Adherence to Heart Rate Training Zones in an Exercise Training Program in Adults with Coronary Artery Disease

Main Article Content

Patric Emerson Oliveira Gonçalves
Tiago da Silva Nogueira
Bruno Rezende Passos
Danielle Aparecida Gomes Pereira
Scott Thomas
Raquel Rodrigues Britto

Abstract

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and determine the relationship between trained intensity and functional capacity. Methods: A retrospective study was conducted on the medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50%–60% of the heart rate reserve, increasing monthly to 70%–80% by the third month. Spearman’s test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg–RPE). Adherence was classified as ‘below’ when HRTZ was not achieved in any phase of the program, ‘intermediate’ when HR was within the HRTZ for one or two months, and ‘above’ when HR was at or higher than HRTZ ≥ two months. Improvement was tested using t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. The trained intensity did not fall below 8.6% of the prescribed HRTZ minimum threshold. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg–RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume in cardiovascular rehabilitation programs.



Article Details

How to Cite
1.
Gonçalves PEO, Nogueira T da S, Passos BR, Pereira DAG, Thomas S, Britto RR. Adherence to Heart Rate Training Zones in an Exercise Training Program in Adults with Coronary Artery Disease. HSJ [Internet]. 2023Dec.26 [cited 2024May19];13(4):4-10. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/1464
Section
ORIGINAL ARTICLE
Author Biographies

Patric Emerson Oliveira Gonçalves, University of British Columbia

Physiotherapist, Master in Kinesiology from the University of British Columbia.

Tiago da Silva Nogueira, Universidade Federal de Minas Gerais

Physiotherapist, Masters student in Rehabilitation Sciences from the Universidade Federal de Minas Gerais.

Bruno Rezende Passos, Universidade Federal de Minas Gerais

Medical Doctor, Cardiologist at the Hospital das Clínicas da Universidade Federal de Minas Gerais.

Danielle Aparecida Gomes Pereira, Universidade Federal de Minas Gerais

PhD. Associate Professor at the Universidade Federal de Minas Gerais.

Scott Thomas, University of Toronto

Professor Emeritus at the Exercise for Health & Performance at the University of Toronto in Canada.

Raquel Rodrigues Britto, Universidade Federal de Minas Gerais

PhD. Full Professor at the Universidade Federal de Minas Gerais.

References

1. Abell B, Glasziou P, Hoffmann T. The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression. Sports Med Open. 2017;3(1):19. https://doi.org/10.1186/s40798-017-0086-z PMid:28477308 PMCid:PMC5419959
2. Epstein E, Rosander A, Pazargadi A, Taub P. Cardiac Rehab for Functional Improvement. Curr Heart Fail Rep. 2020;17(4):161-70. https://doi.org/10.1007/s11897-020-00462-2 PMid:32514659
3. Ozemek C, Arena R, Rouleau CR, Campbell TS, Hauer T, Wilton SB, et al. Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity. J Cardiopulm Rehabil Prev. 2023;43(2):109-14. https://doi.org/10.1097/HCR.0000000000000734 PMid:36203224
4. Hung RK, Al-Mallah MH, McEvoy JW, Whelton SP, Blumenthal RS, Nasir K, et al. Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing) project. Mayo Clin Proc. 2014;89(12):1644-54. https://doi.org/10.1016/j.mayocp.2014.07.011 PMid:25440889
5. Vromen T, Spee RF, Kraal JJ, Peek N, van Engen-Verheul MM, Kraaijenhagen RA, et al. Exercise training programs in Dutch cardiac rehabilitation centres. Neth Heart J. 2013;21(3):138-43. https://doi.org/10.1007/s12471-013-0374-2 PMid:23338553 PMCid:PMC3578523
6. Abell B, Glasziou P, Briffa T, Hoffmann T. Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice. Open Heart. 2016;3(1):374. https://doi.org/10.1136/openhrt-2015-000374 PMid:27127639 PMCid:PMC4847132
7. Hansen D, Rovelo Ruiz G, Doherty P, Iliou MC, Vromen T, Hinton S, et al. Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey. Eur J Prev Cardiol. 2018;25(7):682-91. https://doi.org/10.1177/2047487318760888 PMid:29486587
8. Khushhal A, Nichols S, Carroll S, Abt G, Ingle L. Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: A United Kingdom perspective. PLoS One. 2019;14(6):e0217654. https://doi.org/10.1371/journal.pone.0217654 PMid:31194759 PMCid:PMC6563987
9. Ismail H, McFarlane JR, Dieberg G, Smart NA. Exercise training program characteristics and magnitude of change in functional capacity of heart failure patients. Int J Cardiol. 2014;171(1):62-5. https://doi.org/10.1016/j.ijcard.2013.11.045 PMid:24326210
10. Taylor JL, Bonikowske AR, Olson TP. Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Front Cardiovasc Med. 2021;8:734278. https://doi.org/10.3389/fcvm.2021.734278 PMid:34540924 PMCid:PMC8446279
11. Li WG, Huang Z, Zhang XA. Exercise prescription in cardiac rehabilitation needs to be more accurate. Eur J Prev Cardiol. 2021;28(7):e33-4. https://doi.org/10.1177/2047487320936021
12. Grace SL, Midence L, Oh P, Brister S, Chessex C, Stewart DE, et al. Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial. Mayo Clin Proc. 2016;91(2):140-8. https://doi.org/10.1016/j.mayocp.2015.10.021 PMid:26682921
13. Meneghelo RS, Araújo CGS, Stein R, Mastrocolla LE, Albuquerque PF, Serra SM. III Diretrizes da Sociedade Brasileira de Cardiologia sobre teste ergométrico. Arq. Bras. Cardiol. 2010;95(1):1-30. https://doi.org/10.1590/S0066-782X2010002400001
14. Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, et al. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med. 2021;10(14):3071. https://doi.org/10.3390/jcm10143071 PMid:34300237 PMCid:PMC8306118
15. Herdy AH, López-Jiménez F, Terzic CP, Milani M, Stein R, Carvalho T, et al. South American guidelines for cardiovascular disease prevention and rehabilitation. Arq Bras Cardiol. 2014;103(2 Suppl 1):1-31. https://doi.org/10.5935/abc.2014S003 PMid:25387466
16. Borg G. The Borg CR10 Scale. Borg's perceived exertion and pain scales. 1st ed. Human Kinetics; 1998.
17. Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg's rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol. 2013;113(1):147-55. https://doi.org/10.1007/s00421-012-2421-x PMid:22615009
18. Lelis JD, Chaves G, Ghisi GLM, Grace SL, Britto RR. Validity of the Incremental Shuttle Walk Test to Assess Exercise Safety When Initiating Cardiac Rehabilitation in Low-Resource Settings. J Cardiopulm Rehabil Prev. 2019;39(3):E1-7. https://doi.org/10.1097/HCR.0000000000000412 PMid:31022005
19. Monteiro DP, Britto RR, Carvalho MLV, Montemezzo D, Parreira VF, Pereira DAG. Shuttle walking test como instrumento de avaliação da capacidade funcional: uma revisão da literatura. Cienc Saude. 2014;7(2):92-7. https://doi.org/10.15448/1983-652X.2014.2.16580
20. Maranhão-Neto GDA, Leon ACPD, Farinatti PDTV. Validade e equivalência da versão em português do Veterans Specific Activity Questionnaire. Arq Bras Cardiol. 2011;97:130-5. https://doi.org/10.1590/S0066-782X2011005000071 PMid:21670897
21. Houchen-Wolloff L, Boyce S, Singh S. The minimum clinically important improvement in the incremental shuttle walk test following cardiac rehabilitation. Eur J Prev Cardiol. 2015;22(8):972-8. https://doi.org/10.1177/2047487314540840 PMid:24958737
22. Mitchell BL, Lock MJ, Davison K, Parfitt G, Buckley JP, Eston RG. What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis. Br J Sports Med. 2018;53(21):1341-51. https://doi.org/10.1136/bjsports-2018-099153 PMid:30121584
23. Amorim H, Cadilha R, Parada F, Rocha A. Progression of aerobic exercise intensity in a cardiac rehabilitation program. Rev Port Cardiol (Engl Ed). 2019;38(4):281-6. https://doi.org/10.1016/j.repc.2018.07.009 PMid:31109760