Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up
Background This study investigated exercise response heterogeneity and its mediating role in survival for patients with heart failure. Methods and Results We conducted a retrospective cohort study by examining the registry satabase in 3 institutes from 2009 to 2024. All 182 included patients with he...
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Wiley
2025-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040330 |
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| author | Tieh‐Cheng Fu Shu‐Chun Huang Shin‐Sheng Yuan Chao‐Hung Wang Jong‐Shyan Wang Wen‐Chung Tsai Wen‐Jin Cherng Yu‐Chiau Shyu Chih‐Chin Hsu |
| author_facet | Tieh‐Cheng Fu Shu‐Chun Huang Shin‐Sheng Yuan Chao‐Hung Wang Jong‐Shyan Wang Wen‐Chung Tsai Wen‐Jin Cherng Yu‐Chiau Shyu Chih‐Chin Hsu |
| author_sort | Tieh‐Cheng Fu |
| collection | DOAJ |
| description | Background This study investigated exercise response heterogeneity and its mediating role in survival for patients with heart failure. Methods and Results We conducted a retrospective cohort study by examining the registry satabase in 3 institutes from 2009 to 2024. All 182 included patients with heart failure completed 36 sessions of high‐intensity interval training (HIIT) at alternating intensities of 80% and 40% peak oxygen consumption (V˙o2peak). Based on the improvement of V˙o2peak (ΔV˙o2peak=post‐HIIT V˙o2peak−baseline V˙o2peak), they were classified as responders (ΔV˙o2peak>0) or nonresponders (ΔV˙o2peak ≤0). The end points were the long‐term survivals and readmissions for them. The prevalence of nonresponders was 21% (39/182). Responders (n=143) showed significant improvement of oxygen uptake efficiency slope, arteriovenous oxygen difference and skeletal muscle mass after HIIT. The above physiological adaptations in responders were significantly greater than in nonresponders. The 14‐year cardiovascular event‐free survival was significantly better in responders (91.3%) than nonresponders (76.8%). Higher V˙o2peak was a protective factor for cardiovascular death (adjusted hazard ratio [aHR], 0.411 [95% CI, 0.172–0.985]; P=0.046). Male sex (aHR, 0.320 [95% CI, 0.136–0.757]; P=0.009) and higher oxygen uptake efficiency slope (aHR, 0.995 [95% CI, 0.992–0.998]; P=0.005) were protective factors against cardiovascular readmissions. Causal mediation analysis revealed that V˙o2peak mediated the association between HIIT and all‐cause death, while heart rate reserve mediated HIIT effects on cardiovascular readmissions. Conclusions The longitudinal study has identified different physiological adaptations to HIIT in patients with heart failure. Improvement of cardiorespiratory fitness appears to be the dominant factor in reduction of the cardiovascular event for patients with heart failure. |
| format | Article |
| id | doaj-art-78eda2229b5a4aec8a392cffb08d93ef |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-78eda2229b5a4aec8a392cffb08d93ef2025-08-20T02:37:25ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-06-01141110.1161/JAHA.124.040330Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐UpTieh‐Cheng Fu0Shu‐Chun Huang1Shin‐Sheng Yuan2Chao‐Hung Wang3Jong‐Shyan Wang4Wen‐Chung Tsai5Wen‐Jin Cherng6Yu‐Chiau Shyu7Chih‐Chin Hsu8Department of Physical Medicine and Rehabilitation Keelung Chang Gung Memorial Hospital Keelung TaiwanSchool of Medicine, College of Medicine Chang Gung University Taoyuan TaiwanInstitute of Statistical Science, Academia Sinica Taipei TaiwanSchool of Medicine, College of Medicine Chang Gung University Taoyuan TaiwanDepartment of Physical Medicine and Rehabilitation Keelung Chang Gung Memorial Hospital Keelung TaiwanSchool of Medicine, College of Medicine Chang Gung University Taoyuan TaiwanDivision of Cardiology, Department of Internal Medicine Linkou Chang Gung Memorial Hospital Taoyuan TaiwanCommunity Medicine Research Center, Keelung Chang Gung Memorial Hospital Keelung TaiwanDepartment of Physical Medicine and Rehabilitation Keelung Chang Gung Memorial Hospital Keelung TaiwanBackground This study investigated exercise response heterogeneity and its mediating role in survival for patients with heart failure. Methods and Results We conducted a retrospective cohort study by examining the registry satabase in 3 institutes from 2009 to 2024. All 182 included patients with heart failure completed 36 sessions of high‐intensity interval training (HIIT) at alternating intensities of 80% and 40% peak oxygen consumption (V˙o2peak). Based on the improvement of V˙o2peak (ΔV˙o2peak=post‐HIIT V˙o2peak−baseline V˙o2peak), they were classified as responders (ΔV˙o2peak>0) or nonresponders (ΔV˙o2peak ≤0). The end points were the long‐term survivals and readmissions for them. The prevalence of nonresponders was 21% (39/182). Responders (n=143) showed significant improvement of oxygen uptake efficiency slope, arteriovenous oxygen difference and skeletal muscle mass after HIIT. The above physiological adaptations in responders were significantly greater than in nonresponders. The 14‐year cardiovascular event‐free survival was significantly better in responders (91.3%) than nonresponders (76.8%). Higher V˙o2peak was a protective factor for cardiovascular death (adjusted hazard ratio [aHR], 0.411 [95% CI, 0.172–0.985]; P=0.046). Male sex (aHR, 0.320 [95% CI, 0.136–0.757]; P=0.009) and higher oxygen uptake efficiency slope (aHR, 0.995 [95% CI, 0.992–0.998]; P=0.005) were protective factors against cardiovascular readmissions. Causal mediation analysis revealed that V˙o2peak mediated the association between HIIT and all‐cause death, while heart rate reserve mediated HIIT effects on cardiovascular readmissions. Conclusions The longitudinal study has identified different physiological adaptations to HIIT in patients with heart failure. Improvement of cardiorespiratory fitness appears to be the dominant factor in reduction of the cardiovascular event for patients with heart failure.https://www.ahajournals.org/doi/10.1161/JAHA.124.040330event‐free survivalexercise response heterogeneityheart failurehigh‐intensity interval trainingmediation |
| spellingShingle | Tieh‐Cheng Fu Shu‐Chun Huang Shin‐Sheng Yuan Chao‐Hung Wang Jong‐Shyan Wang Wen‐Chung Tsai Wen‐Jin Cherng Yu‐Chiau Shyu Chih‐Chin Hsu Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease event‐free survival exercise response heterogeneity heart failure high‐intensity interval training mediation |
| title | Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up |
| title_full | Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up |
| title_fullStr | Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up |
| title_full_unstemmed | Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up |
| title_short | Heterogeneous Exercise Responses to High‐Intensity Interval Training Are Associated With Varied Long‐Term Cardiovascular Outcomes in Patients With Heart Failure: A 15‐Year Follow‐Up |
| title_sort | heterogeneous exercise responses to high intensity interval training are associated with varied long term cardiovascular outcomes in patients with heart failure a 15 year follow up |
| topic | event‐free survival exercise response heterogeneity heart failure high‐intensity interval training mediation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040330 |
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