High-intensity interval training in cardiac rehabilitation: a multi-centre randomized controlled trial

G McGregor, R Powell, B Begg, S T Birkett, S Nichols, S Ennis, S McGuire, J Prosser, O Fiassam, S W Hee, T Hamborg, P Banerjee, N Hartfiel, J M Charles, R T Edwards, A Drane, D Ali, F Osman, H He, T LachlanM J Haykowsky, L Ingle, R Shave

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There is a lack of international consensus regarding the prescription of high-intensity interval exercise training (HIIT) for people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).

To assess the clinical effectiveness and safety of low-volume HIIT compared with moderate intensity steady-state (MISS) exercise training for people with CAD.

We conducted a multi-centre RCT, recruiting 382 patients from 6 outpatient CR centres. Participants were randomised to twice-weekly HIIT (n = 187) or MISS (n = 195) for 8 weeks. HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. MISS was 20-40 minutes of moderate intensity continuous exercise (60-80% maximum capacity). The primary outcome was the change in cardiorespiratory fitness (peak oxygen uptake, VO2 peak) at 8-week follow-up. Secondary outcomes included cardiovascular disease risk markers, cardiac structure and function, adverse events, and health-related quality of life.

At 8 weeks, VO2 peak improved more with HIIT (2.37 mL.kg-1.min-1; SD, 3.11) compared with MISS (1.32 mL.kg-1.min-1; SD, 2.66). After adjusting for age, sex and study site, the difference between arms was 1.04 mL.kg-1.min-1 (95% CI, 0.38 to 1.69; p = 0.002). Only 1 serious adverse event was possibly related to HIIT.

In stable CAD, low-volume HIIT improved cardiorespiratory fitness more than MISS by a clinically meaningful margin. Low-volume HIIT is a safe, well tolerated, and clinically effective intervention that produces short-term improvement in cardiorespiratory fitness. It should be considered by all CR programmes as an adjunct or alternative to MISS.
Original languageEnglish
Pages (from-to)745-755
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Issue number9
Early online date8 Feb 2023
Publication statusPublished - 12 Jul 2023

Bibliographical note

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Research activities were supported by Cardiff Metropolitan University, University of Hull, University Hospitals Coventry and Warwickshire NHS Trust, Atrium Health, Coventry University, The Gwent Cardiac Rehab Trust Fund, and The Royal Gwent Cardiology Fund.


  • cardiac rehabilitation
  • exercise training
  • high intensity interval training
  • coronary artery disease
  • cardiorespiratory fitness
  • National Health Service


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