American Heart Journal
Volume 159, Issue 4 , Page e23, April 2010

Reply to Meyer

Stavanger University Hospital, Cardiology, Stavanger, Norway

Article Outline

 

Dear Editor:

We thank Dr Nigam and his group for their interest in our article. There were raised 3 limitations regarding the high-intensity interval training program used in the current study.1

We would like to reply that first, the actual patients did not have angina, the angiogram showed no significant stenosis after revascularization, and there was no ischemia during stress test. In this special subset of CAD-patients, β-blockers, or calcium-channel blockers only have a relative indication. More important is the use of potent statins and dual platelet inhibition to avoid plaque rupture in lesions not detected with angiography. Monitoring running speed or cycling velocity may not always correspond to the same pulse rate and limits patients to use a treadmill for running.

Second, we did not suggest that the “Norwegian” program to be the most effective one. The high-intensity interval training (HIIT) model used in the cited publication of Guiraud et al2 differ substantially from the “Norwegian” model in that very-short high-intensity intervals of 100% of maximal aerobic power have been used, which allows no comparison to the Norwegian model.

Third, we agree that the safety and feasibility of HIIT in higher risk patients with more severe CAD or heart failure is not well documented at this point. However, some reports have described the efficacy and safety in smaller populations of patients with stable heart failure and negative stress electrocardiogram.3 A large ongoing multicenter trial, Study of Myocardial Recovery After Exercise Training in Heart Failure (NCT00917046), is currently recruiting patients and will address these issues.

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References 

  1. Munk PS, Staal EM, Butt N, et al. 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
  2. Guiraud T, Juneau M, Nigam A, et al. Optimization of high intensity interval exercise in coronary heart disease. Eur J Appl Physiol. 2009 Nov 14;[Epub ahead of print]
  3. Nilsson BB, Westheim A, Risberg MA. Effects of group-based high-intensity aerobic interval training in patients with chronic heart failure. Am J Cardiol. 2008;102:1361–1365

PII: S0002-8703(09)00973-9

doi:10.1016/j.ahj.2009.12.019

Refers to article:

  • “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;158:734-41

    Philippe Meyer, Mathieu Gayda, Éve Normandin, Thibaut Guiraud, Martin Juneau, Anil Nigam
    American Heart Journal March 2010 (Vol. 159, Issue 3, Page e21)

  • 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

    Peter S. Munk, Eva M. Staal, Noreen Butt, Kjetil Isaksen, Alf I. Larsen
    American Heart Journal November 2009 (Vol. 158, Issue 5, Pages 734-741)

American Heart Journal
Volume 159, Issue 4 , Page e23, April 2010

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