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Is there a threshold intensity for aerobic training in cardiac patients?


Medicine & Science in Sports & Exercise: July 2002 - Volume 34 - Issue 7 - p 1071-1075
CLINICAL SCIENCES: Clinical Investigations

SWAIN, D. P., and B. A. FRANKLIN. Is there a threshold intensity for aerobic training in cardiac patients? Med. Sci. Sports Exerc., Vol. 34, No. 7, pp. 1071–1075, 2002.

Purpose Recent guidelines have recommended the use of a percentage of oxygen uptake reserve (V̇O2R) for prescribing aerobic exercise intensity for cardiac patients. Moreover, these guidelines suggest that a threshold intensity may exist, below which no improvement in peak oxygen uptake (V̇O2peak) occurs. The purpose, therefore, was to translate the intensity of aerobic exercise in previous training studies using cardiac patients into %V̇O2R units, and determine whether a threshold intensity exists.

Methods Twenty-three studies, using 28 groups of aerobically trained cardiac patients, were identified in which V̇O2peak was measured before and after training by gas exchange. Intensity of exercise was variously described as a percentage of V̇O2peak, percentage of peak heart rate (HRpeak), percentage of heart rate reserve (HRR), or percentage of peak workload. These intensities were translated into equivalent units of %V̇O2R.

Results Of the 28 groups of patients, three failed to show significant improvements in V̇O2peak. These groups exercised at intensities corresponding to 47–55% of V̇O2R. However, six other groups exercised at comparable intensities (i.e., 42% to 55% of V̇O2R) and experienced significant increases in V̇O2peak. Other confounding variables in these studies were similar, including the initial V̇O2peak of the subjects, suggesting that the failure of three groups to significantly improve aerobic capacity was due to their small sample size.

Conclusion No threshold intensity for aerobic training was identified in cardiac patients, with the lowest intensity studied being approximately 45% of V̇O2R. It is possible that intensities below this value may be an effective training stimulus, especially in extremely deconditioned subjects, but further research is needed to test that possibility and to determine whether a threshold exists.

Wellness Institute and Research Center, Old Dominion University, Norfolk, VA; and William Beaumont Hospital, Division of Cardiology (Cardiac Rehabilitation and Exercise Laboratories), Royal Oak, MI

Submitted for publication December 2001.

Accepted for publication February 2002.

©2002The American College of Sports Medicine