Impact of eccentric cycling in coronary rehabilitation program: a pragmatic randomized controlled trial versus conventional rehabilitation.
Delphine Besson, Amadou-Khalilou Sow, Isabelle Fournel and 5 others
PMID 39073358WHAT IT FOUND
Adding eccentric cycling to standard cardiac rehabilitation did not improve functional capacity more than concentric cycling.
Both groups improved similarly in walking distance and strength. The eccentric group reported lower perceived effort and pain, but this did not translate to better clinical outcomes.
Key findings
01The proportion of patients who were 'good responders' (meeting criteria for improved walking distance and ankle strength) did not differ significantly between the eccentric cycling group and the conventional concentric cycling group.
02Both groups showed significant improvements in 6-minute walk test distance and maximal isometric plantar flexor strength, with no significant differences between the groups.
03Patients in the eccentric cycling group perceived the effort as significantly lower and reported less muscle pain compared to the conventional group, despite achieving higher workloads.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was designed as a superiority trial, but the observed difference was smaller than anticipated, so it cannot conclude non-inferiority. Eccentric cycling was only one component of a broader rehab program (34% of total exercise time), which may have masked its specific effects. The participants had a relatively low comorbidity burden and good baseline function, so results may not apply to more deconditioned patients. The trial was open-label, which may have influenced subjective outcomes like perceived exertion and pain.
Declared interests
The authors declare no conflicts of interest. The study was funded by a grant from the Franche Comté – Burgundy regional council.
The easy way to misread this
Do not conclude that eccentric cycling is ineffective or useless. It produced higher workloads with less perceived effort and pain, which are valuable for adherence and tolerance. The null result for functional capacity may be due to the short duration, the low dose of eccentric exercise within the broader program, or the fact that the participants were not severely deconditioned to begin with.