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New AHA Statement Touts Benefits of Resistance Training for Cardiovascular Health

Posted: Wednesday, July 30, 2008

There are "singular" benefits to improving muscular strength in addition to regular aerobic exercise.

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, stated 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.

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

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.

"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."

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.

Practice Pearls

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.

Source: Diabetes In Control: Circulation. Published online July 16, 2007.