Summary: In a secondary analysis of a home-based exercise trial in older patients with coronary heart disease and type 2 diabetes, longer weekly endurance-exercise duration improved fitness, while intensity alone did not, and longer training in the first two weeks predicted sustained adherence.
PICO Summary
| Element | Detail |
|---|---|
| Population | 201 older patients (mean age 67.9; 84.1% men) with both coronary heart disease and type 2 diabetes; secondary analysis of the LeIKD trial, Germany. |
| Intervention | 6 months of home-based, telemedicine-supported endurance exercise; analysis of the influence of exercise duration and intensity. |
| Comparison | Higher versus lower weekly duration and intensity, and higher versus lower adherence. |
| Outcome | Peak oxygen uptake rose by 0.42 mL/kg/min per additional hour of endurance exercise per week (p=0.001), while intensity was not significantly associated overall (p=0.10). Among highly adherent patients, a 10% increase in intensity added 0.26 mL/kg/min (p=0.05). Longer training in the first 2 weeks predicted high adherence over 6 months (OR 1.09 per 10 min/week; p<0.001). |
Expert Commentary
This is a useful secondary analysis that helps simplify exercise prescription for a high-risk group in whom coronary disease and diabetes coexist. Its central finding, that duration rather than intensity drove gains in peak oxygen uptake, is practically valuable because total weekly endurance time is easier to communicate and achieve than precisely titrated high-intensity intervals, and it gently challenges the intensity-centric emphasis of some cardiac rehabilitation. The nuance is worth preserving: intensity was not irrelevant, since among already-adherent patients a higher intensity added a little further benefit, so the message is duration first, intensity as a bonus once consistency is established. The adherence insight is equally clinically actionable, namely that engagement in the first two weeks predicted six-month persistence, pointing to where support should be concentrated. I would note the limitations the post lists: this is a secondary, observational analysis of trial data rather than a randomised comparison of duration versus intensity, the population was older and mostly men, home-based delivery needs technology access, and glycaemic outcomes such as HbA1c were not reported, only fitness. Can I use this with my patients? Yes. I would prescribe achievable endurance duration as the primary goal, add intensity once habit is set, and front-load motivational support in the first weeks.
References
Gass F, Dinges SM, Fegers-Wustrow I, et al. Effects of exercise duration and intensity on maximal exercise capacity over 6 months in coronary heart disease and type 2 diabetes—a secondary analysis of the LeIKD trial. Scand J Med Sci Sports. 2026;36(1):e70209. doi:10.1111/sms.70209