title: High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation.
abstract: Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the 'modern' patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes.
  
  
  
  This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40-70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peakas determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes.
  
  
  
  The study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands-Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR.
  
  
  
  NCT02784873; pre-results.
authors.affiliation: Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK.|Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: McGregor
authors.affiliation: Department of Sport, Health & Exercise Science, University of Hull, Hull, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Nichols
authors.affiliation: Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hamborg
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Bryning
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, UK.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Tudor-Edwards
authors.affiliation: School of Sport, Health & Exercise Sciences, Bangor University, Bangor, Gwynedd, UK.
authors.forename: David
authors.initials: D
authors.lastname: Markland
authors.affiliation: Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Mercer
authors.affiliation: Department of Sport, Health & Exercise Science, University of Hull, Hull, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Birkett
authors.affiliation: Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK.|Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Ennis
authors.affiliation: Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Powell
authors.affiliation: Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.|Aneurin Bevan University Health Board, Gwent, Wales, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Begg
authors.affiliation: College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Haykowsky
authors.affiliation: Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK.|School of Health & Life Sciences, Coventry University, Coventry, UK.
authors.forename: Prithwish
authors.initials: P
authors.lastname: Banerjee
authors.affiliation: Department of Sport, Health & Exercise Science, University of Hull, Hull, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Ingle
authors.affiliation: Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Shave
authors.affiliation: Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Karianne
authors.initials: K
authors.lastname: Backx
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods*; D002985:Clinical Protocols; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006339:Heart Rate; D000072696:High-Intensity Interval Training; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom; D055815:Young Adult
keywords: HEALTH ECONOMICS