The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: A systematic review and meta-analysis of randomised controlled trials

Abstract

Design We aimed to evaluate the effect of progressive resistance training on cardiorespiratory fitness and muscular strength in coronary heart disease, when compared to control or aerobic training, and when combined with aerobic training. Secondary aims were to evaluate the safety and efficacy of progressive resistance training on other physiological and clinical outcomes. Methods and results Electronic databases were searched from inception until July 2016. Designs included progressive resistance training vs control, progressive resistance training vs aerobic training, and combined training vs aerobic training. From 268,778 titles, 34 studies were included (1940 participants; 71.9% male; age 60 ± 7 years). Progressive resistance training was more effective than control for lower (standardized mean difference 0.57, 95% confidence interval (0.17-0.96)) and upper (1.43 (0.73-2.13)) body strength. Aerobic fitness improved similarly after progressive resistance training (16.9%) or aerobic training (21.0%); (standardized mean difference -0.13, 95% confidence interval (-0.35-0.08)). Combined training was more effective than aerobic training for aerobic fitness (0.21 (0.09-0.34), lower (0.62 (0.32-0.92)) and upper (0.51 (0.27-0.74)) body strength. Twenty studies reported adverse event information, with five reporting 64 cardiovascular complications, 63 during aerobic training. Conclusion Isolated progressive resistance training resulted in an increase in lower and upper body strength, and improved aerobic fitness to a similar degree as aerobic training in coronary heart disease cohorts. Importantly, when progressive resistance training was added to aerobic training, effects on both fitness and strength were enhanced compared to aerobic training alone. Reporting of adverse events was poor, and clinical gaps were identified for women, older adults, high intensity progressive resistance training and long-term outcomes, warranting future trials to confirm safety and effectiveness.

Recommendations for resistance exercise in cardiac rehabilitation: Do they need reconsideration?

“…This controversy is evident in clinical practice 8 as well as in the available study results, where the training intensity has been set between 30 and 80% of one repetition maximum (1RM), which makes it difficult to evaluate the overall results. [8][9][10] The former reluctance to implement resistance training in cardiac rehabilitation was mainly based on the caution that its performance may lead to an inadequate blood pressure response and/or other inadequate cardiovascular responses. However, an inadequate response can be avoided by taking into account influencing factors, such as the mode of exercise (the isometric/isotonic components), the amount of the muscle mass used, the exercise intensity, the number and speed/rhythm of repetitions, the duration of loading, the number of sets and the resting period between sets.…”

“…25 Analogue to the discussion of high-intensity aerobic interval training, the discussion about high-intensity resistance exercise should be guided by high-quality research that evaluates the acute response of different exercise intensities on the cardiovascular response in different groups of cardiac patients. 10 In addition, we need to carry out randomized controlled studies evaluating different resistance exercise protocols and their effect on muscular strength and neural adaptations, as well as metabolic adaptations in a broad group of cardiac patients. 10 These studies should also systematically document adverse events to report the safety aspects of such exercises.…”

Efectos del entrenamiento aeróbico y de fuerza combinados vs entrenamiento aeróbico sobre capacidad aeróbica y fuerza muscular en pacientes con enfermedad de las arterias coronarias

“…El entrenamiento aeróbico y de fuerza combinados (EAFC) ha sido menos analizado, obteniendo mayores mejorías sobre capacidad aeróbica y fuerza muscular en comparación al EA (Marzolini, Oh, & Brooks, 2012). Sin embargo, no se han comparado revisiones sistemáticas y no se conocen los efectos del EAFC sobre otras variables relevantes en la RC de esta población, como calidad de vida o composición corporal (Hollings, Mavros, Freeston, & Singh, 2017).…”

“…Al ser evaluado por texto completo, se excluyó 1 estudio por no contener EAFC (Yamamoto et al, 2016). En total se incluyeron 3 estudios, 1 identificado en la búsqueda de la base de datos PubMed (Marzolini et al, 2012) y 2 identificados en la búsqueda manual (Hollings et al, 2017, Xanthos, Gordon, & Kingsley, 2017. Un resumen de los estudios incluidos se presenta en la Tabla 2.…”

Strength and aerobic exercise training in coronary artery disease; it's not ‘either-or’

“…It is therefore of vital importance when, in a recent issue of the journal, Hollings and co-workers 39 report the results of a meta-analysis of randomised trials that examined the effect and safety of progressive resistance training (PRT) on cardiorespiratory fitness and muscular strength compared to control (CT), AT or PRT in combination with AT.…”