Cardiovascular Diseases Clinical Trial
Official title:
Training Levels Comparison (TLC) Trial in Patients With Coronary Heart Disease
To determine the effects of high or low intensity long-term exercise conditioning in patients with coronary artery disease.
BACKGROUND:
A vast amount of literature exists on the improvements in work capacity, reduction of risk
factors, and an increased feeling of well-being among coronary heart disease patients after
physical training programs. Previous observations of short-term training programs which
resulted in an increase in physical working capacity have not usually shown a cardiac
change. The National Exercise and Heart Disease Project did not show such changes, but the
exercise level may have been inadequate. Several other studies suggested that more prolonged
and intense training could result in improved cardiac function.
DESIGN NARRATIVE:
Patients were randomized to high intensity or low intensity long-term exercise groups.
Compliance was strengthened by randomizing following a sequence of eligibility visits and
after a test period of subject reaction to an exercise program. The primary endpoint was
change in exercise ejection fraction at one year. Secondary endpoints included changes in
lipid levels, body composition, blood pressure and heart rate measurements, glucose
tolerance, quality of life measures, compliance, and progression of disease. Patients were
classified into one of four strata based on the documented history of myocardial infarction
and resting left ventricular ejection fraction. Within each stratum, patients were assigned
in equal numbers to the two intensity levels of exercise intervention. All exercise
prescriptions were based on exercise testing of patients maintained on their usual medical
regimen including drugs. Patients underwent standardized multistage treadmill exercise
testing monitored by Doppler echocardiogram at baseline, just prior to randomization and at
the three month, six month, one year and two year visits. Patients participated in the
structured group exercise sessions three days per week. Each exercise session was preceded
by and ended with a five to fifteen minute warm-up and cool-down session. Each patient was
given an exercise prescription that included a 30 minute period of walking or of walking and
jogging sequences and 15 minutes of arm-leg bicycle ergometer exercise. Recruitment started
in May 1987. The last patient was enrolled in March 1990.
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Observational Model: Cohort, Time Perspective: Prospective
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