Feasibility of High-Intensity Interval Nordic Walking in Patients With Coronary Artery Disease

Condition(s) studied

Investigational drug(s) / intervention(s)

High-intensity interval Nordic walking: Participants will complete supervised exercise sessions twice weekly for 10 weeks. Exercise specialists will educate participants in proper use of walking poles and basic Nordic walking techniques and supervise the exercise training sessions. HIIT-NoW will be 45 min in duration using Nordic poles and consists of (i) a 10-min warm-up at 30-59% heart rate reserve (HRR, light-to-moderate intensity); (ii) 4 × 4 min of high-intensity work periods at 60-89% HRR (vigorous intensity) interspersed with 3 min of low-intensity work periods at 30-59% HRR (light-to-moderate intensity); and, (iii) a 10-min cooldown at 30-39% HRR (light intensity). To allow participants to acclimatize to the HIIT-NoW protocol, the training intensity will target 60-69% HRR for the first week, 70-79% HRR in the second week, and 80-89% HRR from the third week onward. If participants do not tolerate 89% HRR well, they will exercise as close to 89% HRR as possible.

Standard cardiovascular rehabilitation: Individuals assigned to standard CR will attend onsite exercise-based CR comprised of one onsite exercise session per week for 8-10 weeks. The onsite CR offers exercise sessions tailored to the fitness of patients and strengthening exercise.

Study summary

Coronary revascularization, such as heart bypass surgery (CABG) and percutaneous coronary intervention (PCI \[inserting a stent to open up blood vessels\]) improve survival for people with coronary artery disease. Yet, many patients suffer from poor physical and mental health after coronary revascularization. Traditional cardiac rehabilitation involving moderate-to-vigorous intensity continuous training (MICT) improves physical and mental health. However, alternative exercise programs, such as high-intensity interval training (HIIT) and Nordic walking may provide superior benefits. Nordic walking is like Nordic skiing but uses specifically designed poles for walking. Nordic walking involved core, upper and lower body muscles, resulting in greater energy expenditure while reducing loading stress at the knee. To date, HIIT used in cardiac rehabilitation settings has focused on lower body (e.g., leg cycling). The investigators are not aware of HIIT protocols that target both upper and lower body at the same time. An exercise program that combines HIIT and Nordic walking (HIIT-NoW) may offer an alternative time-efficient whole-body exercise to improve physical and mental health. This study will test if HIIT-NoW can be an alternative exercise option to improve physical and mental health in patients with coronary artery disease.

Eligibility

Primary outcome measure(s)

• Recruitment — Baseline to week 11 follow up
  Recruitment will be assessed for feasibility. Recruitment will be assessed by the proportion of patients remained interested and randomized after being informed of the requirements of the study
• Adherence — Baseline to week 11 follow up
  Adherence will be assessed for feasibility. Adherence will be assessed by the attendance to the prescribed exercise sessions
• Compliance — Baseline to week 11 follow up
  Compliance will be assessed for feasibility. Compliance will be assessed by the proportion of participants adhering to prescribed exercise intensity. All HIIT-NoW sessions will be monitored by study personnel and compliance to prescribed exercise intensity will be assessed for each exercise session.
• Adverse events — Baseline to week 11 follow up
  Safety will be assessed for feasibility. All mild, moderate, and severe symptoms and adverse events throughout this study will be recorded.
• Subjective exercise experiences — Baseline to week 11 follow up
  Subjective exercise experiences will be assessed for feasibility. Physical activity enjoyment will be collected using the PACES.
• Self-efficacy — Baseline to week 11 follow up
  Self-efficacy will be assessed for feasibility. Exercise self-efficacy will be assessed using the MSES-R.

Trial sites (1)

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