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Updated: Nov 23, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
The acute and long-term effects of a cardiac rehabilitation program on endothelial progenitor cells in chronic heart
Christos Kourek1, Manal Alshamari1, Georgios Mitsiou1
1Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Cardiac rehabilitation programs significantly increase endothelial progenitor cells (EPCs) at rest and improve their response to exercise in chronic heart failure (CHF) patients. These benefits were consistent across different exercise protocols and patient functional classes.
Area of Science:
- Cardiovascular Medicine
- Exercise Physiology
- Cellular Biology
Background:
- Vascular endothelial dysfunction and impaired endothelial progenitor cells (EPCs) are key features of chronic heart failure (CHF).
- Cardiac rehabilitation (CR) is a crucial intervention for CHF management.
Purpose of the Study:
- To evaluate the impact of a 36-session CR program on EPCs at rest and their acute response to maximal exercise in CHF patients.
- To compare the effects of high-intensity interval training (HIIT) versus combined HIIT and muscle strength (COM) protocols.
- To investigate differences between patients classified as NYHA II and NYHA III.
Main Methods:
- Forty-four stable CHF patients participated in a 36-session CR program, randomized into HIIT or COM protocols.
- Maximal cardiopulmonary exercise testing (CPET) was performed before and after the CR program.
- Blood samples were analyzed using flow cytometry to quantify five endothelial cellular populations.
Main Results:
- A significant increase in all endothelial cellular populations at rest was observed post-CR (p < 0.01).
- The acute response of four out of five endothelial populations to maximal exercise improved after rehabilitation.
- No significant differences were found between HIIT and COM groups or between NYHA II and NYHA III classes (p > 0.05).
Conclusions:
- A 36-session CR program effectively enhances EPCs at rest and their acute response to maximal exercise in CHF patients.
- The observed benefits of CR on EPCs are comparable between HIIT and COM training protocols.
- CR program benefits on EPCs are similar across different functional classes (NYHA II and III) in CHF patients.
Background:
Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are also impaired. The purpose of the study was to assess the effect of a cardiac rehabilitation (CR) program on the increase of EPCs at rest and on the acute response after maximal exercise in patients with CHF and investigate whether there were differences between two exercise training protocols and patients of NYHA II and III classes.
Methods:
Forty-four patients with stable CHF enrolled in a 36-session CR program and were randomized in one training protocol; either high-intensity interval training (HIIT) or HIIT combined with muscle strength (COM). All patients underwent maximum cardiopulmonary exercise testing (CPET) before and after the CR program and venous blood was drawn before and after each CPET. Five endothelial cellular populations, expressed as cells/106 enucleated cells, were quantified by flow cytometry.
Results:
An increase in all endothelial cellular populations at rest was observed after the CR program (p < 0.01). The acute response after maximum exercise increased in 4 out of 5 endothelial cellular populations after rehabilitation. Although there was increase in EPCs at rest and the acute response after rehabilitation in each exercise training group and each NYHA class, there were no differences between HIIT and COM groups or NYHA II and NYHA III classes (p > 0.05).
Conclusions:
A 36-session CR program increases the acute response after maximum CPET and stimulates the long-term mobilization of EPCs at rest in patients with CHF. These benefits seem to be similar between HIIT and COM exercise training protocols and between patients of different functional classes.
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