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Circulation. 2019 Feb 18. doi: 10.1161/CIRCULATIONAHA.118.036747. [Epub ahead of print]

Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia: 1-Year Follow-Up of the HITTS Randomized, Controlled Study.

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Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway.
Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Norway.
Kardiology, Oslo University Hospital Rikshospitalet, Norway.
Sahlgrenska University Hospital, Sweden.
Department of Cardiology and Institute of Sports Medicine, Bispebjerg University Hospital, Denmark.
Department of Cardiology, Rigshospitalet, Denmark.
Department of Molecular and Clinical Medicine, University of Gothenburg, Sahlgenska Academy, Institute of Medicine, Sweden.
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.



There is no consensus on how, when, or at what intensity exercise should be performed after heart transplantation (HTx). We have recently shown that high-intensity interval training (HIT) is safe, well tolerated, and efficacious in the maintenance state after HTx, but studies have not investigated HIT effects in the de novo HTx state. We hypothesized that HIT could be introduced early after a HTx, and that it could lead to clinically meaningful increases in exercise capacity and health-related quality of life (HRQoL).


This multicenter, prospective, randomized, controlled trial included 81 patients, mean 11 weeks (range 7- 16) after a HTx. Patients were randomized, 1:1, to either nine months of HIT (4x4-min intervals at 85-95% of peak effort) or moderate intensity continuous training (MICT) (60-80% of peak effort). The primary outcome was the effect of HIT vs. MICT on the change in aerobic exercise capacity, assessed as the VO2peak. Secondary outcomes included tolerability, safety, adverse events, isokinetic muscular strength, body composition, HRQoL, left ventricular function, hemodynamics, endothelial function, and biomarkers.


From baseline to follow-up, 96% of patients completed the study. There were no serious exercise-related adverse events. The population comprised 73% men, and the mean (±SD) age was 49 (± 13) years. At the 1-y follow-up, the HIT group demonstrated greater improvements than those observed in the MICT group; the groups showed significantly different changes in the VO2peak (mean difference between groups: 1.8 ml/kg/min), the anaerobic threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor muscle exercise capacity (464 Joules). The 1.8 ml/kg/min difference was equal to approximately 0.5 metabolic equivalents, which is regarded as clinically meaningful and relevant. HRQoL was similar between the groups, based on results from Short Form-36 (version 2), the Hospital Anxiety and Depression scale, and a visual analogue scale.


We demonstrated that HIT was a safe, efficient exercise method in de novo HTx recipients. HIT, compared to MICT, resulted in a clinically significantly greater change in exercise capacity, based on the VO2peak values (25% vs. 15%), the anaerobic threshold, the peak expiratory flow, and muscular exercise capacity.


URL: Unique Identifier NCT01796379.


Effects of exercise; high-intensity interval training; peak oxygen consumption

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