Exercise-based cardiac rehabilitation is integral to secondary prevention in patients
with coronary artery disease. Recently, the effectiveness and “superiority” of high-intensity
interval training (HIIT) is a purported time-saving alternative to “traditional” moderate-intensity
continuous training (MICT) in cardiac rehabilitation. The rationale for HIIT adoption
is, however, not fully substantiated in the scientific literature. Established guidelines
for exercise testing and training, when carefully adhered to, reduce the likelihood
of triggering a cardiac event or inducing musculoskeletal injury. Clinicians should
likewise consider patient risk stratification and introduce HIIT as an alternative
to MICT only after patients exhibit stable and asymptomatic responses to vigorous
exercise training. Although HIIT adherence appears comparable with MICT during outpatient
rehabilitation, compliance drops dramatically for unsupervised exercise. Despite the
enthusiasm surrounding HIIT, its main advantage over MICT appears to be short-term
exercise performance outcomes and indices of vascular function. Regarding benefits
to cardiovascular disease risk factor modification, management of vital signs, and
measures of cardiac performance, current evidence indicates that HIIT does not outperform
MICT. Long-term outcomes to HIIT are currently uncertain and logistical constraints
to HIIT incorporation need additional clarification. Based on these limited findings,
derived from facilities and clinicians at the forefront of cardiac rehabilitation,
the routine adoption of HIIT should be viewed cautiously. In conclusion, the current
review highlights numerous specific research directives that are needed before the
safety and effectiveness of HIIT can be confirmed and widely adopted in patients with
known or suspected coronary artery disease, especially in unsupervised, nonmedical
settings.
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Article info
Publication history
Published online: January 23, 2019
Received in revised form:
January 6,
2019
Received:
November 27,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
