BACKGROUND: Cardiac rehabilitation (CR) for patients with cardiovascular disease has traditionally involved low- to moderate-intensity continuous aerobic exercise training (MICT). There is growing and robust evidence that high-intensity interval training (HIIT) shows similar or greater efficacy compared with MICT across a range of cardiovascular and metabolic measures, in both healthy populations and populations with a chronic illness. However, there is understandable concern about the safety aspects of applying HIIT in CR settings. This systematic review analyzed safety data drawn from recent proof-of-concept studies of HIIT during CR among patients with cardiovascular disease. METHODS AND RESULTS: We included trials comparing HIIT with either MICT or usual care in patients with coronary artery disease or heart failure participating in tertiary care services, such as phase 2 (outpatient) CR. Adverse events occurring during or up to 4 hours after an exercise training session were collated. There were 23 studies included, which analyzed 1,117 participants (HIIT = 547; MICT = 570). One major cardiovascular adverse event occurred in relation to an HIIT session, equating to 1 major cardiovascular event per 17 083 training sessions (11,333 training hours). One minor cardiovascular adverse events and 3 noncardiovascular adverse events (primarily musculoskeletal complaints) were also reported for HIIT. Two noncardiovascular events were reported in relation to MICT. CONCLUSIONS: HIIT has shown a relatively low rate of major adverse cardiovascular events for patients with coronary artery disease or heart failure when applied within CR settings.

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