Combined arm-leg endurance training vs. leg endurance training in patients with an implantable cardioverter defibrillator: A randomized controlled study

Background: There is a lack of evidence regarding the effect of combining arm and leg training on arm exercise capacity, upper extremity functionality and safety in patients with implantable cardioverter-defibrillators (ICDs). Objective: The aim of this study was to compare the effects of combined arm-leg endurance training (ET_arm+leg) with leg endurance training (ET_leg) alone on arm exercise capacity, cardiorespiratory fitness, and safety issues in patients with ICDs. Methods: In this prospective randomized controlled study, 24 caucasian patients with an ICD (NYHA class II–III, mean age: 59.38±11.54 years, 20 male, 4 female) underwent cardiopulmonary exercise testing (CPET) and arm ergometry. The ET_leg intervention consisted of cycle ergometer training for 40 min at workload of 70–80 % of peak oxygen consumption (VO_2peak). The ET_arm+leg intervention also included arm ergometer training for 20 min at 60 % peak workload (W_peak). Both exercise programs were performed for a total of 30 sessions (5 days for 6 weeks). Quade's non-parametric covariance analysis was performed for changes between groups by adjusting before treatment. Results: Significant increases in time to reach VO_2peak (min), VO_2peak (L), VO_2peak/kg (L/kg/min), VO_2peak (%), W_peak, and test duration during arm ergometry were observed in the ET_arm+leg group (p < 0.05). No shocks or ventricular tachycardia/fibrillation episodes were recorded. Conclusions: ET_arm+leg had a more pronounced effect on cardiopulmonary exercise capacity and arm exercise capacity in patients with ICDs. Arm exercise training is safe in terms of ICD parameters and should be incorporated into cardiac rehabilitation for patients with ICDs.