Combined endurance–resistance training improves submaximal exercise capacity in elderly heart failure patients: A systematic review of randomized controlled trials

The ‘aerobic/resistance/inspiratory muscle training hypothesis in heart failure’

Evidence from large multicentre exercise intervention trials in heart failure patients, investigating both moderate continuous aerobic training and high intensity interval training, indicates that the ‘crème de la crème’ exercise programme for this population remains to be found. The ‘aerobic/resistance/inspiratory (ARIS) muscle training hypothesis in heart failure’ is introduced, suggesting that combined ARIS muscle training may result in maximal exercise pathophysiological and functional benefits in heart failure patients. The hypothesis is based on the decoding of the ‘skeletal muscle hypothesis in heart failure’ and on revision of experimental evidence to date showing that exercise and functional intolerance in heart failure patients are associated not only with reduced muscle endurance, indication for aerobic training (AT), but also with reduced muscle strength and decreased inspiratory muscle function contributing to weakness, dyspnoea, fatigue and low aerobic capacity, forming the grounds for the addition of both resistance training (RT) and inspiratory muscle training (IMT) to AT. The hypothesis will be tested by comparing all potential exercise combinations, ARIS, AT/RT, AT/IMT, AT, evaluating both functional and cardiac indices in a large sample of heart failure patients of New York Heart Association class II–III and left ventricular ejection fraction ≤35% ad hoc by the multicentre randomized clinical trial, Aerobic Resistance, InSpiratory Training OutcomeS in Heart Failure (ARISTOS-HF trial).

Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials

OBJECTIVE

To summarise all meta-analyses of randomised controlled trials that have evaluated the effects of exercise therapy on functional capacity in patients with chronic diseases.

DESIGN

Umbrella review of meta-analyses of randomised controlled trials.

DATA SOURCES

We systematically searched the CENTRAL, CINAHL, DARE, Medline, OTSeeker, PEDro, SPORTDiscus, ProQuest Nursing & Allied Health Database, Web of Science, Scopus, OpenGrey and BMC Proceedings from database inception to 1 September 2016.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included meta-analyses that compared the effects of exercise therapy with no treatment or usual care in adults with non-communicable chronic diseases and included outcomes related to functional capacity. We excluded meta-analyses with less than 100 patients.

RESULTS

Eighty-five meta-analyses with 22 different chronic diseases were included. The exercise interventions resulted in statistically significant (p<0.05) improvements for 126 of 146 (86%) functional capacity outcomes, compared with the control group. The standardised mean differences were small in 64 (44%), moderate in 54 (37%) and large in 28 (19%) of the 146 functional capacity outcomes. The results were similar for aerobic exercise, resistance training, and aerobic and resistance training combined. There were no significant differences in serious adverse effects between the intervention and control groups in any of the meta-analyses.

CONCLUSION

Exercise therapy appears to be a safe way to improve functional capacity and reduce disability in individuals with chronic disease.

Molecular effects of exercise training in patients with cardiovascular disease: focus on skeletal muscle, endothelium, and myocardium

For decades, we have known that exercise training exerts beneficial effects on the human body, and clear evidence is available that a higher fitness level is associated with a lower incidence of suffering premature cardiovascular death. Despite this knowledge, it took some time to also incorporate physical exercise training into the treatment plan for patients with cardiovascular disease (CVD). In recent years, in addition to continuous exercise training, further training modalities such as high-intensity interval training and pyramid training have been introduced for coronary artery disease patients. The beneficial effect for patients with CVD is clearly documented, and during the last years, we have also started to understand the molecular mechanisms occurring in the skeletal muscle (limb muscle and diaphragm) and endothelium, two systems contributing to exercise intolerance in these patients. In the present review, we describe the effects of the different training modalities in CVD and summarize the molecular effects mainly in the skeletal muscle and cardiovascular system.

LIMIAR ANAERÓBIO EM EXERCÍCIOS RESISTIDOS: ANÁLISE DE ASPECTOS METODOLÓGICOS E HEMODINÂMICOS

Introdução A determinação do limiar anaeróbio em exercícios resistidos tem sido tema de diversos estudos. No entanto, o impacto desta avaliação sobre os parâmetros hemodinâmicos de pressão arterial e frequência cardíaca ainda é desconhecido. Objetivo Comparar a estimativa do limiar anaeróbio (LAn) obtido em teste e reteste de protocolo incremental nos exercícios resistidos de supino reto (SR) e rosca direta (RD) e analisar o comportamento das variáveis hemodinâmicas de frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólica (PAD) durante protocolo de cargas incrementais. Métodos Oito voluntários do sexo masculino praticantes de treinamento resistido foram recrutados e realizaram quatro testes de cargas incrementais (dois no SR e dois na RD) em dias distintos para a determinação do LAn. Durante cada teste, as variáveis de lactato sanguíneo, FC, PAS e PAD foram mensuradas ao final de cada estágio. Resultados Os valores do LAn expressos em porcentagens da carga máxima (1-RM) para o SR em teste e reteste foram de 19,7±4,0% e 18,4±3,4% respectivamente e para RD de 17,7±3,4% e 19,4±3,1% respectivamente, não sendo identificadas diferenças estatísticas entre estas. No decorrer dos testes, a FC variou em média entre 90 e 135bpm para SR e entre 98 a 150bpm para RD. Apenas a PAS se alterou no decorrer dos testes, variando entre 111,8 a 123,3mmHg no SR e entre 119,4 a 141,3mmHg na RD. Conclusão Tais resultados nos sugerem que a intensidade relativa ao LAn não é diferente para SR ou RD em teste ou reteste. Não obstante, apesar de diferenças nos comportamentos hemodinâmicos entre os tipos de exercícios (SR vs. RD), os valores de FC e PAS se elevaram dentro de limites clinicamente aceitáveis, como sugerido pela literatura.

Exercise training in patients with heart disease: review of beneficial effects and clinical recommendations

Over the last decades exercise training has evolved into an established evidence-based therapeutic strategy with prognostic benefits in many cardiovascular diseases (CVDs): In stable coronary artery disease (CAD) exercise training attenuates disease progression by beneficially influencing CVD risk factors (i.e., hyperlipidemia, hypertension) and coronary endothelial function. In heart failure (HF) with reduced ejection fraction (HFrEF) training prevents the progressive loss of exercise capacity by antagonizing peripheral skeletal muscle wasting and by promoting left ventricular reverse remodeling with reduction in cardiomegaly and improvement of ejection fraction. Novel areas for exercise training interventions include HF with preserved ejection fraction (HFpEF), pulmonary hypertension, and valvular heart disease. In HFpEF, randomized studies indicate a lusitropic effect of training on left ventricular diastolic function associated with symptomatic improvement of exercise capacity. In pulmonary hypertension, reductions in pulmonary artery pressure were observed following endurance exercise training. Recently, innovative training methods such as high-intensity interval training, resistance training and others have been introduced. Although their prognostic value still needs to be determined, these approaches may achieve superior improvements in aerobic exercise capacity and gain in muscle mass, respectively. In this review, we give an overview of the prognostic and symptomatic benefits of exercise training in the most common cardiac disease entities. Additionally, key guideline recommendations for the initiation of training programs are summarized.