High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation

Gordon McGregor, Simon Nichols, Thomas Hamborg, Lucy Bryning, Rhiannon Tudor-Edwards, David Markland, Jenny Mercer, Stefan Birkett, Stuart Ennis, Richard Powell, Brian Begg, Mark J Haykowsky, Prithwish Banerjee, Lee Ingle, Rob Shave, Karianne Backx

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Abstract

INTRODUCTION: Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the 'modern' patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes.

METHODS AND ANALYSIS: This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40-70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peak as determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes.

ETHICS AND DISSEMINATION: The study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands-Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR.

TRIAL REGISTRATION NUMBER: NCT02784873; pre-results.

Original languageEnglish
Article numbere012843
JournalBMJ
Volume6
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016
Externally publishedYes

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Cost-Benefit Analysis
Randomized Controlled Trials
Coronary Disease
Exercise
Guidelines
Research Ethics Committees
Prednisolone
Heart Rate
Economics
Outcome Assessment (Health Care)
High-Intensity Interval Training
Cardiac Rehabilitation
Oxygen
Health
Research
Therapeutics

Keywords

  • Journal Article

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High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK) : study protocol for a multicentre randomised controlled trial and economic evaluation. / McGregor, Gordon; Nichols, Simon; Hamborg, Thomas; Bryning, Lucy; Tudor-Edwards, Rhiannon; Markland, David; Mercer, Jenny; Birkett, Stefan; Ennis, Stuart; Powell, Richard; Begg, Brian; Haykowsky, Mark J; Banerjee, Prithwish; Ingle, Lee; Shave, Rob; Backx, Karianne.

In: BMJ, Vol. 6, No. 11, e012843, 01.11.2016.

Research output: Contribution to journalArticle

McGregor, G, Nichols, S, Hamborg, T, Bryning, L, Tudor-Edwards, R, Markland, D, Mercer, J, Birkett, S, Ennis, S, Powell, R, Begg, B, Haykowsky, MJ, Banerjee, P, Ingle, L, Shave, R & Backx, K 2016, 'High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation' BMJ, vol. 6, no. 11, e012843. https://doi.org/10.1136/bmjopen-2016-012843
McGregor, Gordon ; Nichols, Simon ; Hamborg, Thomas ; Bryning, Lucy ; Tudor-Edwards, Rhiannon ; Markland, David ; Mercer, Jenny ; Birkett, Stefan ; Ennis, Stuart ; Powell, Richard ; Begg, Brian ; Haykowsky, Mark J ; Banerjee, Prithwish ; Ingle, Lee ; Shave, Rob ; Backx, Karianne. / High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK) : study protocol for a multicentre randomised controlled trial and economic evaluation. In: BMJ. 2016 ; Vol. 6, No. 11.
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AU - McGregor, Gordon

AU - Nichols, Simon

AU - Hamborg, Thomas

AU - Bryning, Lucy

AU - Tudor-Edwards, Rhiannon

AU - Markland, David

AU - Mercer, Jenny

AU - Birkett, Stefan

AU - Ennis, Stuart

AU - Powell, Richard

AU - Begg, Brian

AU - Haykowsky, Mark J

AU - Banerjee, Prithwish

AU - Ingle, Lee

AU - Shave, Rob

AU - Backx, Karianne

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N2 - INTRODUCTION: Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the 'modern' patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes.METHODS AND ANALYSIS: This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40-70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peak as determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes.ETHICS AND DISSEMINATION: The study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands-Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR.TRIAL REGISTRATION NUMBER: NCT02784873; pre-results.

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