Combined high-intensity strength and aerobic training in diverse phase II cardiac rehabilitation patients

Lean Mass Abnormalities in Heart Failure: The Role of Sarcopenia, Sarcopenic Obesity, and Cachexia

The role of body composition in patients with heart failure (HF) has been receiving much attention in the last few years. Particularly, reduced lean mass (LM), the best surrogate for skeletal muscle mass, is independently associated with abnormal cardiorespiratory fitness (CRF) and muscle strength, ultimately leading to reduced quality of life and worse prognosis. While in the past, reduced CRF in patients with HF was thought to result exclusively from cardiac dysfunction leading to reduced cardiac output at peak exercise, current evidence supports the concept that abnormalities in LM may also play a critical role. Abnormalities in the LM body composition compartment are associated with the development of sarcopenia, sarcopenic obesity, and cachexia. Such conditions have been implicated in the pathophysiology and progression of HF. However, identification of such conditions remains challenging, as universal definitions for sarcopenia, sarcopenic obesity, and cachexia are lacking. In this review article, we describe the most common body composition abnormalities related to the LM compartment, including skeletal and respiratory muscle mass abnormalities, and the consequences of such anomalies on CRF and muscle strength in patients with HF. Finally, we discuss the potential nonpharmacologic therapeutic strategies such as exercise training (ie, aerobic exercise and resistance exercise) and dietary interventions (ie, dietary supplementation and dietary patterns) that have been implemented to target body composition, with a focus on HF.

Relation between serum myokines and phase II cardiac rehabilitation

Patients with coronary heart disease or acute myocardial infarction after cardiac catheterization with stenting referred for phase II cardiac rehabilitation (CR) were grouped according to their preference. Cardio-pulmonary exercise testing (CPET) was used to determine oxygen uptake ((Equation is included in full-text article.)) at peak exercise and anaerobic threshold (AT). The control patients received counseling only while the experiment group received 36 sessions of CR in 3 to 6 months. Exercise physiology parameters and serum myokines (myostatin, insulin-like growth factor-1 (IGF-1), and interleukin-6 (IL-6) were measured pre- and postrehabilitation.There were 29 patients in the experiment group and 10 in the control group, with no significant differences in baseline parameters. The experiment group had prominent progress in aerobic capacity and body composition after CR, but their serum myokine concentrations did not change significantly. Serum myostatin is positively correlated to peak (Equation is included in full-text article.)pre- and post-training, and pretraining AT (Equation is included in full-text article.), after adjusting for age, sex, and body composition. Serum IGF-1 is positively correlated with grip strength before training.Serum myostatin level is positively correlated to aerobic capacity, and IGF-1 level is positively correlated to grip strength in cardiac patients receiving CR.

Implementing resistance training in the rehabilitation of coronary heart disease: A systematic review and meta-analysis

BACKGROUND

Resistance training has demonstrated efficacy in cardiac rehabilitation programs, but the optimal prescription of resistance training is unknown. This systematic review with meta-analysis compared the effectiveness of cardiac rehabilitation consisting of resistance training either alone (RT) or in combination with aerobic training (CT) with aerobic training only (AT) on outcomes of physical function. Further, resistance training intensity and intervention duration were examined to identify if these factors moderate efficacy.

METHODS

Six electronic databases were searched to identify studies investigating RT, coronary heart disease and physical function. The overall quality of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible and qualitative analysis was performed for the remaining data.

RESULTS

Improvements in peak oxygen uptake (WMD: 0.61, 95% CI: 0.20-1.10), peak work capacity (SMD: 0.38, 95% CI: 0.11-0.64) and muscular strength (SMD: 0.65, 95% CI: 0.43-0.87) significantly favoured CT over AT with moderate quality evidence. There was no evidence of a difference in effect when comparing RT and AT. Shorter duration CT was superior to shorter duration AT for improving peak oxygen uptake and muscular strength (low quality evidence) while longer duration CT was only superior to longer duration AT in improving muscular strength (moderate quality evidence).

CONCLUSIONS

CT is more beneficial than AT alone for improving physical function. Although preliminary findings are promising, more high-quality evidence is required to determine the efficacy of high intensity resistance training. Shorter duration interventions that include resistance training might allow patients to return to their normal activities of daily living earlier.

Effects of pomegranate extract on blood flow and vessel diameter after high-intensity exercise in young, healthy adults

The effects of pomegranate extract (PE) supplementation were evaluated on high-intensity exercise performance, blood flow, vessel diameter, oxygen saturation (SPO₂), heart rate (HR), and blood pressure (BP). In a randomized, crossover design, nineteen recreationally resistance-trained participants were randomly assigned to PE (1000 mg) or placebo (PL), which were consumed 30 min prior to a repeated sprint ability (RSA) test and repetitions to fatigue (RTF) on bench and leg press. The RSA consisted of ten six-second sprints on a friction-loaded cycle ergometer with 30 s recovery. Brachial artery blood flow and vessel diameter were assessed by ultrasound. Blood flow, vessel diameter, SPO₂, HR, and BP were assessed at baseline, 30 min post ingestion, immediately post exercise (IPost), and 30 min post exercise (30minPost). With PE, blood flow significantly increased IPost RSA (mean difference = 18.49 mL min^-1; P < .05), and IPost and 30minPost RTF (P < .05) according to confidence intervals (CI). Vessel diameter increased significantly 30minPost RSA according to CI and resulted in a significant interaction IPost and 30minPost RTF (P < .05). With PE, according to CI, average and peak power output increased significantly in sprint 5 of the RSA (P < .05). There was no significant difference between PE and PL for bench (P = .25) or leg press (P = .15) repetitions. Acute PE supplementation enhanced vessel diameter and blood flow, suggesting possible exercise performance enhancement from increased delivery of substrates and oxygen. The acute timing and capsule form of PE may be advantageous to athletic populations due to ergogenic effects, taste, and convenience.

Women and cardiac rehabilitation: A review of the literature

There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.

Physical exercise and health

Regular physical exercise is an established recommendation for preventing and treating the main modifiable cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. Performing physical activity of moderate intensity for a minimum of 30 min 5 days a week or of high intensity for a minimum of 20 min 3 days a week improves functional capacity and is associated with reductions in the incidence of cardiovascular disease and mortality. Physical exercise induces physiological cardiovascular adaptations that improve physical performance, and only in extreme cases can these adaptations lead to an increased risk of physical exercise-associated complications. The incidence of sudden death or serious complications during physical exercise is very low and is concentrated in people with heart diseases or with pathological cardiac adaptation to exercise. Most of these cases can be detected by cardiology units or well-trained professionals.

Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial

This study aims to evaluate the effect of 18-week progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, in prevention of falls in postmenopausal women with osteoporosis. The incidence of falls in the intervention group was significantly lower than in the control group (incidence rate ratio (IRR) = 0.263, 95% CI 0.10-0.68).

INTRODUCTION

This study aims to evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, balance, quality of life, and reduction in the risk of falls in postmenopausal women with osteoporosis.

METHODS

One hundred sedentary postmenopausal women with osteoporosis, ages ranging from 55 to 75, were selected and randomized into two groups: the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle (50% up to 80% of 1-RM-one maximum repetition) and proprioception training associated to a drug treatment of osteoporosis and the control group that included 50 patients who only underwent a drug treatment of osteoporosis. The muscular strength, balance, functional mobility, and quality of life were evaluated in the beginning and end of the research. The number of falls was evaluated 24 weeks post-treatment.

RESULTS

Eighty-five patients concluded the research. The program promoted a significant difference among the groups for SF-36 in the eight sub-scales (p <or= 0.0018), Timed Up & Go Test (p < 0.0001), 1-RM test (p < 0.0001), Berg Balance Scale (p < 0.0001) and also a decrease in the number of falls in the intervention group compared to control (IRR = 0.263, 95% CI 0.10-0.68, p = 0.0064).

CONCLUSION

The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities.

Financial, family, and social factors impacting on cardiac rehabilitation attendance

BACKGROUND

Attendance in phase 2 cardiac rehabilitation program after acute myocardial infarction is poor.

OBJECTIVE

To identify and explore the demographic factors that influence peoples' decisions to attend cardiac rehabilitation programs.

METHODS

A descriptive-interpretive design was used. Semi-structured interviews were conducted with 10 people post infarction in Victoria, Australia after their first scheduled appointment to attend outpatient cardiac rehabilitation. The interview transcripts were thematically analysed.

RESULTS

The perceived relevance of cardiac rehabilitation related to the context of people's lives, namely their financial, family and social situation, and how important program outcomes were seen to be relevant to this context.

CONCLUSION

The findings of this study suggest that there are a proportion of people unlikely to attend outpatient cardiac rehabilitation programs following an AMI despite encouragement to attend. It may be unrealistic to aim for 100% referral and uptake into cardiac rehabilitation programs and therefore an inappropriate endpoint by which to evaluate such programs.

A new paradigm for post-cardiac event resistance exercise guidelines

Existing guidelines for resistance exercise in cardiac rehabilitation are vague and/or overly restrictive, limiting the ability of cardiac rehabilitation programs to help patients achieve their desired levels of daily activity in a timely manner after cardiac events. This study examines the illogical nature of the existing guidelines in relation to the activities of daily living patients are expected or required to carry out during the period of cardiac rehabilitation and the existing recommendations for dynamic exercise in cardiac rehabilitation. An improved method is proposed for prescribing resistance exercise in cardiac rehabilitation. A tool is presented that stratifies the risk associated with each of 13 common resistance exercises for 3 cardiac rehabilitation diagnosis groups (myocardial infarction [MI], pacemaker or implantable cardioverter defibrillator implantation, and coronary artery bypass graft surgery) that, if used in conjunction with blood pressure and heart rate measurements, will safely facilitate more efficacious resistance training in cardiac rehabilitation patients. In conclusion, changing the approach to resistance exercise in cardiac rehabilitation will accelerate patients' return to their desired levels of daily activity, improving patient satisfaction and decreasing cardiac rehabilitation program attrition.

Physiological and health-related quality of life outcomes following cardiac rehabilitation after cardiac surgery

We investigated the changes of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQL) in Japanese cardiac surgery patients. Subjects were 47 consecutive outpatients (32 men, 15 women; mean age 59.4 ± 12.6 years) recovering from cardiac surgery. Patients performed both aerobic exercise on a treadmill at anaerobic threshold intensity and moderate resistance training 2 days per week, 60 min per session, from 1 to 3 months after cardiac surgery. Differences in the eight SF-36 subscale scores and physiological outcomes within the patient group at 1 month and at 3 months after cardiac surgery were analyzed. Peak oxygen uptake, handgrip strength, and knee extension strength were used as physiological outcome measures. HRQL was assessed with the Japanese version Medical Outcome Study Short Form 36 (SF-36). Significant change in overall physiological outcome from 1 month to 3 months was observed. There was also significant change in seven of the eight SF-36 health status subscale scores (physical functioning, role-physical, bodily pain, general health, vitality, role-emotional, and mental health). However, with the exception of physical functioning and mental health scores, values did not reach those of the average healthy Japanese. In conclusion, we found that CR exercise training for Japanese cardiac surgery patients during the recovery phase changes not only physiological outcomes but also HRQL as assessed by the SF-36.

Resistance Exercise Training in Patients with Heart Failure

The utility, safety and physiological adaptations of resistance exercise training in patients with chronic heart failure (CHF) are reviewed and recommendations based on current research are presented. Patients with CHF have a poor clinical status and impaired exercise capacity due to both cardiac limitations and peripheral maladaptations of the skeletal musculature. Because muscle atrophy has been demonstrated to be a hallmark of CHF, the main principle of exercise programmes in such patients is to train the peripheral muscles effectively without producing great cardiovascular stress. For this reason, new modes of training as well as new training methods have been applied. Dynamic resistance training, based on the principles of interval training, has recently been established as a safe and effective mode of exercise in patients with CHF. Patients perform dynamic strength exercises slowly, on specific machines at an intensity usually in the range of 50-60% of one repetition maximum; work phases are of short duration (< or =60 seconds) and should be followed by an adequate recovery period (work/recovery ratio >1 : 2). Patients with a low cardiac reserve can use small free weights (0.5, 1 or 3 kg), elastic bands with 8-10 repetitions, or they can perform resistance exercises in a segmental fashion. Based on recent scientific evidence, the application of specific resistance exercise programmes is safe and induces significant histochemical, metabolic and functional adaptations in skeletal muscles, contributing to the treatment of muscle weakness and specific myopathy occurring in the majority of CHF patients. Increased exercise tolerance and peak oxygen consumption (V-dotO(2peak)), changes in muscle composition, increases in muscle mass, alterations in skeletal muscle metabolism, improvement in muscular strength and endurance have also been reported in the literature after resistance exercise alone or in combination with aerobic exercise. According to new scientific evidence, appropriate dynamic resistance exercise should be recommended as a safe and effective alternative training mode (supplementary to conventional aerobic exercise) in order to counteract peripheral maladaptation and improve muscle strength, which is necessary for recreational and daily living activities, and thus quality of life, of patients with stable, CHF.

A meta-analysis of periodized versus nonperiodized strength and power training programs

The purpose of this study was to quantitatively combine and examine the results of studies examining the effectiveness of periodized (PER) compared to nonperiodized (Non-PER) training programs for strength and/or power development. Two analyses were conducted to (a) examine the magnitude of treatment effect elicited by PER strength training programs compared to Non-PER programs and (b) compare these effects after controlling for training volume, frequency, and intensity. Studies meeting the inclusion criteria were coded based on characteristics that might moderate the overall effects (i.e., participant characteristics and characteristics related to the training program). Effect sizes (ESs) were calculated for each study, and an overall ES of 0.84 (+/- 1.41) favoring PER training was found. Further analyses identified the treatment effect specific to training variation to be ES = 0.25. Significant moderating variables included age, training status, and length of training program. As a result of this statistical review of the literature, it is concluded that PER training is more effective than Non-PER training for men and women, individuals of varying training backgrounds, and for all age groups. In line with the overload principle, additions to volume, intensity, and frequency result in additional training adaptations.

[Strength training with elastic bands: measure of its effects in cardiac rehabilitation after coronary diseases]

OBJECTIVES

To compare high intensity strength training with weightlifting exercises or with elastic bands.

SETTING

Outpatient unit of cardiac rehabilitation. TYPE: Prospective randomised clinical trial.

POPULATION

Inclusion of coronary patients in phase II after medical or surgical treatment of a myocardiac infarction, without cardiac insufficiency; beta-blockers were accepted.

METHOD

Evaluation of coronary patients at beginning and at the end of a 4 week cardiac rehabilitation program. It included progressive aerobic training according to Karvonen method for all the patients, associated with weightlifting exercises (Koch press) in the control group, or use of elastic bands in the experimental group. Cardiac rate, oxygen consumption at rest and at maximum power were the main criteria with also muscle strength of quadriceps, hamstrings, biceps brachii, latissimus dorsi and triceps brachii, body mass indexes, quality of life with SF-36, anxiety (stay T test) and perceived exertion with the Borg 10-point category-ratio scale, myotendinous injuries (Shaw scale).

RESULTS

Twenty-six coronary patients, all male from 45 to 65 years old, all receiving beta-blockers, were included, 13 in each group. Control and experimental groups were initially similar. At the end of the 4 week program, all the two groups improved significantly their strength and power and there were no differences between the two groups. Perceived exertion was lower in the group using elastic bands and there were no myotendinous lesions.

CONCLUSION

Strength training with elastic bands is a low-cost, attractive, playful technique, proposed to a group of coronary patients, which appears as effective in cardiac rehabilitation as individual weightlifting training.

Improvement in Physiological Outcomes and Health-Related Quality of Life Following Cardiac Rehabilitation in Patients With Acute Myocardial Infarction

BACKGROUND

The present study examined the impact of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQOL) of patients with acute myocardial infarction (AMI).

METHODS AND RESULTS

A total of 124 consecutive AMI patients were divided into a supervised outpatient CR group (n=82) and a non-CR group as a control (n=42). Peak oxygen uptake, handgrip strength, and knee extension muscular strength were used as physiological outcome measures. HRQOL outcomes were assessed by the Medical Outcome Study Short Form 36 (SF-36). CR group patients performed both aerobic exercise and moderate resistance training from 1 month (T1) to 3 months (T2) after AMI onset. Age, sex, body mass index, medications, and ejection fraction were similar in both groups. Significantly greater increases in overall physiological outcomes from T1 to T2 were measured in the CR group compared with those of the non-CR group. There were also significantly greater improvements in 4 of the 8 SF-36 health status subscales (physical functioning, role-physical, general health, and vitality) in the CR group compared with the non-CR group.

CONCLUSIONS

Eight weeks of exercise training have specific effects on improvement in HRQOL and physiological outcomes in Japanese patients.

A meta-analysis to determine the dose response for strength development

PURPOSE

The identification of a quantifiable dose-response relationship for strength training is important to the prescription of proper training programs. Although much research has been performed examining strength increases with training, taken individually, they provide little insight into the magnitude of strength gains along the continuum of training intensities, frequencies, and volumes. A meta-analysis of 140 studies with a total of 1433 effect sizes (ES) was carried out to identify the dose-response relationship.

METHODS

Studies employing a strength-training intervention and containing data necessary to calculate ES were included in the analysis.

RESULTS

ES demonstrated different responses based on the training status of the participants. Training with a mean intensity of 60% of one repetition maximum elicits maximal gains in untrained individuals, whereas 80% is most effective in those who are trained. Untrained participants experience maximal gains by training each muscle group 3 d.wk and trained individuals 2 d.wk. Four sets per muscle group elicited maximal gains in both trained and untrained individuals.

CONCLUSION

The dose-response trends identified in this analysis support the theory of progression in resistance program design and can be useful in the development of training programs designed to optimize the effort to benefit ratio.

American College of Sports Medicine position stand. Progression models in resistance training for healthy adults

In order to stimulate further adaptation toward a specific training goal(s), progression in the type of resistance training protocol used is necessary. The optimal characteristics of strength-specific programs include the use of both concentric and eccentric muscle actions and the performance of both single- and multiple-joint exercises. It is also recommended that the strength program sequence exercises to optimize the quality of the exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher intensity before lower intensity exercises). For initial resistances, it is recommended that loads corresponding to 8-12 repetition maximum (RM) be used in novice training. For intermediate to advanced training, it is recommended that individuals use a wider loading range, from 1-12 RM in a periodized fashion, with eventual emphasis on heavy loading (1-6 RM) using at least 3-min rest periods between sets performed at a moderate contraction velocity (1-2 s concentric, 1-2 s eccentric). When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number. The recommendation for training frequency is 2-3 d x wk(-1) for novice and intermediate training and 4-5 d x wk(-1) for advanced training. Similar program designs are recommended for hypertrophy training with respect to exercise selection and frequency. For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion, with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity. Higher volume, multiple-set programs are recommended for maximizing hypertrophy. Progression in power training entails two general loading strategies: 1) strength training, and 2) use of light loads (30-60% of 1 RM) performed at a fast contraction velocity with 2-3 min of rest between sets for multiple sets per exercise. It is also recommended that emphasis be placed on multiple-joint exercises, especially those involving the total body. For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (> 15) using short rest periods (< 90 s). In the interpretation of this position stand, as with prior ones, the recommendations should be viewed in context of the individual's target goals, physical capacity, and training status.

Progressive strength training in sedentary, older African American women

PURPOSE

This study investigated effects of an 8-wk, low-frequency and low-volume, supervised, progressive strength training program emphasizing free weight, multijoint movements on the muscular power, strength, endurance, and flexibility of African American women 44 to 68 yr of age.

METHODS

Nineteen sedentary African American women were randomly assigned to a strength training (ST) only group (N = 12; mean age, 51 yr) or a nonexercise control (C) group (N = 7; mean age, 52 yr). Maximal power, strength, absolute endurance, and flexibility were assessed before and after training. Subjects trained 2 d x wk(-1) using free weight (barbells and dumbbells) and machine (plate loaded) exercises for two to three sets of 8 to 10 repetitions on both primary and assistance exercises.

RESULTS

Upper body power (medicine ball put distance) significantly increased statistically (P = 0.002), but gains possibly lacked practical significance because of measurement variation. Lower body power (peak watts on bicycle) experienced a small, nonsignificant increase in the ST group. Significant increases (P = 0.000) in 1RM muscle strength occurred in the ST group (leg press, +99.8%; bench press, +34.4%). Absolute endurance significantly increased (P = 0.000) in the ST group (leg press repetitions to failure at 70% pretest 1RM, +221%; bench press repetitions to failure at 50% pretest 1RM, +112%). Significant flexibility gains occurred in the ST group (sit-and-reach test, +8.2%; P = 0.017). No significant changes occurred in power, strength, absolute endurance, or flexibility in the C group.

CONCLUSION

This study demonstrates that 8 wk of low-frequency, supervised, progressive strength training emphasizing free weight, multijoint movements can safely cause significant gains in muscle strength, absolute endurance, and flexibility in older African American women.