Continuous Versus Interval Training in Patients With Coronary Artery Disease: FRAXIO Study

• Outline of the training program: Duration of the rehabilitation course is 7 or 10 weeks, 2 or 3 training sessions a week, 21 sessions altogether. Each training session consist in cycling on an ergometer. In the interval training group, the training session alternates one minute at 100% workload at the ventilatory threshold and one minute active pause at 50% workload at the ventilatory threshold; total exercise time is 20 minutes. In continuous training, the training session lasts 20 minutes at 80% workload at the ventilatory threshold.
• Exercise testing: Exercise capacity is measured before and at the end of the exercise training program and at 6 month follow-up. A first exercise test with respiratory gas exchange is performed 2 weeks after hospitalization: this is the baseline exercise test. The protocol consists of 3-min warm up at a workload of 30 watts. At each stage, the workload is increased by 10 or 15 watts per min. Patients are instructed to maintain a speed of 55 to 65 rotations per min. Four exercise tests with gas analysis are programmed during cardiac rehabilitation: three maximal tests (before exercise training program to precise exercise intensity during the sessions, after training program to evaluate the primary end point and at 6 months) and one sub maximal exercise test during the tenth session to adjust the intensity of training exercises (this test is stopped when the ventilatory threshold is obtained).

Inclusion criteria

• Age > 18 years
• Patient hospitalized at Limoges University Hospital, cardiology department, for acute coronary syndrome:

• with or without ST segment elevation
• with or without elevated troponin
• with or without revascularization
• Patients stabilized with medication without rest myocardial ischemia
• Left ventricular ejection fraction >= 35% measured on echocardiography
• Patient who have signed and dated informed consent
• Patient who can do a maximal metabolic exercise test

Exclusion criteria

• Contraindication for exercise testing:

• acute myocardial infraction < 5 days
• unstable angina
• left main coronary stenosis
• uncontrolled cardiac arrhythmia
• uncontrolled symptomatic heart failure
• acute pulmonary embolism or phlebitis
• acute myocarditis, pericarditis or endocarditis
• patient's physical inability or refusal
• left ventricular thrombus after acute myocardial infarction
• pulmonary hypertension > 60 mmHg
• uncontrolled arterial hypertension
• Age < 18 years
• Patient revascularized by coronary artery bypass grafting after acute coronary syndrome
• Chronic supraventricular arrhythmias
• Impossible physical exercise
• Patient who can't understand the protocol or who refused to give his consent
• Patient who already attended a training program over the last 6 months
• Patient with difficult follow-up
• Current participation in another study
• Patient under guardianship