Resting heart rate (HR) and HR variability (HRV) are known to predict mortality in patients after myocardial infarction (MI).

We assessed acute and chronic effects of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise (MICE) on HR and HRV in individuals after acute ST-segment elevation MI (STEMI).

Participants within 7 weeks after MI were randomly assigned to HIIT or MICE groups for a 9-week intervention. HR and the power spectrum of HRV were measured pre- and post-intervention by using orthostatic challenge and during sleep to assess chronic effects. Sleep measurements were performed at night after HIIT, MICE or no training to assess acute effects. Mixed models assessed time*group interaction for differences in chronic and acute effects, adjusted for beta-blocker dose and number of training sessions.

Overall, 34 of 37 and 35 of 36 participants in the HIIT and MICE groups completed the study. We found a trend for an acute increase in HR of 2.5 bpm (4%, P=0.023) during sleep after HIIT. We found a trend for a chronic decrease in HR during supine and standing position as well as during sleep in the MICE group but a trend for an increase in HR during supine and standing position in the HIIT group. Low- and high-frequency power (LF, HF) of the standing segment increased from pre- to post-intervention in the MICE group but decreased in the HIIT group (group*time interaction P=0.005 and P=0.026, respectively).

HR during sleep tended to be increased acutely during the night after HIIT but not after MICE as compared with controls. Chronic effects on resting HR, HF and LF tended to be more beneficial after MICE than HIIT in individuals with recent STEMI.