IMR Press / RCM / Volume 24 / Issue 1 / DOI: 10.31083/j.rcm2401029
Open Access Original Research
Does the Addition of Strength Training to a High-Intensity Interval Training Program Benefit More the Patients with Chronic Heart Failure?
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1 Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, School of Medicine National and Kapodistrian University of Athens, 10676 Athens, Greece
2 Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, 3050 Doha, Qatar
3 Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), 11521 Athens, Greece
4 Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
5 Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
6 Department of Respiratory Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
7 Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
*Correspondence: (Manal Alshamari)
These authors contributed equally.
Academic Editors: Kazuhiro P. Izawa and Peter H. Brubaker
Rev. Cardiovasc. Med. 2023, 24(1), 29;
Submitted: 8 August 2022 | Revised: 25 August 2022 | Accepted: 31 August 2022 | Published: 16 January 2023
(This article belongs to the Special Issue Cardiac Rehabilitation—Volume 2)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Aerobic exercise, either continuous or high intensity interval training (HIIT), induces important benefits in chronic heart failure (CHF) patients. Resistance training has been also shown to be beneficial in CHF. However, data regarding combined aerobic exercise and muscle strength training is still limited. The aim of this study was to investigate whether adding strength training to a HIIT protocol within a cardiac rehabilitation (CR) program has a cumulative beneficial effect on the functional capacity (FC) and quality of life (QoL) in patients with CHF. Methods: Forty-four consecutive patients [35 males, ejection fraction (EF) <50%] with CHF under medication enrolled in a 36-session CR program and were randomized in two exercise groups; HIIT (HIIT group) or HIIT combined with strength training (high intensity interval training combined with strength training (COM) group). All patients underwent baseline and endpoint outcome measures of a symptom-limited maximal cardiopulmonary exercise testing (CPET), 1 repetition maximum (1RM) test, muscular endurance test, echocardiography, and Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Results: Most of the CPET indices, EF, 1RM test, muscular endurance and QoL were improved after the CR program in each exercise training group (p < 0.05). However, COM group demonstrated a further improvement in chest muscle testing and workload at anaerobic threshold (AT) compared to HIIT group. Conclusions: An exercise-based CR program, consisted of either HIIT or HIIT combined with strength training, improves FC and QoL of patients with CHF. However, the addition of strength training to HIIT seems to have further beneficial effects on chest muscle strength and endurance, as well as workload at AT. Clinical Trial Registration: The study was registered in with number NCT02387411.

high-intensity interval training (HIIT)
strength training
cardiac rehabilitation
functional capacity
chronic heart failure (CHF)
quality of life
Fig. 1.
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