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Disabling atrial fibrillation (AF)-related symptoms and different testing settings may influence day-to-day cardiopulmonary exercise testing (CPET) measurements, which can affect exercise prescription for high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (M-VICT) and their outcomes. This study examined the reliability of CPET in patients with AF and assessed the proportion of participants achieving minimal detectable changes (MDC) in peak oxygen consumption (V̇O2peak) following HIIT and M-VICT. Participants were randomized into HIIT or M-VICT after completing two baseline CPETs: one with cardiac stress technologists (CPETdiag) and the other with a research team of exercise specialists (CPETresearch). Additional CPET was completed following 12 weeks of twice-weekly training. Reliability of CPETdiag and CPETresearch was assessed by intraclass correlation coefficient (ICC) and dependent t-tests. The MDC score was calculated for V̇O2peak using a reliable change index. The proportion of participants achieving MDC was compared between HIIT and M-VICT using chi-square analysis. Eighteen participants (69±7 years, 33% females) completed two baseline CPETs. ICC was significant for all measured variables. However, peak power output (POpeak: 124±40 vs. 148±40 watts, p<0.001) and HR (HRpeak: 136±22 vs. 148±30 bpm, p=0.023) were significantly greater in CPETresearch than CPETdiag. Few participants achieved MDC in V̇O2peak (5.6 mL/kg/min) with no difference between HIIT (0%) and M-VICT (10.0%, p=0.244). POpeak and HRpeak differed significantly in patients with AF when CPETs were repeated under different settings. Caution must be practiced when prescribing exercise intensity based on these measures as under-prescription may increase the number of exercise non-responders.

Nearly 20 years have elapsed since the first clinical trial investigated the impact of interval training on patients with cardiovascular disease (CVD). This clinical corner discusses the health outcomes of systematic reviews and meta-analyses and appropriately powered randomized controlled trials (RCTs) which have tested these interval training programs across various CVDs (i.e., coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, and cardiac implantable electronic devices). The publications included in this clinical corner have shown that interval training leads to similar or superior improvements in V̇O2peak, functional capacity, pain free walking, QoL, anxiety, depression, and endothelial function, but the magnitude of improvements across varying protocols (e.g., length and number of work periods, intensities of work periods, duration of exercise sessions, frequency of exercise sessions, duration of program) and optimal dosage for males and females is unclear across CVD conditions. The heterogeneity in protocols, physical and mental health outcome measures, and lack of sex- and gender-based analyses calls for more high-quality research in this area.

This pre-post study examined sex-differences in peak aerobic power ( V̇ O 2peak ) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HR peak )) and lower- (3×3 minutes 60-70% HR peak ) intensity intervals twice weekly for 10 weeks. V̇ O 2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇ O 2peak did not differ between sexes (interaction: p  = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇ O 2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇ O 2peak , BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇ O 2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇ O 2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).

Following coronary revascularization, patients treated with coronary artery bypass graft surgery (CABG) have lower risk of major adverse cardiovascular events when compared with those treated with percutaneous coronary intervention (PCI). We compared changes in cardiovascular risk factors, such as psychological and cardiometabolic health indicators, among patients who completed cardiac rehabilitation (CR) following CABG and PCI. Longitudinal records of 278 patients who completed an outpatient CR program following CABG or PCI were analyzed. We compared changes in anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS); health-related quality of life (HR-QoL) measured by the Medical Outcomes Study Short Form-36 (SF-36); and indicators of cardiometabolic health (i.e., body mass, blood pressure, glucose, and lipid profiles) between CABG and PCI groups using analysis of covariance (ANCOVA). At baseline, patients treated with PCI ( n = 191) had superior physical function (i.e., physical functioning: 62.5 ± 22.1 vs. 54.3 ± 23.0 points, p = 0.006; and role limitations due to physical health: 31.2 ± 36.8 vs. 20.6 ± 31.8 points, p = 0.024) when compared with those treated with CABG ( n = 87). Following CR, patients treated with PCI showed significantly smaller improvements in depression (-0.4 ± 3.1 vs. -1.3 ± 2.7 points, p = 0.036) and mental HR-QoL (mental component summary: 2.4 ± 10.8 vs. 5.7 ± 10.7 points, p = 0.020) when compared with those treated with CABG. Novelty Patients with coronary artery disease treated with PCI have smaller functional limitations but similar psychological health when compared with those treated with CABG at CR enrollment. Patients participating in CR following PCI appear to achieve smaller psychological health benefits from CR when compared with those recovering from CABG.

Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. -2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.