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Effect of High-Intensity Interval Training on Coronary Atheromatous Plaques
Coronary atheroma volume is associated with risk of coronary events in coronary artery disease (CAD). Exercise training is a cornerstone in primary and secondary prevention of CAD, but the effect of exercise on coronary atheromatous plaques is largely unknown.
We assessed the effect of six months supervised high intensity interval training (HIIT) on coronary plaque geometry using intravascular ultrasound in patients with stable CAD following percutaneous coronary intervention (PCI).
Sixty patients were randomized to two sessions of weekly supervised HIIT at 85-95% of peak heart rate (n = 30) or to follow contemporary preventive guidelines (control group, n = 30). The study endpoints were change in percent atheroma volume (PAV) and total atheroma volume (TAV) normalized for segment length (TAVnorm) at six-month follow-up.
The change in average PAV for matched coronary segments from baseline to follow-up showed a significant between-group difference (-1.4, 95% CI: -2.7 to -0.1, p = 0.036). There was a significant reduction in the HIIT group (-1.2, 95% CI: -2.1 to -0.2, p = 0.017) while not in the control group (0.2, 95% CI: -0.7 to 1.1, p = 0.616). TAVnorm was reduced (-9 mm3, 95% CI: -14.7 to -3.4, p = 0.002) after HIIT, with a significant between-group difference (-12.0 mm3, 95% CI: -19.9 to -4.2, p = 0.003).
In patients with established CAD, a regression of atheroma volume was observed in those undergoing six months of supervised HIIT compared with patients following contemporary preventive guidelines. Our study indicates that high intensity interval training counteracts atherosclerotic coronary disease progression and reduces atheroma volume in residual coronary atheromatous plaques following PCI.
High intensity interval training induces beneficial effects on coronary atheromatous plaques - a randomized trialEur J Prev Cardiol 2022 Dec 23;[EPub Ahead of Print], EK Vesterbekkmo, IL Aamot Aksetøy, T Follestad, HO Nilsen, K Hegbom, U Wisløff, R Wiseth, E Madssen
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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Coronary atheroma volume is associated with the risk of coronary events in patients with established coronary artery disease (CAD). The beneficial protection of physical activity from CAD has been known for decades, and multiple beneficial biological effects are demonstrated with regular exercise training. Furthermore, several studies have shown solid and positive associations between physical exercise and life expectancy in healthy people and patients with CAD. Nevertheless, the mechanism by which physical activity reduces coronary events still needs to be determined. In particular, there is a need for research on the effect of physical exercise on coronary artery atheromatous plaques.
Now published in the European Journal of Preventive Cardiology and presented at the ESC 2022 Congress, Vesterbekkmo and colleagues report the results from the analyses of the predefined secondary endpoints from the CENIT trial (Impact of Cardiac Exercise Training on Lipid Content Coronary Atheromatous Plaque Evaluated by Near‐Infrared Spectroscopy — A Randomized Trial).1 In this study, the investigators assessed the effect of 6 months of supervised high-intensity interval training (HIIT) on coronary plaque geometry using intravascular ultrasound in patients with stable CAD following PCI.
In all, 60 patients were randomized to two sessions of weekly supervised HIIT at 85% to 95% of peak heart rate (n = 30) or to follow contemporary preventive guidelines (control group; n = 30). Both groups underwent baseline and 6‐month intracoronary imaging and cardiopulmonary exercise testing to assess peak oxygen consumption (VO2peak). All patients were on stable statin treatment before entering the study, with no further adjustments during the study period. The study endpoints were changes in percent atheroma volume and total atheroma volume normalized for segment length at 6-month follow-up.
Why this matters
So far, only a few studies have used intracoronary imaging when assessing the effects of exercise. Data derived from this study indicate that HIIT counteracts atherosclerotic coronary disease progression and reduces atheroma volume in residual coronary atheromatous plaques following PCI. These findings are important contributions to understanding exercise's influence on CAD. The study also confirms the ability of exercise, especially HIIT, to enhance cardiovascular health with substantial increases in VO2peak and reductions in body mass index. These results reinforce the scientific background for recommending physical exercise as an essential component of cardiac rehabilitation programs.