Implementation of Super-circuit Training Protocol to Improve Functional Capacity in A Patient with Coronary Artery Disease: A Case Report
Article Sidebar
Published:
Dec 24, 2025
Keywords:
Cardiac Rehabilitation, Circuit-Based Exercise, Coronary Artery Disease, Percutaneous Coronary Intervention, Resistance Training
Main Article Content
Abstract
Introduction: Phase II cardiac rehabilitation (CR) was the primary intervention used to improve functional capacity (FC) and facilitate patients with coronary artery disease (CAD) in returning to their pre-illness functional activities. This case report described the implementation of super-circuit training (SCT) as a novel exercise modality to assess its efficacy and safety.
Case Description: A 37-year-old man underwent phase II CR eight weeks after percutaneous coronary intervention with an FC of 5.4 metabolic equivalents, which limited his activities. Fear of recurrent heart attacks further contributed to these limitations. The patient participated in a six-week SCT program aimed at improving FC as the primary cause of functional impairment. After completing the program, improvements in FC, muscular fitness, and psychological well-being were observed, leading to enhanced daily, vocational, and sexual activities. No adverse events occurred during the CR program.
Discussion: The SCT protocol was a novel form of circuit training combining high-intensity aerobic exercise (AE) and resistance training (RT), specifically designed for CAD and heart failure patients with reduced ejection fraction. In this case, the protocol was adapted with modified RT intensity and type. AE was performed at 75%-85% of heart rate reserve, while RT included calisthenic exercises at 50% of repetition to failure. Physiologically, this regimen effectively increased metabolic and hemodynamic demand, improving muscular endurance, strength, and cardiorespiratory fitness. SCT was found to be safe and beneficial, consistent with previous studies.
Conclusion: The implementation of SCT in a CAD patient undergoing phase II CR resulted in significant FC improvement and was considered safe.
Case Description: A 37-year-old man underwent phase II CR eight weeks after percutaneous coronary intervention with an FC of 5.4 metabolic equivalents, which limited his activities. Fear of recurrent heart attacks further contributed to these limitations. The patient participated in a six-week SCT program aimed at improving FC as the primary cause of functional impairment. After completing the program, improvements in FC, muscular fitness, and psychological well-being were observed, leading to enhanced daily, vocational, and sexual activities. No adverse events occurred during the CR program.
Discussion: The SCT protocol was a novel form of circuit training combining high-intensity aerobic exercise (AE) and resistance training (RT), specifically designed for CAD and heart failure patients with reduced ejection fraction. In this case, the protocol was adapted with modified RT intensity and type. AE was performed at 75%-85% of heart rate reserve, while RT included calisthenic exercises at 50% of repetition to failure. Physiologically, this regimen effectively increased metabolic and hemodynamic demand, improving muscular endurance, strength, and cardiorespiratory fitness. SCT was found to be safe and beneficial, consistent with previous studies.
Conclusion: The implementation of SCT in a CAD patient undergoing phase II CR resulted in significant FC improvement and was considered safe.
Article Details
How to Cite
Nazir, A., Andrew Joshua Siahaan, Muhammad Luthfi Dharmawan, Brandon Clementius, & Hana Athaya Nurhalizah. (2025). Implementation of Super-circuit Training Protocol to Improve Functional Capacity in A Patient with Coronary Artery Disease: A Case Report. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 238 - 244. https://doi.org/10.36803/indojpmr.v14i2.468
Section
Case Report
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles published in the Indonesian Journal of Physical Medicine and Rehabilitation (IJPMR) are licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows others to share, copy, distribute, adapt, and build upon the work for any purpose, including commercial use, as long as proper attribution is given to the original authors.
Indonesian Journal of Physical Medicine and Rehabilitation is Full license terms: https://creativecommons.org/licenses/by/4.0/
References
1. Gander JC, Sui X, Hébert JR, Hazlett LJ, Cai B, Lavie CJ, et al., editors. Association of cardiorespiratory fitness with coronary heart disease in asymptomatic men. Mayo Clin Proc; 2015: Elsevier.
2. Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Blair SN. Age-specific exercise capacity threshold for mortality risk assessment in male veterans. Circulation. 2014;130(8):653-8.
3. BACPR. The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2023. London: The British Association for Cardiovascular Prevention and Rehabilitation; 2023.
4. Dor-Haim H, Barak S, Horowitz M, Yaakobi E, Katzburg S, Swissa M, et al. Improvement in cardiac dysfunction with a novel circuit training method combining simultaneous aerobic-resistance exercises. A randomized trial. PLoS One. 2018;13(1):e0188551.
5. Silva M, Baptista L, Neves R, França E, Loureiro H, Rezende M, et al. High intensity interval training improves health-related quality of life in adults and older adults with diagnosed cardiovascular risk. J Phys Educ Sport. 2019;19(01):611-8.
6. Stern G, Psycharakis SG, Phillips SM. Effect of high-intensity interval training on functional movement in older adults: a systematic review and meta-analysis. Sports Med Open. 2023;9(1):5.
7. MarÃn-Pagán C, Blazevich AJ, Chung LH, Romero-Arenas S, Freitas TT, Alcaraz PE. Acute physiological responses to high-intensity resistance circuit training vs. traditional strength training in soccer players. Biology (Basel). 2020;9(11):383.
8. 9 science-backed benefits of circuit training [Internet]. 2021 [cited 2025 February 26]. Available from: https://www.healthline.com/health/fitness/benefits-of-circuit-training.
9. Fan Y, Yu M, Li J, Zhang H, Liu Q, Zhao L, et al. Efficacy and safety of resistance training for coronary heart disease rehabilitation: a systematic review of randomized controlled trials. Front Cardiovasc Med. 2021;8:754794.
10. Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee D-c, et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation. 2024;149(3):e217-e31.
11. Nazir A, Heryaman H, Juli C, Ugusman A, Martha JW, Moeliono MA, et al. Resistance training in cardiovascular diseases: A review on its effectiveness in controlling risk factors. Integr Blood Press Control. 2024;17:21-37.
12. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58(5):950-8.
13. ACSM. ACSM's resource manual for guidelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
14. ACSM. ACSM’s guidelines for exercise testing and prescription 11 ed. Philadelphia: Wolters Kluwer; 2022.
15. AACVPR. Guidelines for cardiac rehabilitation and secondary prevention programs. 5th ed. Champaign: Human Kinetics; 2013.
16. El-Sobkey SB. Resistance training is an effective exercise therapy in cardiac rehabilitation program for patients with coronary artery disease: a systematic review. Beni Suef Univ J Basic Appl Sci. 2022;11(1):22.
17. Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, et al. Exercise intolerance in patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(17):2209-25.
18. Naclerio FJ, Jiménez A, Alvar BA, Peterson MD. Assessing strength and power in resistance training. J Hum Sport Exerc. 2009;4(II):100-13.
19. Thomas E, Bianco A, Mancuso EP, Patti A, Tabacchi G, Paoli A, et al. The effects of a calisthenics training intervention on posture, strength and body composition. Isokinet Exerc Sci 2017;25(3):215-22.
20. Uhlemann M, Adams V, Lenk K, Linke A, Erbs S, Adam J, et al. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial): study protocol for a randomized controlled trial. Trials. 2012;13:167.
21. Mustafa MA, Jabbar DA, Mohammed HQ, Luaibi SI, Al-Ghrebawi RH. Effect of percutaneous coronary intervention (PCI) upon lung functions among patients with ischemic heart disease at Al-Najaf Cardiac Center: Correlation Study. Indian J Forensic Med Toxicol. 2020;14(3):1569-75.
22. Arabaci Ü, Akdur H, Yigit Z. Effects of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients. Jpn Heart J. 2003;44(1):61-72.
23. Hagmeyer L, Randerath W. Smoking-related interstitial lung disease. Dtsch Arztebl Int. 2015;112(4):43-50.
24. Bédard A, Carsin A-E, Fuertes E, Accordini S, Dharmage SC, Garcia-Larsen V, et al. PLoS One. PloS one. 2020;15(8):e0237769.
25. Nonoyama ML, Kin SMR, Brooks D, Oh P. Comparison of cardiac rehabilitation outcomes in individuals with respiratory, cardiac or no comorbidities: a retrospective review. Can J Respir Ther. 2016;52(2):43-9.
26. Toor H, Kashyap S, Yau A, Simoni M, Farr S, Savla P, et al. Efficacy of incentive spirometer in increasing maximum inspiratory volume in an out-patient setting. Cureus. 2021;13(10):e18483.
27. Freitas ER, Soares BG, Cardoso JR, Atallah ÃN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev. 2007;18(3):CD004466.
28. Sweity EM, Alkaissi AA, Othman W, Salahat A. Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial. J Cardiothorac Surg. 2021;16(1):241.
2. Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Blair SN. Age-specific exercise capacity threshold for mortality risk assessment in male veterans. Circulation. 2014;130(8):653-8.
3. BACPR. The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2023. London: The British Association for Cardiovascular Prevention and Rehabilitation; 2023.
4. Dor-Haim H, Barak S, Horowitz M, Yaakobi E, Katzburg S, Swissa M, et al. Improvement in cardiac dysfunction with a novel circuit training method combining simultaneous aerobic-resistance exercises. A randomized trial. PLoS One. 2018;13(1):e0188551.
5. Silva M, Baptista L, Neves R, França E, Loureiro H, Rezende M, et al. High intensity interval training improves health-related quality of life in adults and older adults with diagnosed cardiovascular risk. J Phys Educ Sport. 2019;19(01):611-8.
6. Stern G, Psycharakis SG, Phillips SM. Effect of high-intensity interval training on functional movement in older adults: a systematic review and meta-analysis. Sports Med Open. 2023;9(1):5.
7. MarÃn-Pagán C, Blazevich AJ, Chung LH, Romero-Arenas S, Freitas TT, Alcaraz PE. Acute physiological responses to high-intensity resistance circuit training vs. traditional strength training in soccer players. Biology (Basel). 2020;9(11):383.
8. 9 science-backed benefits of circuit training [Internet]. 2021 [cited 2025 February 26]. Available from: https://www.healthline.com/health/fitness/benefits-of-circuit-training.
9. Fan Y, Yu M, Li J, Zhang H, Liu Q, Zhao L, et al. Efficacy and safety of resistance training for coronary heart disease rehabilitation: a systematic review of randomized controlled trials. Front Cardiovasc Med. 2021;8:754794.
10. Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee D-c, et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation. 2024;149(3):e217-e31.
11. Nazir A, Heryaman H, Juli C, Ugusman A, Martha JW, Moeliono MA, et al. Resistance training in cardiovascular diseases: A review on its effectiveness in controlling risk factors. Integr Blood Press Control. 2024;17:21-37.
12. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension. 2011;58(5):950-8.
13. ACSM. ACSM's resource manual for guidelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
14. ACSM. ACSM’s guidelines for exercise testing and prescription 11 ed. Philadelphia: Wolters Kluwer; 2022.
15. AACVPR. Guidelines for cardiac rehabilitation and secondary prevention programs. 5th ed. Champaign: Human Kinetics; 2013.
16. El-Sobkey SB. Resistance training is an effective exercise therapy in cardiac rehabilitation program for patients with coronary artery disease: a systematic review. Beni Suef Univ J Basic Appl Sci. 2022;11(1):22.
17. Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, et al. Exercise intolerance in patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(17):2209-25.
18. Naclerio FJ, Jiménez A, Alvar BA, Peterson MD. Assessing strength and power in resistance training. J Hum Sport Exerc. 2009;4(II):100-13.
19. Thomas E, Bianco A, Mancuso EP, Patti A, Tabacchi G, Paoli A, et al. The effects of a calisthenics training intervention on posture, strength and body composition. Isokinet Exerc Sci 2017;25(3):215-22.
20. Uhlemann M, Adams V, Lenk K, Linke A, Erbs S, Adam J, et al. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial): study protocol for a randomized controlled trial. Trials. 2012;13:167.
21. Mustafa MA, Jabbar DA, Mohammed HQ, Luaibi SI, Al-Ghrebawi RH. Effect of percutaneous coronary intervention (PCI) upon lung functions among patients with ischemic heart disease at Al-Najaf Cardiac Center: Correlation Study. Indian J Forensic Med Toxicol. 2020;14(3):1569-75.
22. Arabaci Ü, Akdur H, Yigit Z. Effects of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients. Jpn Heart J. 2003;44(1):61-72.
23. Hagmeyer L, Randerath W. Smoking-related interstitial lung disease. Dtsch Arztebl Int. 2015;112(4):43-50.
24. Bédard A, Carsin A-E, Fuertes E, Accordini S, Dharmage SC, Garcia-Larsen V, et al. PLoS One. PloS one. 2020;15(8):e0237769.
25. Nonoyama ML, Kin SMR, Brooks D, Oh P. Comparison of cardiac rehabilitation outcomes in individuals with respiratory, cardiac or no comorbidities: a retrospective review. Can J Respir Ther. 2016;52(2):43-9.
26. Toor H, Kashyap S, Yau A, Simoni M, Farr S, Savla P, et al. Efficacy of incentive spirometer in increasing maximum inspiratory volume in an out-patient setting. Cureus. 2021;13(10):e18483.
27. Freitas ER, Soares BG, Cardoso JR, Atallah ÃN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev. 2007;18(3):CD004466.
28. Sweity EM, Alkaissi AA, Othman W, Salahat A. Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial. J Cardiothorac Surg. 2021;16(1):241.