# Does the Addition of Strength Training to a High-Intensity Interval Training Program Benefit More the Patients with Chronic Heart Failure

PMID: 39076879
Journal: Reviews in cardiovascular medicine
Published: 2023 Jan
Authors: Alshamari M, Kourek C, Sanoudou D, Delis D, Dimopoulos S, Rovina N, Nanas S, Karatzanos E, Philippou A

## Question

Does adding strength training to a supervised HIIT cardiac rehabilitation program provide extra benefits for functional capacity and quality of life in patients with chronic heart failure?

## Summary

This randomized cardiac rehabilitation trial tested whether patients with stable chronic heart failure got more benefit from HIIT alone or HIIT plus strength training. Both groups completed a 3-month, 36-session supervised program using the same 31-minute cycling HIIT structure. Functional capacity, ejection fraction, strength/endurance, and quality of life improved within groups. Adding strength training did not improve most outcomes more than HIIT alone, but it did add benefits for chest muscle strength/endurance and workload at the anaerobic threshold.

## Population

- Stable chronic heart failure patients with NYHA class II/III and EF <=49%.
- Sample size: 44
- Age: 56 +/- 10 years overall.
- Sex: 35 male, 9 female.
- Fitness level: Reduced functional capacity; baseline peak VO2 about 18.4 mL/kg/min.
- Health status: Stable CHF under medication.

## Methodology

- Single-blinded randomized controlled clinical study with two exercise groups.
- 3 months; 36 sessions at 3 sessions per week.
- Hospital/cardiac rehabilitation program with supervised stationary cycling and clinical monitoring.
- Randomized and controlled study design.

## Protocol

- HIIT cardiac rehabilitation.
- Modality: Stationary cycling.
- Work intervals: 4 minutes at 80% peak VO2, progressed over sessions.
- Recovery: 3 minutes active recovery at 50% peak VO2.
- Sets or repetitions: 4 high-intensity work intervals per session.
- Intensity: CPET-derived watts corresponding to peak VO2 percentages; Borg monitored.
- Session duration: 31 minutes for aerobic HIIT.
- Frequency: 3 sessions per week.
- Program length: 3 months / 36 sessions.
- Progression: 5% increase sessions 10-18, additional 10% sessions 19-27, additional 10% sessions 28-36.
- HIIT plus strength training.
- Modality: Same stationary cycling HIIT plus resistance training.
- Work intervals: Same 4-minute cycling work intervals; strength sets of 10-12 reps.
- Recovery: Same 3-minute active recovery; 1-minute rest between strength sets.
- Sets or repetitions: Same 4 cycling intervals; 2-3 sets of 10-12 reps for quadriceps, leg curl, shoulder flexion/chest press.
- Intensity: Same HIIT intensity; strength training 60-75% 1RM.
- Session duration: Same aerobic duration plus strength component.
- Frequency: 3 sessions per week.
- Program length: 3 months / 36 sessions.
- Progression: Strength intensity increased by 5% over staged session blocks.

## Outcomes

### Functional capacity and quality of life
Status: improved
Both HIIT and COM improved multiple CPET indices and MLWHFQ physical/total scores within groups.

Reported p < 0.05 for many within-group changes; most between-group comparisons were not significant.

### Chest strength/endurance
Status: improved
COM improved chest 1RM and chest muscular endurance more than HIIT.

Between-group p = 0.039 for chest 1RM, p = 0.021 for relative chest 1RM, p = 0.002 for chest endurance.

### Workload at anaerobic threshold
Status: improved
COM showed greater improvement in workload at AT than HIIT.

Between-group difference reported significant in Table 2.

## Practical Insights

- A supervised 4x4-minute cycling HIIT protocol can be used in stable CHF cardiac rehab with medical oversight.
- Adding strength training to HIIT mainly adds strength/endurance benefits rather than broad additional VO2 or quality-of-life benefits.
- Clinical HIIT protocols should use measured prescription, progressive overload, and monitoring.

## Limitations

- Small clinical sample.
- Only compliant completers included in analysis.
- No usual-care or moderate continuous exercise control in this comparison.
- Not directly translatable to unsupervised consumer workouts.

## Safety And Adherence

- Patients were medically screened before participation.
- BP, oxygen saturation, HR, dyspnea, and fatigue were monitored during sessions.
- Adverse event counts were not clearly reported in extracted sections.

## Original Sources

- [PubMed](https://pubmed.ncbi.nlm.nih.gov/39076879/) (pubmed)
- [DOI](https://doi.org/10.31083/j.rcm2401029) (doi)
- [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270399/) (full text)

## Agent Guidance

Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.