Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation

Abstract

Aerobic endurance training has been an integral component of the international recommendations for cardiac rehabilitation for more than 30 years. Notwithstanding, only in recent years have recommendations for a dynamic resistance-training program been cautiously put forward. The perceived increased risk of cardiovascular complications related to blood pressure elevations are the primary concern with resistance training in cardiac patients; recent studies however have demonstrated that this need not be a contraindication in all cardiac patients. While blood pressure certainly may rise excessively during resistance training, the actual rise depends on a variety of controllable factors including magnitude of the isometric component, the load intensity, the amount of muscle mass involved as well as the number of repetitions and/or the load duration. Intra-arterial blood pressure measurements in cardiac patients have demonstrated that that during low-intensity resistance training [40-60% maximum voluntary contraction (MVC)] with 15-20 repetitions, only modest elevations in blood pressure are revealed, similar to those seen during moderate endurance training. When properly implemented by an experienced exercise therapist, in specific patient groups an individually tailored, medically supervised dynamic resistance training program carries no inherent higher risk for the patient than aerobic endurance training. As an adjunct to endurance training, in selected patients, resistance training can increase muscle strength and endurance, as well as positively influence cardiovascular risk factors, metabolism, cardiovascular function, psychosocial well-being and quality of life. According to present data, resistance training is however not recommended for all patient groups. The appropriate training method and correct performance are highly dependent on each patient's clinical status, cardiac stress tolerance and possible comorbidities. Most studies have used middle-aged men of average normal aerobic performance capacity and with good left-ventricular (LV) function. Data are lacking for high-risk groups, women and older patients. With the current knowledge it is reasonable to include resistance training without any restraints as part of cardiac rehabilitation programs for coronary artery disease (CAD) patients with good cardiac performance capacity (i.e., revascularised and with good myocardial function). As patients with myocardial ischaemia and/or poor left ventricular function may develop wall motion disturbances and/or severe ventricular arrhythmias during resistance exercise, the following criteria are suggested for resistance training: moderate-to-good LV function, good cardiac performance capacity [>5-6 metabolic equivalents of oxygen consumption (METS)=1.4 watt/kg body weight], no symptoms of angina pectoris or ST segment depression under continued maintenance of the medical therapy. Based on available data, this article presents recommendations for risk stratification in cardiac rehabilitation programs with respect to ...

Respostas hemodinâmicas a um protocolo de treinamento isométrico de preensão manual

“…In fact, in many everyday situations, human beings need to perform movements that require significant amounts of strength and muscular power 5,6 . While in the past, predominantly static exercises were prohibited for most individuals with hypertension and heart disease, more recent institutional guidelines 4,[7][8][9][10] have been promoting, to a greater or lesser extent, the progressive use of these exercises in clinical practice.…”

“…Throughout time, these exercises were progressively replaced by joint movement or dynamic exercises and are currently rarely used as part of the strength training of a cardiac rehabilitation session 8 . Nevertheless, it has been known for many years that an isometric handgrip exercise during cardiac catheterization induces hemodynamic and ventricular function responses 11 , and it was around 1990, with the advent of modern non-invasive techniques for the study of vascular and autonomic functions that the interest in this kind of exercise was renewed, as a possibility that can favorably influence the pressure behavior of normotensive and even hypertensive individuals.…”

A Percepção de Esforço no Treinamento de Força

“…A PE é um método de mensuração e monitoração da intensidade do esforço utilizada em áreas do treinamento físico. Apesar de ser principalmente empregada em exercícios de características aeróbicas, o uso da PE nas salas de musculação para o auxílio na determinação da intensidade utilizada tem sido observada (4,5) , sendo recomendado por diferentes pesquisadores e instituições internacionais reconhecidas (American College of Sports and Medicine, American Heart Association) (6)(7)(8)(9) . Contudo, é importante ressaltar que a sua utilização e suas recomendações estabelecidas até então são feitas sem haver um referencial teórico que embase e sustente a sua utilização no treinamento de força (TF).…”

Resposta pressórica após exercício resistido de diferentes segmentos corporais em hipertensos

“…From the measurements of weight and height obtained, the body mass index (BMI) = weight/height 2 (kg/m 2 ) was calculated for classifying the nutritional status 14 .…”

“…Although the latest guidelines for control of HBP have recommended that resistance exercise should be add to the aerobic exercise component in the physical training program targeted for hypertensive patients, it has not been widely incorporated yet into the clinical practice 5,[12][13][14] . Additionally, it is not known whether resistance exercise of different body segments promotes distinct pressure responses.…”