Name: impact of high-intensity interval exercise and moderate-intensity continuous exercise on the cardiac troponin t level at an early stage of training
Uploaded: 2019-10-10T14:00:00
Description: Watch this Scientific Journal Video about Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training at JoVE.co

This work was supported by the National Natural Science Foundation of China (Grant No. 31771319).

The protocol (No. 31771319) was approved by the Hebei Normal University Review Board and conformed to the Declaration of Helsinki. All participants provided written informed consent before participating in the testing described.
1. Participant Screening and Preparation for the Experiment
<ol>
	<li>For recruitment, ensure that the participants satisfy the following inclusion criteria: aged between 18 and 25, a minimum body mass index (BMI) of 23 kg/m, which is the overweight cut-off for Asian...

<ol>
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The repetitive short to long bouts of rather high-intensity exercise interspersed with recovery periods are involved in HIE, which is subdivided into traditional HIE (&#8220;near maximal&#8221; efforts) and SIE (&#8220;supramaximal&#8221; efforts), using a common classification scheme6. In addition, RSE is a particularly intense form of SIE, where the activity is &#8220;all-out&#8221; but only lasts for 3 to 7 s6. To the best of our knowledge, this is the first integrated s...

The benefits of regular exercise on the heart are well-documented1. However, the risk of cardiac events, such as acute myocardial infarction (AMI), transiently increases during an intense exercise2,3. Individuals with low levels of regular physical activity show higher risk towards AMI2,3. Cardiac troponin T (cTnT) is the biochemical gold standard in the diagnosis of AMI4. However, there is a burgeoning evidence that the cTnT is elevated after continuous prolonged exercise, which undoubtedly distorts the diagnostic role of the cTnT assay5.
The repetitive bouts of relatively intense exercise interspersed with short breaks are a typical element of high-intensity interval exercise (HIE), which is growing in popularity in various fields such as cardiac rehabilitation, health and fitness6,7. The widespread interest in HIE is due in part to the ability of HIE training to elicit beneficial physiological adaptations similar or superior to the traditional moderate-intensity continuous exercise (MCE) training, despite a reduced total exercise volume and time commitment6. However, concerns related to the safety of HIE have been expressed due to the high cardiac demand8. To date, available data related to cTnT release upon HIE is limited. Moreover, no previous integrated study has investigated the effect of various modalities of HIE and traditional MCE on the appearance of cTnT with exercise. Thus, it is unclear whether, with equalization of total mechanical work between HIE and MCE, different exercise formats will lead to the distinction in cTnT concentrations and what the range of the elevated cTnT values is. Given that exercise conducted at higher intensities might lead to a higher risk of cardiac events2,3, it is pertinent to develop a representative HIE and MCE proposals with the known range of cTnT responses. The evaluation of exercise-associated cTnT elevation could potentially be helpful in clinical decision-making and assist clinical physiologists in developing more effective and safe exercise prescriptions.
Consequently, we outline protocols of the three representative types of HIE and one representative type of MCE to gather physiological data while observing cTnT responses. Considering that the risk of acute cardiac events is higher in people who do not engage in regular exercise2,3 and the overall release of cTnT induced by exercise reduces with regular training9, this study recruited sedentary, overweight females who completed a 10 day training program. This provided the prospect to work in the early stage of training and target an under-researched group.

<table>
	<tbody>
		<tr>
			<td>Cobas E 601 analyser</td>
			<td>Roche Diagnostics, Penzberg, Germany</td>
			<td></td>
			<td>Used for measuring the circulating cardiac troponin T concentration</td>
		</tr>
		<tr>
			<td>Monark 839E Stress Testing Cycle Ergometer&#160;</td>
			<td>Monark Exercise AB, Vansbro, Sweden</td>
			<td></td>
			<td>Used for all exercise protocols except repeated sprint exercise</td>
		</tr>
		<tr>
			<td>Monark 894E Wingate Testing Cycle Ergometer&#160;</td>
			<td>Monark Exercise AB, Vansbro, Sweden</td>
			<td></td>
			<td>Only used for repeated sprint exercise protocol</td>
		</tr>
		<tr>
			<td>Quark-PFT-ergo Metabolic Analyser</td>
			<td>Cosmed, Rome, Italy</td>
			<td>C09072-02-99</td>
			<td></td>
		</tr>
		<tr>
			<td>SPSS Statistics 20.0 software package</td>
			<td>IBM Corp., Armonk, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Zephyr BioHarness 3.0</td>
			<td>Zephyr Technology, Auckland, New Zealand</td>
			<td>9800.0189/9600.0190</td>
			<td>Electrocardiograph Monitor</td>
		</tr>
	</tbody>
</table>

impact of high-intensity interval exercise and moderate-intensity continuous exercise on the cardiac troponin t level at an early stage of training

An elevation in cardiac troponin T (cTnT), as a highly specific biomarker of cardiomyocyte damage, after moderate-intensity continuous exercise (MCE) has been described. The exercise-induced cTnT response distorts the diagnostic role of the cTnT assay. Although high-intensity interval exercise (HIE) is growing in popularity and concerns remain about its safety, available data related to cTnT release after HIE is limited, which hampers the use of HIE as a health intervention. Here, we present three representative HIE protocols [traditional HIE (repeated 4 min cycling at 90% V&#775;O2max interspersed with 3 min rest, 200 kJ/session); sprint interval exercise (SIE, repeated 1 min cycling at 120% V&#775;O2max interspersed with 1.5 min rest, 200 kJ/session); and repeated sprint exercise (RSE, 40 x 6 s all-out sprints interspersed with 9 s rest)] and one representative MCE protocol (continuous cycling exercise at an intensity of 60% V&#775;O2max, 200 kJ/session). Forty-seven sedentary, overweight young women were randomly assigned to one of four groups (HIE, SIE, RSE, and MCE). Six bouts of respective exercise were performed by every single group, with each being 48 h apart. Meanwhile, for four groups, the duration of the entire testing period was identical, being 10 days. Before and after the first and final exercise bouts, an assessment was conducted of cTnT. The current study provides a frame of reference giving a clear picture of how a specific exercise session affects the circulating cTnT concentration at the early stage of training. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise, especially for HIE.

All participants (n = 47) completed the study, and no adverse cardiac events (e.g., chest pain and sign of myocardial ischemia on ECG) were found during testing in the four groups. As expected, the acute exercise heart rate (HR) data, including HRmean and %HRmax, at the 1ST assessment is similar (all P &#62; 0.05) to those in the 6TH assessment in all four groups. Further, the HR data in the RSE and MCE groups is the highest and lowest among the four groups, respectively, but is similar bet...

Watch this Scientific Journal Video about Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training at JoVE.co

Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training

Here, we present protocols of high-intensity interval and moderate-intensity continuous exercise to observe the response of circulating cardiac troponin T (cTnT) concentration to acute exercise over 10 days. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise.

An elevation in cardiac troponin T (cTnT), as a highly specific biomarker of cardiomyocyte damage, after moderate-intensity continuous exercise (MCE) has ...

We present protocol of three representative types of high intensity interval exercise and one representative type of moderate intensity continuous exercise. To observe response of circulating cardiac troponin T concentration to exercise. We recruited sedentary, overweight females, who completed a 10 day training program.This allowed us to work in the early stage of training. And target an under researched group. The frame of cardiac troponin T release, provided by the current study, it's conditions fits with the challenge with interpreting the bell marker data clinically in the post exercise study.The current study also provides templates of different exercise protocols with potential cardiac troponin T responses. When considering initiating exercise prescription in sedentary populations, especially for high intensity interval exercise. Start by assessing maximal oxygen uptake, or Vo2 max, of each participant by instructing them to perform a continuous incremental test on a stress testing cycle ergometer.The participant should warm up for five minutes at 25 watts. Then begin the test by performing continuous two minute stages, starting at 50 watts, with a pedal frequency of 60RPM, until volitional exhaustion. Simultaneously, us a breath by breath metabolic analyzer to measure oxygen consumption during the exercise.And calculate the Vo2 max based on the highest 30 second average value. During exercise record a continuous electrocardiogram via a portable ECG monitor. Ensure that all exercise tests are performed at the same time of day, in a laboratory with temperature and humidity control.Five days after the pre-intervention assessment, instruct the particpants to commence their respective training. After a routine warmup, instruct all participants to engage in their respective exercise program on a cycle ergometer. Perform six exercise sessions over a time span of 10 days, testing for the cTnT response, on the first and sixth exercise session.Draw venous blood samples before, and immediately after exercise. As well as three and four hours after the exercise session. For cTnT analysis, allow the blood to clot at room temperature, and centrifuge it at 3, 500 times G, for 20 minutes.Then use an analyser to perform a quantitative measurement of the cTnT with a high sensitivity amino acid based on electrochemiluminescence. Take one milliliter of the serum, and put it into a test tube. Then insert the tube into the analyser, and press the start button.For each exercise session, instruct participants from all four exercise groups to complete an identical 10 minute warmup at 50 to 60 percent of maximal heart rate, before exercise. After the warmup, conduct a two minute recovery period where participants remain seated, but stationary on the cycle ergometer. Direct the participant to accelerate as soon as possible at the beginning of each exercise bout to reach the intended intensity.For the HIE protocol, the participant will repeat four minute bouts of exercise on a stress testing cycle ergometer at an intensity of 90%Vo2 max. Followed by a three minute passive recovery until the targeted 200 kilojoules of work is achieved. After setting the HIE protocol in a PC computer, count down five, four, three, two, one, go.As the participant begins to exercise the computerized system will automatically activate. Monitor the participants revolutions per minute, to make sure it is maintained at 60. The participant should remain seated while cycling.And their feet should be secured to the pedals with a toe clip. Verbally encourage them to give a maximal effort to exercise at the desired intensity throughout each session. For the SIE protocol, the participant will repeat one minute bouts of exercise at an intensity of 120%Vo2 max, follow by a 1.5 minute passive recovery until 200 kilojoules of work is reached.Set the protocol and count down to indicate the participant should start to exercise which will activate the computerized system. Monitor the system to ensure the participant maintains 60 revolutions per minute. And verbally encourage them to give a maximal effort at the desired intensity.For the RSE protocol, the participant will repeat six second all out sprints inter-spaced with nine second passive recovery periods. With a resistance of one kilogram, until the targeted 40 repetitions are achieved. Prior to starting, make sure that the participant's feet are secured to the pedals.After setting the protocol in the computer, count down, five, four, three, two, one, go. And monitor the participant as they start to exercise. For the MCE protocol, the participant will perform continuous cycling at 60%Vo2 max until 200 kilojoules of work is achieved.Set protocol in a PC computer and count down as previously described. Then monitor the system to make sure that the participant maintains 60 revolutions per minute. After each exercise session, instruct participants from all four exercise groups to complete an identical five minute cool down, at 20 watts.All 47 participants completed the study, and no adverse cardiac effects were found during testing. As expected, acute exercise heart rate data at the first session, was similar to that at the sixth in all four groups. The heart rate data was highest in the RSE group, and lowest in the MCE groups.The cTnT concentration increased, following acute exercise in all four groups. No significant difference was found in cTnT concentration among the groups, except for a smaller response at the first session in the RSE group. The appearance of higher increase than expected in cTnT in participants with recent history of acute exercise should be considered for further clinical investigation especially for repeated sprint exercise.It remains unclear why the cTnT has similar responses in other populations, except house of young females. Which makes it worthy of further research, using the exercise protocols developed in this study.

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