE AD, GREENE SJ, KRAUS WE,O‘CONNOR CM, PIÑA IL, WHELLAN DJ, WOJDYLA D, WU A, MENTZ RJ. Aerobic exercise training and general health status inambulatory heart failure patients with a reduced ejectionfraction-Findings from the Heart Failure and A Controlled TrialInvestigating Outcomes of Exercise Training (HF-ACTION)trial.Am Heart J. 2017; 186: 130-138.
  4. BALADY GJ, WILLIAMS MA, ADES PA, BITTNER V, COMOSS P, FOODY JA,FRANKLIN B, SANDERSON B, SOUTHARD D; AMERICAN HEART ASSOCIATIONEXERCISE, CARDIAC REHABILITATION, AND PREVENTION COMMITTEE;COUNCIL ON CLINICAL CARDIOLOGY; COUNCILS ON CARDIOVASCULARNURSING, EPIDEMIOLOGY AND PREVENTION, AND NUTRITION,PHYSICAL ACTIVITY, AND METABOLISM; AMERICAN ASSOCIATIONOF CARDIOVASCULAR AND PULMONARY REHABILITATION. Core Components of Cardiac Rehabilitation/Secondary PreventionPrograms: 2007 Update: A Scientific Statement from theAmerican Heart Association Exercise, Cardiac Rehabilitation,and Prevention Committee, the Council on Clinical Cardiology;the Councils on Cardiovascular Nursing, Epidemiology andPrevention, and Nutrition, Physical Activity, and Metabolism;and the American Association of Cardiovascular and PulmonaryRehabilitation. Circulation. 2007; 115: 2675-2682.
  5. CHRYSOHOOU C, ANGELIS A, TSITSINSAKIS G, SPETSIOTI S, NASIS I,TSIACHRIS D, RAPAKOULIAS P, PITSAVOS C, KOULOURIS NG, VOGIATZIS I,DIMITRIS T. Cardiovascular effects of high-intensity intervalaerobic training combined with strength exercise in patientswith chronic heart failure. A randomized phase III clinical trial.Int J Cardiol. 2015; 179: 269-274.
  6. DIMOPOULOS S, ANASTASIOU-NANA M, SAKELLARIOU D, DRAKOS S,KAPSIMALAKOU S, MAROULIDIS G, RODITIS P, PAPAZACHOU O,VOGIATZIS I, ROUSSOS C, NANAS S. Effects of exercise rehabilitationprogram on heart rate recovery in patients with chronicheart failure. Eur J Cardiovasc Prev Rehabil. 2006; 13: 67-73.
  7. EDELMANN F, GELBRICH G, DÜNGEN HD, FRÖHLING S, WACHTER R,STAHRENBERG R, BINDER L, TÖPPER A, LASHKI DJ, SCHWARZ S,HERRMANN-LINGEN C, LÖFFLER M, HASENFUSS G, HALLE M, PIESKE B. Exercise training improves exercise capacity and diastolicfunction in patients with heart failure with preserved ejectionfraction: results of the Ex-DHF (Exercise training in DiastolicHeart Failure) pilot study. J Am Coll Cardiol. 2011; 58: 1780-1791.
  8. EDELMANN F, BOBENKO A, GELBRICH G, ET AL. Exercise trainingin diastolic heart failure (Ex-DHF): rationale and design of amulticentre, prospective, randomized, controlled, parallel grouptrial. Eur J Heart Fail. 2017; 19: 1067-1074.
  9. ELLINGSEN Ø, HALLE M, CONRAADS V, SAQUETTO MB, ELLINGSEN Ø,CARVALHO VO. High intensity interval training in heart failurepatients with reduced ejection fraction. Circulation. 2017; 135:839-849.
  10. FOSTER C, FLORHAUG A, FRANKLIN J, GOTTSCHALL L, HROVATIN LA,PARKER S, DOLESHAL P, DODGE C. A new approach to monitoringexercise training. J Strength Cond Res. 2001; 15: 109-115.
  11. FREYSSIN C, VERKINDT C, PRIEUR F, BENAICH P, MAUNIER S, BLANC P. Cardiac Rehabilitation in Chronic Heart Failure: Effect of an8-week, high-Intensity interval training versus continuoustraining. Arch Phys Med Rehabil. 2012; 93: 1359-1364.
  12. FU TC, WANG CH, LIN PS, HSU CC, CHERNG WJ, HUANG SC, LIU MH,CHIANG CL, WANG JS. Aerobic interval training improves oxygenuptake efficiency by enhancing cerebral and muscularhemodynamics in patients with heart failure. Int J Cardiol. 2013;167: 41-50.
  13. GAYDA M, RIBEIRO PA, JUNEAU M, NIGAM A. Comparison of DifferentForms of Exercise Training in Patients With Cardiac Disease:Where Does High-Intensity Interval Training Fit? Can J Cardiol.2016; 32: 485-494.
  14. GUAZZI M. High intensity exercise training in heart failure:Understanding the exercise “overdose”. Eur J Prev Cardiol. 2016;23: 1940-1942.
  15. GUIRAUD T, NIGAM A, GREMEAUX V, MEYER P, JUNEAU M, BOSQUET L. High-Intensity Interval Training in Cardiac Rehabilitation.Sports Med. 2012; 42: 587-605.
  16. HAYKOWSKY MJ, TIMMONS MP, KRUGER C, MCNEELY M, TAYLOR DA,CLARK AM. Meta-analysis of aerobic interval training on exercisecapacity and systolic function in patients with heart failure andreduced ejection fractions. Am J Cardiol. 2013; 111: 1466-1469.
  17. IELLAMO F, MANZI V, CAMINITI G, VITALE C, CASTAGNA C, MASSARO M,FRANCHINI A, ROSANO G, VOLTERRANI M. Matched dose interval andcontinuous exercise training induce similar cardiorespiratoryand metabolic adaptations in patients with heart failure. Int JCardiol. 2013; 167: 2561-2565.
  18. IELLAMO F, MANZI V, CAMINITI G, VITALE C, MASSARO M, CERRITO A,ROSANO G, VOLTERRANI M. Validation of rate of perceived exertionbasedexercise training in patients with heart failure: insightsfrom autonomic nervous system adaptations. Int J Cardiol. 2014;176: 394-398.
  19. ISMAIL H, MCFARLANE JR, NOJOUMIAN AH, DIEBERG G, SMART NA. Clinical outcomes and cardiovascular responses to differentexercise training intensities in patients with heart failure : asystematic review and meta-analysis. J Am Coll Cardiol: HeartFailure. 2013; 1: 514-522.
  20. LABRUNEE M, GUIRAUD T, GAUCHER-CAZALIS K, ET AL. Improvement ofventricular arrhythmias and heart rate variability after a singlesession of intermittent exercise in chronic heart failure patients[abstract no P567]. Eur J Cardiovasc Prev Rehabil. 2011; 18: 122S.
  21. LEE AP, ICE R, BLESSEY R, SANMARCO ME. Long-term effects ofphysical training on coronary patients with impaired ventricularfunction. Circulation. 1979; 60: 1519-1526.
  22. MEYER K, SAMEK L, SCHWAIBOLD M, WESTBROOK S, HAJRIC R,LEHMANN M, ESSFELD D, ROSKAMM H. Physical responses to differentmodes of interval exercise in patients with chronic heart failure:application to exercise training. Eur Heart J. 1996; 17: 1040-1047.
  23. MEYER K, SCHWAIBOLD M, WESTBROOK S, BENEKE R, HAJRIC R,GÖRNANDT L, LEHMANN M, ROSKAMM H. Effects of short-termexercise training and activity restriction on functional capacityin patients with severe chronic congestive heart failure. Am JCardiol. 1996; 78: 1017-1022.
  24. MEYER K, SAMEK L, SCHWAIBOLD M, WESTBROOK S, HAJRIC R, BENEKE R,LEHMANN M, ROSKAMM H. Interval training in patients with severechronic heart failure: analysis and recommendations forexercise procedures. Med Sci Sports Exerc. 1997; 29: 306-312.
  25. MEYER P, NORMANDIN E, GAYDA M, BILLON G, GUIRAUD T, BOSQUET L,FORTIER A, JUNEAU M, WHITE M, NIGAM A. High intensity intervalexercise in chronic heart failure: protocol optimization. J CardFail. 2012; 18: 126-133.
  26. MOHOLDT T, MADSSEN E, ROGNMO O, AAMOT IL. The higher the better?Interval training intensity in coronary heart disease. J Sci MedSport. 2014; 17: 506-510.
  27. NECHWATAL RM, DUCK C, GRUBER G. Physical training as intervalor continuous training in chronic heart failure for improvingfunctional capacity, hemodynamics and quality of life--acontrolled study. Z Kardiol. 2002; 91: 328-337.
  28. PIEPOLI MF, DAVOS C, FRANCIS DP, COATS AJ; EXTRAMATCHCOLLABORATIVE. Exercise training meta-analysis of trials inpatients with chronic heart failure (ExTraMATCH). BMJ. 2004;328: 189-195.
  29. PIEPOLI MF, CORRÀ U, BENZER W, BJARNASON-WEHRENS B,DENDALE P, GAITA D, MCGEE H, MENDES M, NIEBAUER J, ZWISLER AD,SCHMID JP; CARDIAC REHABILITATION SECTION OF THE EUROPEANASSOCIATION OF CARDIOVASCULAR PREVENTION AND REHABILITATION. Secondary prevention through cardiac rehabilitation: fromknowledge to implementation. A position paper from theCardiac Rehabilitation Section of the European Association ofCardiovascular Prevention and Rehabilitation. Eur J CardiovascPrev Rehabil. 2010; 17: 1-17.
  30. CORRÀ U, PIEPOLI MF, CARRÉ F, ET AL., EUROPEAN ASSOCIATION OFCARDIOVASCULAR PREVENTION AND REHABILITATION COMMITTEEFOR SCIENCE GUIDELINES; EACPR. Secondary prevention throughcardiac rehabilitation: physical activity counselling and exercisetraining. Key components of the position paper from theCardiac Rehabilitation Section of the European Association ofCardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31: 1967-1974.
  31. PRESSLER A. Training bei Herzinsuffizienz: Intervall oderAusdauer? Herzmedizin. 2013; 30: 24-30.
  32. O‘CONNOR CM, WHELLAN DJ, LEE KL, KETEYIAN SJ, COOPER LS, ELLIS SJ,LEIFER ES, KRAUS WE, KITZMAN DW, BLUMENTHAL JA, RENDALL DS,MILLER NH, FLEG JL, SCHULMAN KA, MCKELVIE RS, ZANNAD F, PIÑA IL;HF-ACTION INVESTIGATORS. Efficacy and safety of exercise trainingin patients with chronic heart failure: HF-ACTION randomizedcontrolled trial. JAMA. 2009; 301: 1439-1450.
  33. ROGNMO O, MOHOLDT T, BAKKEN H, HOLE T, MØLSTAD P, MYHR NE,GRIMSMO J, WISLØFF U. Cardiovascular risk of high- versusmoderate-intensity aerobic exercise in coronary heart diseasepatients. Circulation. 2012; 126: 1436-1440.
  34. SMART NA, STEELE M. A comparison of 16 weeks of continuousvs intermittent exercise training in chronic heart failurepatients. Congest Heart Fail. 2012; 18: 205-211.
  35. SMART NA, DIEBERG G, GIALLAURIA F. Intermittent versus continousexercise training in chronic heart failure: a meta-analysis. Int JCardiol. 2013; 166: 352-358.
  36. SPEE RF, NIEMEIJER VM, WIJN PF, DOEVENDANS PA, KEMPS HM. Effectsof high-intensity interval training on central haemodynamicsand skeletal muscle oxygenation during exercise in patients withchronic heart failure. Eur J Prev Cardiol. 2016; 23: 1943-1952.
  37. SUCHY C, MASSEN L, ROGNMO O, VAN CRAENENBROECK EM4, BECKERS P,KRAIGHER-KRAINER E, LINKE A, ADAMS V, WISLØFF U, PIESKE B, HALLE M. Optimising exercise training in prevention and treatment ofdiastolic heart failure (OptimEx-CLIN): rationale and design ofa prospective, randomised, controlled trial. Eur J Prev Cardiol.2014; 21: 18-25.
  38. TASOULIS A, PAPAZACHOU O, DIMOPOULOS S, GEROVASILI V,KARATZANOS E, KYPRIANOU T, DRAKOS S, ANASTASIOU-NANA M,ROUSSOS C, NANAS S. Effects of interval exercise training onrespiratory drive in patients with chronic heart failure. RespirMed. 2010; 104: 1557-1565.
  39. TAYLOR RS, SAGAR VA, DAVIES EJ, BRISCOE S, COATS AJ, DALAL H,LOUGH F, REES K, SINGH S. Exercise-based rehabilitation forheart failure. Cochrane Database Syst Rev. 2014; 4: CD003331.
  40. UDDIN J, ZWISLER AD, LEWINTER C, MONIRUZZAMAN M, LUND K, TANG LH,TAYLOR RS. Predictors of exercise capacity following exercisebasedrehabilitation in patients with coronary heart diseaseand heart failure: A meta-regression analysis. Eur J Prev Cardiol.2016; 23: 683-693.
  41. ULBRICH AZ, ANGARTEN VG, NETTO AS, WEISS STIES S, BÜNDCHEN DC,SAMPAIO DE MARA L, CORNELISSEN VA, DE CARVALHO T. Comparativeeffects of high intensity interval training versus moderateintensity continuous training on quality of life in patients withheart failure: study protocol for a randomized controlled trial.Clinical Trials and Regulatory Science in Cardiology. 2016; 13: 21-28.
  42. VOLTERRANI M, IELLAMO F. Cardiac rehabilitation in patients withheart failure: New perspectives in exercise training. CardiacFailure Review. 2016; 2: 63-68.
  43. WISLØFF U, STOYLEN A, LOENNECHEN JP, BRUVOLD M, ROGNMO Ø,HARAM PM, TJØNNA AE, HELGERUD J, SLØRDAHL SA, LEE SJ, VIDEM V,BYE A, SMITH GL, NAJJAR SM, ELLINGSEN Ø, SKJAERPE T. Superiorcardiovascular effect of aerobic interval training versusmoderate continuous training in heart failure patients: arandomized study. Circulation. 2007; 115: 3086-3094.
  44. YANCY CW, JESSUP M, BOZKURT B, ET AL., AMERICAN COLLEGE OFCARDIOLOGY FOUNDATION; AMERICAN HEART ASSOCIATION TASKFORCE ON PRACTICE GUIDELINES. 2013 ACCF/AHA Guideline forthe Management of Heart Failure. A Report of the AmericanCollege of Cardiology Foundation/American Heart AssociationTask Force on Practice Guidelines. J Am Coll Cardiol. 2013; 62:e147-e239.
  45. WILLENHEIMER R, ERHARDT L, CLINE C, RYDBERG E, ISRAELSSON B. Exercise training in heart failure improves quality of life andexercise capacity. Eur Heart J. 1998; 19: 774-781.
  46. DELAGARDELLE C, FEIEREISEN P, AUTIER P, SHITA R, KRECKE R, BEISSEL J. Strength/endurance training versus endurance training incongestive heart failure. Med Sci Sports Exerc. 2002; 34: 1868-1872.
  47. SABELIS LW, SENDEN PJ, FIJNHEER R, DE GROOT PG, HUISVELD IA,MOSTERD WL, ZONDERLAND ML. Endothelial markers in chronicheart failure: training normalizes exercise-induced vWFrelease. Eur J Clin Invest. 2004; 34: 583-589.
  48. RODITIS P, DIMOPOULOS S, SAKELLARIOU D, SARAFOGLOU S, KALDARA E,VENETSANAKOS J, VOGIATZIS J, ANASTASIOU-NANA M, ROUSSOS C,NANAS S. The effects of exercise training on the kinetics ofoxygen uptake in patients with chronic heart failure. EurJ Cardiovasc Prev Rehabil. 2007;14: 304-311.
  49. KEMPS HM, DE VRIES WR, SCHMIKLI SL, ZONDERLAND ML, HOOGEVEEN AR,THIJSSEN EJ, SCHEP G. Assessment of the effects of physicaltraining in patients with chronic heart failure: the utility ofeffort-independent exercise variables. Eur J Appl Physiol. 2010;108: 469-476.
  50. NILSSON BB, WESTHEIM A, RISBERG MA, ARNESEN H, SELJEFLOT I. Noeffect of group-based aerobic interval training on N-terminalpro-B-type natriuretic peptide levels in patients with chronicheart failure. Scand Cardiovasc J. 2010; 44: 223-229.
  51. BOUCHLA A, KARATZANOS E, DIMOPOULOS S, TASOULIS A, AGAPITOU V,DIAKOS N, TSELIOU E, TERROVITIS J, NANAS S. The addition of strengthtraining to aerobic interval training: effects on muscle strengthand body composition in CHF patients. J Cardiopulm RehabilPrev. 2011; 31: 47-51.
Dr. med. Roland Nebel
Kardiologische Prävention - Medizin II
Strandbadstrasse 106
78315 Radolfzell am Bodensee