Short-term HIIT in deconditioned patients
11–16 bpm, p < 0.01). HR 1min decreased significantly
(mean difference 5 bpm, 95% CI 4–7 bpm, p < 0.001).
Dyspnoea sensation increased significantly from the
first to the last session (mean difference 0.8 points,
95% CI 1.2–2.1 points, p < 0.001). Leg fatigue also
increased significantly (mean difference 0.8 points,
95% CI 1.4–1.8 points, p < 0.001).
Overall, there was a decrease in HR rest and in HR 1min
between the first and the last training sessions, whereas
W session and HR session increased. There were no statisti-
cally significant effects of sex, age or body mass index
(BMI) on the evolution of HR rest . The higher baseline
HR rest at the start, the greater was the decrease in HR rest
in the final session. The decrease in HR rest in the final
session amounted to a mean of –2 bpm (95% CI –1 to
–3 bpm, p <0.001) for an increase in 10 bpm HR rest at
baseline (see Fig. 3).
Evolution of W session was not significantly affected
by age, sex or BMI. There was a trend for an elevated
baseline W session to be associated with a greater increase
in W session . The increase in HR session between the first
and the last sessions was negatively associated with its
baseline value and with age. The higher HR session at the
start, the lower the increase in the final session. With
increased age HR session increased less with training.
The increase in HR session dropped by a mean of 0.3 bpm
(95% CI 0.1–0. 6 bpm, p = 0.014) per year.
Fitness and exercise capacity
There was significant decrease in HR rest from the first
to the third sessions (mean difference –6 bpm, 95% CI
–4 to –7 bpm, p < 0.001). Significant changes in CPET
and 6MWT were observed at the end of the intervention
for the PH group. There was a significant increase in
VO 2peak (median 14%, 95% CI 3–26%, p = 0.004), and
in W peak (median 7%, 95% CI 2–13%, p < 0.01). There
was a significant increase in the walking distance of
Fig. 3. Reduction in resting heart rate after 3 weeks of high-intensity
interval training (HIIT) (delta HR rest ) as a function of baseline resting
heart rate (HR rest ).
715
Table II. Changes in cardiopulmonary exercise testing (CPET)
and 6-min walk test (6MWT) parameters for the usual care and
prehabilitation groups in the preoperative period (deltas)
Variables n Usual care
Median (IQR) Prehabilitation
Median (IQR) p-value
Delta-VO 2peak , ml/kg/min
Delta-W peak watts
Delta-AT, %
Delta-HR peak /min
Delta-6MWT, m
Delta-HR peak 6MWT 151
150
136
149
148
120 –1.5 (–3.2 to 0.5)
–4 (–9 to 1)
–2.5 (–6.9 to 3.1)
–9 (–16 to 0)
–2 (–9 to 5)
–1 (–10 to 8) 2.9 (1.1 to 4.2)
8 (1 to 15)
3 (–2.1 to 8.3)
–5 (–11 to 1)
66 (8 to 125)
0 (–12 to 9)
0.004
0.021
0.183
0.237
0.001
0.804
Data analysed by Mann–Whitney U test. Adapted from Licker et al. (16).
Significant values are shown in bold.
IQR: interquartile range; VO 2peak : maximum oxygen uptake reached during
CPET; W peak : peak power output reached during CPET; AT: anaerobic threshold;
HR peak , peak heart rate reached during CPET; 6MWT: distance covered walking
in 6 minutes (m); HR peak 6MWT: peak heart reached during 6MWT
the 6MWT (median 20%, 95% CI 14–26, p < 0.001)
(Table II).
Cardiopulmonary exercise testing variable
associations in the prehabilitation group
The W peak was higher in men compared with women
(mean difference 13 watt, 95% CI 3–23, p = 0.010).
There was a lower increase in W peak with an increase
in age (the increase reduced by 0.58 watt per 1 year
increment in age). There was less increase in W peak
in patients with a higher baseline W peak (the increase
reduces by 0.17 per increment of 1 watt in initial W peak )
The HR peak during CPET was significantly lower in
women compared with men (mean difference 7 bpm,
95% CI 1–13 bpm, p = 0.018).
DISCUSSION
The objective of this paper was to report the design,
application and efficacy of a particular HIIT paradigm
to improve cardiorespiratory fitness in deconditioned
patients with lung cancer. Our hypotheses were that
candidates awaiting primary lung resection surgery for
NSCLC would be able to perform such HIIT despite
deconditioning, and that HIIT would improve aerobic
power output (W peak ), aerobic capacity (VO 2peak ), res-
ting heart rate (HR rest ), recovery heart rate (HR 1min ),
dyspnoea and exercise capacity (6MWT) in these
patients. We found that the particular HIIT paradigm
was well supported by this group of patients and that
a median of only 8 training sessions significantly
increased VO 2peak and W peak . During the preoperative
waiting period (median 25 days), VO 2peak and 6MWT
both increased by 15%, while they declined in the
UC group.
Given that VO 2peak is an important predictor of out-
come for patients with NSCLC this finding is encou-
raging (2, 3). Not only VO 2peak , but also 6MWT, was
increased suggesting that the increase in aerobic power
J Rehabil Med 51, 2019