The Influence of Exercise Training on Cardiovascular Health Outcomes in Adults with Cardiac Implantable Electronic Devices

Abstract

Aims and Methods: The overall purpose of this dissertation was to examine the influence of exercise training on cardiovascular health outcomes in patients with cardiac implantable electronic devices (CIEDs). Study 1 retrospectively examined the changes in physical (e.g., cardiorespiratory fitness [CRF]), and mental health (e.g., anxiety levels) outcomes in patients with CIEDs completing an exercise-based cardiovascular rehabilitation (CR) program. Study 2 retrospectively assessed the associations of CR on major adverse cardiovascular events (MACE) among adults with CIEDs. Study 3 investigated, through a systematic review and meta-analysis, sex differences in CRF changes following exercise training in women and men with CIEDs. Study 4 tested the feasibility of a pilot randomized controlled trial comparing a 12-week virtual program of high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (MICT) in women with CIEDs.

Results: Study 1 showed that patients with CIEDs (n = 252, 26% females) completing CR improved CRF and reduced anxiety and depression levels in patients with CIEDs. Study 2 found that CR was not associated with lower 5-year risk of MACE comparing propensity score-matched CIED patients with and without CR (n = 344, 23% females), whereas females derived greater benefit from CR. Study 3 demonstrated no sex differences in CRF following exercise among patients with CIEDs (n = 365, 22% women). Study 4 revealed that, among women with CIEDs (n = 20), a 12-week virtual HIIT intervention was feasible, whereas virtual MICT was not.

Conclusions: Findings of this dissertation highlight (i) the importance of CR to improve CRF, a strong predictor of mortality, in individuals with CIEDs, (ii) the need of large-scale studies to understand the impact of CR on MACE in patients with CIEDs, (iii) a call to action to advance sex-specific inclusion and reporting practices in exercise trials with CIEDs, and (iv) remote HIIT is a feasible and safe exercise alternative to women with CIEDs, where results on key cardiovascular data can inform future trials.