High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis
Abstract
:1. Background
2. Methods
Study Design
3. Participants
3.1. Recruitment and Consent
3.2. Eligibility Criteria
4. Intervention Period
4.1. Experimental Group
4.2. Control Group
4.3. Assessment Periods
5. Measurements Related to the Primary Research Question
5.1. Primary Outcome
Exercise Capacity
5.2. Secondary Outcomes
Health-Related Quality of Life, Exercise Self-Efficacy, Feelings of Anxiety and Depression, and Enjoyment
6. Measurements Related to the Secondary Research Questions
6.1. Post-Exercise Muscle Soreness
6.2. Tolerance
6.3. Debriefs
6.4. Statistical Analyses
7. Results
Recruitment and Retention
8. Measures Related to the Primary Research Question
8.1. Primary Outcome
Endurance Exercise Capacity
8.2. Secondary Outcomes
8.2.1. Peak Exercise Capacity
8.2.2. Health-Related Quality of Life
8.2.3. Exercise Self-Efficacy, Feelings of Anxiety and Depression, Exercise Enjoyment, and Lung Function
9. Measurements Related to the Secondary Research Questions
9.1. Post Exercise Muscle Soreness
9.2. Tolerance and Exercise Intensity
9.3. Debrief Interviews
10. Discussion
11. Limitations
12. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variable | Total Sample (n = 14) | Experimental Group (n = 7) | Control Group (n = 7) |
---|---|---|---|
Age (year) | 31 (28, 35) | 31 (29, 31) | 31 (26, 39) |
Height (cm) | 176 (163, 182) | 172 (163, 183) | 179 (159, 182) |
Sex (n female (%)) | 6 (43) | 4 (57) | 2 (29) |
Weight (kg) | 75 (64, 92) | 75 (64, 101) | 76 (63, 92) |
BMI (kg·m−2) | 23.92 (21.40, 30.25) | 23.23 (21.40, 34.47) | 24.60 (20.53, 28.49) |
FEV1 (L) | 2.20 (1.74, 3.40) | 2.21 (1.90, 3.40) | 1.81 (1.71, 3.58) |
FEV1 (% predicted) | 61 (45, 80) | 66 (45, 83) | 57 (39, 80) |
FVC (L) | 3.35 (3.07, 5.17) | 3.30 (3.00, 5.60) | 3.57 (3.07, 5.17) |
FVC (% predicted) | 82 (64, 95) | 88 (62, 100) | 79 (64, 92) |
FEV1/FVC (%) | 66 (58, 72) | 67 (61, 72) | 60 (54, 69) |
Comorbidity | n | % | |
Asthma | 2 | 14 | |
CFRD | 4 | 29 | |
CF-related liver disease | 2 | 14 | |
Cholelithiasis | 2 | 14 | |
Ileus | 1 | 7 | |
OSA | 1 | 7 | |
Osteopenia | 3 | 21 | |
Pancreatic insufficiency | 10 | 71 | |
Reflux | 4 | 29 |
Variable | Experimental Group (n = 5) | Control Group (n = 5) | |||
Ramp-Based Cycle Ergometry Test | Baseline | Follow-Up | Baseline | Follow-Up | Between-Group Difference |
VO2peak (L·min−1) | 2.25 (1.70, 2.79) | 2.76 (2.12, 3.72) | 2.25 (1.62, 2.31) | 2.25 (1.53, 2.31) | p = 0.50 |
VO2peak (mL·kg−1·min−1) | 32.57 (22.60, 39.75) | 40.75 (28.17, 42.96) | 27.14 (21.70, 31.00) | 27.14 (20.18, 30.23) | p = 0.20 |
VO2peak (% predicted) | 93 (75, 105) | 90 (75, 114) | 64 (62, 69) | 64 (58, 69) | p = 0.16 |
VCO2peak (L·min−1) | 2.84 (2.13, 3.52) | 3.20 (2.50, 4.42) | 2.74 (2.23, 2.81) | 2.20 (2.12, 2.62) | p = 0.27 |
Wmax (Watts) | 179 (122, 241) | 250 (135, 253) | 200 (161, 207) | 202 (146, 203) | p = 0.017 ** |
Wmax (% predicted) | 90 (84, 138) | 93 (90, 148) | 82 (70, 85) | 80 (68, 82) | p = 0.017 ** |
VEpeak (L·min−1) | 85.44 (60.58, 107.00) | 99.50 (74.94, 134.00) | 61.37 (60.00, 71.10) | 60.66 (56.73, 67.00) | p = 0.10 |
End-test breathlessness | 7 (6, 8) | 8 (7, 9) | 5 (4, 8) | 5 (4, 6) | p = 0.62 |
End-test leg muscle fatigue | 9 (8, 9) | 9 (7, 10) | 9 (9, 9) | 5 (5, 9) | p = 0.25 |
Nadir SpO2 (%) | 93 (92, 94) | 93 (91, 95) | 93 (93, 94) | 93 (89, 96) | p = 0.71 |
HRmax (bpm) | 166 (152, 172) | 172 (158, 173) | 161 (159, 162) | 159 (159, 159) | p = 0.17 |
HRmax (% predicted) | 86 (81, 89) | 86 (84, 91) | 85 (84, 89) | 85(83, 88) | p = 0.19 |
End-test RR (breaths·min−1) | 44 (40, 51) | 44 (42, 50) | 32 (31, 43) | 33 (30, 40) | p = 0.64 |
O2 pulse | 14 (11, 16) | 16 (11, 21) | 14 (11, 15) | 14 (11, 15) | p = 0.56 |
AT (% VO2peak) | 45 (41, 57) | 46 (43, 63) | 28 (27, 32) | 31 (29, 47) | p = 0.46 |
VO2/work slope (mL·min−1 W−1) | 10.40 (9.00, 10.77) | 10.39 (9.94, 11.49) | 9.70 (9.40, 9.80) | 9.72 (8.50, 9.80) | p = 0.58 |
Variable | Experimental Group (n = 6) | Control Group (n = 5) | |||
Constant Work Rate Cycle Ergometry Test | Baseline | Follow-Up | Baseline | Follow-Up | Between-Group Difference |
Tlim (s) | 276 (222, 360) | 555 (317, 620) | 248 (238, 262) | 230 (228, 262) | p = 0.017 ** |
VO2peak (L·min−1) | 2.23 (1.60, 2.90) | 2.21 (1.69, 2.98) | 2.14 (1.43, 2.36) | 2.08(1.57, 2.22) | p = 0.27 |
VO2peak (mL·kg−1·min−1) | 31.48 (21.55, 40.27) | 31.8 (22.53, 40.68) | 23.47 (20.47, 31.01) | 23.47 (19.40, 29.64) | p = 0.27 |
VO2peak (% predicted) | 92 (67, 105) | 95 (73, 112) | 67 (58, 68) | 62 (56, 64) | p = 0.20 |
VCO2peak (L·min−1) | 2.46 (1.89, 3.16) | 2.39 (1.91, 2.88) | 2.60 (2.35, 2.85) | 2.29 (2.17, 2.67) | p = 1.00 |
VEpeak (L·min−1) | 84.31 (55.91, 104.00) | 84.22 (64.00, 107.97) | 57.06 (55.61, 68.60) | 57.36 (55.79, 67.00) | p = 0.86 |
End-test breathlessness | 7 (5, 7) | 7 (5, 9) | 7 (7, 7) | 7 (6, 7) | p = 0.36 |
End-test leg muscle fatigue | 9 (7, 9) | 8 (5, 10) | 7 (5, 9) | 5 (4, 9) | p = 0.92 |
Nadir SpO2 (%) | 93 (90, 95) | 94 (89, 95) | 96 (95, 97) | 95 (94, 96) | p = 0.13 |
HRmax (bpm) | 163 (148, 169) | 164 (158, 168) | 156 (155, 162) | 156 (155, 160) | p = 0.26 |
End-test RR (breaths·min−1) | 44 (43, 44) | 46 (45, 47) | 30 (28, 32) | 38 (33, 40) | p = 0.07 |
(a) | |
Tolerability | “The first couple times my legs were a bit sore, but it wasn’t really that much, it wasn’t unbearable, it wasn’t like it hurt to walk or anything like that” (P2) “I actually felt more energized afterwards” (P2) “It was certainly challenging, it wasn’t a walk in the park, but then the feeling I got after I had done a session was like an adrenaline rush… it was really motivating” (P8) “Most of the time it was my legs that got to me more than my breathing” (P8) “If I was having a bad day with my lungs, that was more effort (to attend), but I also know that when I felt that way we just adjusted the intensity that day accordingly, so I didn’t ever feel like I was going to ‘over-do’ it” (P8) “I was never sore, I never had leg pain or anything like that… I always felt good after, more energy and motivation” (P9) “I never had muscle soreness or anything like that, I knew I had done exercise, but that was it” (P11) “It wasn’t so hard that I couldn’t do it, but hard enough that it pushed me” (P14) |
Commitment/ Flexibility | “It was easy to do because it was only 10 min, you only had to sweat it out for 10 min” (P2) “It was quite flexible with my work schedule” (P2) “The sessions weren’t ‘easy’ but the fact that it was a small amount of time really worked for my schedule” (P2) “It didn’t have a massive impact on my routine” (P8) “If I did a good session, I didn’t feel like I needed much else (additional exercise)” (P8) “The fact that the physio was so available (to supervise) all the time, to fit in with my schedule. I liked that” (P9) “The fact that it was quick and it was going to be over soon, it’s like, I can do this” (P9) |
Enjoyment | “The actual sessions were challenging, but as much as they were challenging, I felt a real adrenaline rush after them, and it felt like a sense of achievement after each session, so yeah, really positive, I enjoyed it” (P8) “My experience overall was really positive, this was higher intensity exercise and a different style to how I would normally exercise. I really enjoyed that” (P8) “I was buzzing after doing the study, I even tried some interval running after the study finished with some friends” (P8) “I got into a routine, coming in here, I enjoyed it… it was an enjoyable experience” (P11) “You look forward it” (P9) “Short and sweet… I really enjoyed it!” (P9) “I really enjoyed it… I am sad that it is finishing, I probably will incorporate it into my routine going forward” (P11) “I would test myself, using the Watts on the bike, I could see the number, so I actually really enjoyed that, I would definitely incorporate it (the training) into my daily, weekly exercise routine, yeah, I enjoyed it” (P11) “I really enjoyed the structure of it (the program), having to be at a certain place at a certain time, it gave me focus” (P14) “I think because I enjoyed it, that was a real enabler (for me to continue)” (P14) |
Therapist Presence | “Having the little cheer squad on the side really helps, because it is not something that I would probably do on my own. I think having the physio there to go ‘ok let’s get this done’ is much easier” (P2) “The supervision component was definitely motivating, I liked the structure” (P8) “The supervision component was really beneficial” (P8) “Having someone here, and knowing you’re only going to be exercising for a little bit makes it better” (P9) “I like to be pushed” (P9) “Having the intensity (Watts) and the number of bars (intervals) remaining on the screen, we also spoke about the heart rate; I liked having information and feedback because it helped me motivate and challenge myself for the next session, so yeah, I felt like I had good information from the physiotherapist throughout” (P11) “Knowing there was going to be someone supervising, you couldn’t just miss a session because you’d be letting someone down. I think I enjoyed that, it was a real enabler” (P11) “Say, for example I had the equipment at home or at the local gym, and you said ‘go three times per week’, I probably wouldn’t have felt as motivated, but having someone to encourage along the way, it is something different to what I have had before” (P14) |
(b) | |
Internal Motivation | “If I skipped one session, it was tougher the next time” (P2) “Motivation for me is a tough one, like I said, I didn’t like, I still don’t like exercise, and it is not something I will ever be comfortable with, yep, not my thing… that was probably my biggest struggle, the motivation to do it, and I found if I missed a session, it was even harder the next time” (P2) “I reverted back to my old ways after finishing the program, but I don’t have the equipment (bike) at home, so I wasn’t going to continue anyway…” (P2) “I am not one for exercise… I kind of feel like I am allergic to it!” (P2) “I don’t know what to do if I am by myself, what (exercise) is going to be effective and what’s not” (P9) “I think if I am going to do it (the HIIT) on my own, I need to find the right gym… because I need the motivation” (P9) “Probably just not having the motivation (is the main barrier to exercise). When someone is there with a plan… it is probably just my own laziness when it comes down to it, I need to stop being lazy” (P9) “I haven’t done any exercise since (completing the program)” (P9) “Once you make a commitment to someone, you can’t change it, so it was like ‘I have to go’ (to the HIIT sessions), whereas now I will be on my own, it could be easier to tell myself I don’t feel like it today” (P11) “If I hadn’t enjoyed the sessions, that would have been a barrier” (P11) “Some days I just don’t have the energy (to exercise)… it’s the motivation, definitely” (P14) |
Travel/ Location | “The main thing was finding parking” (P2) “Being at home would be better” (P2) “I was lucky that I worked down the road, so if it was any further, that would have been a barrier” (P8) “I don’t have any (barriers). It’s easy for me… I live close and parking wasn’t an issue” (P11) “I work close by and live close by, so it was easy. Whereas if I perhaps lived or worked further away, it might have been more effort to get there” (P14) |
Life/Other Commitments | “Having CF I am pretty busy, and I’ve got a child, and a full-time job, I work long hours, so it is important to me for it (exercise) to be flexible” (P2) “Mainly just work (was a barrier)… having to go around work” (P9) “If the sessions were longer, that could have been a barrier… trying to fit it in with everything else” (P14) |
Disease | “It was tough during the time when I wasn’t well, but I was still able to do it (the HIIT)” (P2) “If I was having a bad day with my lungs, that was more effort (to attend), but I also know that when I felt that way we just adjusted the intensity that day accordingly, so I didn’t ever feel like I was going to ‘over-do’ it” (P8) “I guess if you are feeling sick it is obviously harder to exercise” (P9) “The better I am feeling, the more likely I am to go (to exercise)” (P14) “When you feel unwell, and then you have all your medication and you have to try and schedule exercise in, it’s just hard” (P14) |
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Sawyer, A.; Cavalheri, V.; Jenkins, S.; Wood, J.; Cecins, N.; Bear, N.; Singh, B.; Gucciardi, D.; Hill, K. High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis. J. Clin. Med. 2020, 9, 3098. https://doi.org/10.3390/jcm9103098
Sawyer A, Cavalheri V, Jenkins S, Wood J, Cecins N, Bear N, Singh B, Gucciardi D, Hill K. High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis. Journal of Clinical Medicine. 2020; 9(10):3098. https://doi.org/10.3390/jcm9103098
Chicago/Turabian StyleSawyer, Abbey, Vinicius Cavalheri, Sue Jenkins, Jamie Wood, Nola Cecins, Natasha Bear, Bhajan Singh, Daniel Gucciardi, and Kylie Hill. 2020. "High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis" Journal of Clinical Medicine 9, no. 10: 3098. https://doi.org/10.3390/jcm9103098