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Resistance Training for Cardiovascular Health

New AHA Statement Touts Benefits of Resistance Training for Cardiovascular Health

New AHA Statement Touts Benefits of Resistance Training for Cardiovascular Health  CME/CE

News Author: Shelley Wood
CME Author: Laurie Barclay, MD

Disclosures

Release Date: July 20, 2007

from Heartwire — a professional news service of WebMD

July 20, 2007 — A new AHA scientific statement summarizing recommendations for resistance training in people with and without cardiovascular disease (CVD) should serve as a reminder to clinicians that there are "singular" benefits to improving muscular strength in addition to regular aerobic exercise, experts say. Dr Mark Williams (Creighton University, Omaha, NE) who led the writing group, told heartwire that there is important new information in the statement, that updates the original resistance training guidelines of 2000.

Despite this being the second set of recommendations on this topic to come from the American Heart Association (AHA), Williams says physicians may still overlook resistance exercise — lifting weights, or exerting force against resistance — as part of cardiovascular (CV) fitness regimen.

"Telling someone to exercise typically does either directly or indirectly suggest that they should be doing more walking," he told heartwire. "I don't think resistance training is frequently thought of as part of an overall exercise program."

The statement was published in a rapid access issue of Circulation, July 16, 2007.

Resistance Training Additive to Aerobic Exercise

The statement reviews the health benefits of resistance training and its impact on the CV function. It also summarizes the role of resistance training in modifying CVD risk factors, its benefit in specific CVD populations, and provides recommendations on evaluating patients prior to starting a resistance training regimen and suggestions for how such a regimen could be prescribed.

Williams highlighted a table in the AHA statement that compares the effects of aerobic activities and resistance training on different parameters, noting that some clinicians may be unaware of the differential effects. For example, while aerobic exercise can have moderate effects on percent body fat, compared with merely a small effect of resistance training, resistance training has moderate effects on lean body mass, and major effects on muscle strength, while aerobic exercise has no effect, and minimal effects, respectively. By contrast, both aerobic and resistance exercise produce similarly small effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, while aerobic exercise has greater effects than resistance training on triglycerides. Importantly, both forms of exercise can have similar effects on quality of life.

Williams pointed out that the importance of resistance training is now fairly well recognized in cardiac rehabilitation programs, but its benefits are less commonly appreciated in primary prevention. He also highlighted the role of resistance training in groups where it has been used the least: in older women, the elderly, and in patients with heart failure.

"People with heart failure have significantly dysfunctional hearts and as a result of that, their peripheral musculature and their ability to get around and do the things they need to do is significantly and negatively impacted by the fact that they have heart failure," Williams said. "We have been including patients with heart failure in our aerobic cardiac rehabilitation programs, but now there are data to suggest that patients, under appropriate evaluation and supervision, can improve functional capacity, physical strength, endurance, and quality of life by incorporating some resistance training into their exercise programs, too."

Just Do It — Correctly

Proper instruction and technique is essential for anyone beginning resistance training for the first time, but it is especially important for people with existing cardiovascular disease, Williams noted.

"Patients who come into cardiac rehabilitation programs typically get that kind of instruction, but people who are not participating in those formal kinds of programs should get in touch with an exercise specialist, or a physical therapist to provide some input on how to be doing resistance training properly. And the key there is that patients who do have cardiovascular disease need to identify themselves as such, so people don't assume they are healthy and give them instructions that would be inappropriate."

Of note, Williams added, in all of the research to date, there are almost no reports of significant adverse effects of resistance training, although these were all supervised, controlled studies where risk is minimized. "The downsides are there, but the upsides are greater, and the downsides appear mostly to be related to the fact that people do things they shouldn't be doing, or don't seek advice or evaluation prior to starting," he said.

The authors have disclosed no relevant financial relationships.

Circulation. Published online July 16, 2007.

The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

Clinical Context

In persons with and without CVD, supervised resistance training improves muscular strength and endurance, functional capacity and independence, and quality of life while reducing disability. The AHA published guidelines in 2000 describing the rationale for participation and considerations for prescribing resistance training.

This updated AHA statement describes current evidence concerning the health benefits of resistance training, the effect of resistance training on cardiovascular structure and function, the role of resistance training in modifying CVD risk factors, benefits of resistance training in selected populations, the process of medical evaluation for participation in resistance training, and methods for prescribing resistance training.

Study Highlights

  • Since the AHA first published resistance training guidelines in 2000, resistance training has become even more accepted and used in exercise training programs for individuals with and without CVD.
  • Potential benefits may include enhanced cardiovascular health, weight management, and prevention of disability and falls.
  • Persons at low risk for cardiac events do not require extensive cardiovascular screening before starting resistance training, but a graded approach is recommended.
  • With proper preparation, guidance, and surveillance, persons at moderate to high risk for cardiac events can safely undertake resistance training.
  • Incorporating resistance training in the training regimen can potentially improve maintenance of interest and compliance. Because of the extensive evidence supporting the benefits of aerobic exercise training on modulating cardiovascular risk factors, however, resistance training should be used as a complement to, and not a replacement for, aerobic exercise.
  • Absolute contraindications to resistance training include unstable coronary heart disease; decompensated heart failure; uncontrolled arrhythmias; severe pulmonary hypertension with mean pulmonary arterial pressure greater than 55 mm Hg; severe and symptomatic aortic stenosis; acute myocarditis, endocarditis, or pericarditis; uncontrolled hypertension (> 180/110 mm Hg); aortic dissection; Marfan's syndrome; and high-intensity resistance training, defined as 80% to 100% of 1-repetition maximum, in patients with active proliferative retinopathy or moderate or worse nonproliferative diabetic retinopathy.
  • Patients with relative contraindications to resistance training should consult a healthcare provider before participation. These include major risk factors for coronary heart disease, diabetes at any age, uncontrolled hypertension (> 160 / > 100 mm Hg), low functional capacity (< 4 metabolic equivalents), musculoskeletal limitations, and implanted pacemakers or defibrillators.
  • Recommendations for the initial prescription of resistance training are that it should be performed in a rhythmic manner at a moderate to slow controlled speed. It should encompass a full range of motion. Breath-holding and straining (Valsalva maneuver) should be avoided by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase.
  • In addition, resistance training should alternate between upper and lower body work, allowing adequate rest between exercises. The initial weight load should not exceed 8 to 12 repetitions per set for healthy sedentary adults or 10 to 15 repetitions at a low level of resistance (eg, less than 40% of 1-repetition maximum) for older individuals (aged > 50 to 60 years), more frail persons, or cardiac patients.
  • At first, resistance training should not exceed a single set performed 2 days/week. It should involve the major muscle groups of the upper and lower extremities. Suitable exercises include chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower-back extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise.

Pearls for Practice

  • Absolute contraindications to resistance training include unstable coronary heart disease; decompensated heart failure; uncontrolled arrhythmias; severe pulmonary hypertension; severe and symptomatic aortic stenosis; acute myocarditis, endocarditis, or pericarditis; uncontrolled hypertension; aortic dissection; Marfan's syndrome; and high-intensity resistance training in patients with active proliferative retinopathy or moderate or worse nonproliferative diabetic retinopathy.
  • Recommendations for the initial prescription of resistance training include performing it in a rhythmic manner at a moderate to slow controlled speed through a full range of motion without breath-holding or straining, alternating between upper and lower body work, and involving the major muscle groups of the upper and lower extremities.

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