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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).