Heart Disease - HIIT vs. LSD

[Pmeisterx]

Jordan,

I am a 53 year old male, that has had a mild heart attack when I was 40 and another blocked artery a few years ago. Both required stents to be inserted. I have been following the starting strength program for about 8 months and feel great. I am 6'2" and weigh 205lbs and am pretty athletic for my age. My doctor says I need to be doing slower steady cardio for my heart, like LSD for 30 minutes 3 times a week. In your study is he right? Would HIIT be better or not? Is there any studies worth anything that shows which is ideal?

Thanks for your time on the forums, it is really informative.

Phil

[Jordan Feigenbaum]

Phil,

Thanks for the post and I hope you are doing well. To be brief, yes there is data to support HIIT being more efficient, effective, and more tolerable than LSD specifically in cardiac patients. While doing a full literature review right now is beyond the time I have available, here are some quick fun facts:

High-intensity interval training in cardiac rehabilitation. Sports Med 2012

To summarize, HIIT appears safe and better tolerated by patients than moderate-intensity continuous exercise (MICE). HIIT gives rise to many short- and long-term central and peripheral adaptations in these populations. In stable and selected patients, it induces substantial clinical improvements, superior to those achieved by MICE, including beneficial effects on several important prognostic factors (peak oxygen uptake, ventricular function, endothelial function), as well as improving quality of life. HIIT appears to be a safe and effective alternative for the rehabilitation of patients with CAD and HF. It may also assist in improving adherence to exercise training. Larger randomized interventional studies are now necessary to improve the indications for this therapy in different populations.

Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Archives of Physical Medicine and Rehabilitation 2012

This study shows that IT (interval training) at very high intensity for patients with heart failure appears to be more effective than CT (continuous training) in improving indices of submaximal exercise capacity.

Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. Journal of Cardiopulmonary Rehabilitation and Prevention 2014

Among patients with stable coronary heart disease on evidence-based therapy, HIIT was successfully integrated into a standard CR (cardiac rehab) setting and, when compared to MCT (moderate continuous training), resulted in greater improvement in peak exercise capacity and submaximal endurance.

Cardiovascular Risk of High- Versus Moderate-Intensity Aerobic Exercise in Coronary Heart Disease Patients Circulation 2012

The results of the current study indicate that the risk of a cardiovascular event is low after both high-intensity exercise and moderate-intensity exercise in a cardiovascular rehabilitation setting. Considering the significant cardiovascular adaptations associated with high-intensity exercise, such exercise should be considered among CHD (coronary heart disease) patients.

[asmuts]

My post doesn't address the main point, but I find it curious that the first abstract suggests HIIT "may also assist in improving adherence to exercise training." I wonder if this the case. I haven't even begun looking into the literature. But I've seen all sort of stuff referred to as "high intensity" that's really just moderate at best. I recently saw someone suggest a Tabata of air squats!?! Better than sitting on the couch, but not HIIT. . . I'd worry that people aren't really keeping the intensity up. Instead they are just exercising for less time. It certainly takes less time to do HIIT, but I find that I'd rather run 7 miles than do intervals on the rower. I'm rowing. But the rower intervals are brutally hard, at least for me. I can barely make myself do 7 x :20|1:40 intervals. As I've been able to up the intensity (split times starting at 1:24), I am more and more reluctant to row. For me, it takes a lot more dedication to row intervals than to run or do some kind of LSD. I wonder if I'm alone here.

Is there anything on HIIT and resting heart rate? Or is this an unimportant metric. When I used to run, my RHR was in the upper 40's to low 50's. Now that I'm only doing HIIT it's in the low 60's. Perhaps I'm a fluke case and there are other variables at play. And perhaps it just doesn't matter. . . .

[Jordan Feigenbaum]

I do think there are more ways to screw up HIIT as compared to LISS in that people will either not do it at a high enough intensity or otherwise make it easier. I think this is analogous to people screwing up a barbell squat more easily than a leg press, for instance. So should we recommend leg presses bc it's less likely that people will screw them up? I'm not so sure.

As far as lowering resting heart rate, HIIT will lower it in an untrained person- but not as much as someone who has a significantly higher volume of training, which is typical of LISS. Still, I think there are adaptations that LISS/moderate intensity cardio provides that HIIT can't ever touch and I think towards the end range of resting heart rate lowering LISS > HIIT- though from an "outcome" standpoint it matters very little IMO.

[vanslix]

Still, I think there are adaptations that LISS/moderate intensity cardio provides that HIIT can't ever touch and I think towards the end range of resting heart rate lowering LISS > HIIT- though from an "outcome" standpoint it matters very little IMO.

I'm a skeptical bastard. I like HIIT in concept but until I see hard outcomes like deaths, recrrent events, etc showing an improvement over other forms of exercise, I'll reserve judgement. For all we know, connectedness with other human beings or having meaning/purpose in life may be more powerful than exercise post MI. Obviously, it doesn't have to be either/or, but you get my point.

[Jordan Feigenbaum]

I'm a skeptical bastard. I like HIIT in concept but until I see hard outcomes like deaths, recrrent events, etc showing an improvement over other forms of exercise, I'll reserve judgement. For all we know, connectedness with other human beings or having meaning/purpose in life may be more powerful than exercise post MI. Obviously, it doesn't have to be either/or, but you get my point.

I don't know if the logic to arrive at the above is sound or evidence based. For instance, data continues to emerge that resistance training and HIIT are better in acute outcomes such as post cardiac surg, post MI, COPD, and other serious illnesses that impact functional status. We also have observational data that independent of vo2max and aerobic metrics, the stronger person has decreased mortality in a myriad of situations. We also know that HIIT improves muscle mass and strength significantly more than LISS. So one could make the argument that yes indeed, HIIT is better for longevity than LISS. Current ACSM recommendations actually reflect the paradigm I'm describing when considering the moderate to vigorous activity RPE ratings as compared to traditional LISS's RPE ratings.

So while I can see your point in that the evidence is lacking in a "nail in the coffin" sort of way, I think it's misguided to cling to LISS as being equivalent to the other modalities being discussed.

[Farback]

I'm not a doctor, but I play one on TV. Only the other old farts will likely get the reference. I had a STEMI 13 months ago and ended up with one stent. I currently do a lot of HITT in the form of sprints, 8 times 30/90 split. I also run at a moderate pace (5-6MPH) on other non-lift days. I've been doing SS since last September when I decided to make my non-negotiable hour of daily exercise result in more than cardio fitness. My checkups indicate I'm doing something right. My fitness is good, as are my blood tests. When they stress-tested me last they pushed me to RCMP (police) test levels with no issues. I feel, while it's not a qualified opinion, that HITT is working well for me.

[Jordan Feigenbaum]

Glad to hear you're doing better and thanks for sharing!