Influence of warm‑up ischemia on the effects of exercise training in patients with stable angina

It is still unknown whether ischemia‑inducing training in patients with stable angina is superior to the training conducted below the ischemic threshold (IT) according to the current guidelines.

The aim of the study was to assess the influence of warm‑up ischemia prior to training on the effects of training conducted either at or below the IT in patients with stable angina.

Thirty male patients aged 56 ±8 years, after myocardial infarction, with stable angina and positive exercise test (ET1) were divided into 2 groups: group A included 18 patients with the warm‑up effect, group B - 12 patients without this effect. All patients followed an 8‑week interval training program (TP). The intensity of training was planned to reach the heart rate at the IT. Successive ETs were performed immediately after the TP (ET2), at day 3 (ET3), day 10 (ET4), and at 1 month (ET5).

After the TP, there was a statistically significant improvement in group A in all analyzed variables except maximum ST depression (max STD). Maximal workload increased by 28%, walking distance by 24%, duration by 20%, and time to 1‑mm STD by 28%. Max STD reduction amounted to 14% (P =0.13). The beneficial effect of training on exercise‑induced ischemia was maintained for up to 10 days (ET4) and on physical capacity for up to 1 month (ET5). In group B, the TP did not affect time to 1‑mm STD, but physical capacity improved significantly and was maintained for up to 1 month (ET5).

The warm‑up effect appears to be necessary to attenuate myocardial ischemia after training.