Small Muscle Mass Training in Heart Failure: A Scoping Review of The Literature

Comparison of the effects of high and low-moderate load lower limb resistance training on muscle strength and exercise capacity in individuals with COPD: A systematic review and meta-analysis

BACKGROUND

Extrapulmonary changes also occur in COPD. Resistance training can increase muscle strength and exercise capacity.

OBJECTIVE

The objective of this systematic review was to examine and compare the effectiveness of high and low-moderate load lower limb resistance training on muscle strength and exercise capacity in individuals with stable chronic obstructive pulmonary disease (COPD).

METHODS

The PubMed/Medline, Scopus, Cochrane Library, ClinicalTrials.gov, Web of Science, EBSCO, and CINAHL databases were searched to identify the articles published in English between January 1970 and July 2023.

RESULTS

Seven randomized controlled trials with a total of 188 individuals with COPD (RT: 100, CG: 88) met the inclusion criteria. A significant difference was revealed (favoring high load) in the change in knee extensor muscle strength and leg press strength in the high load resistance training group compared to the low-moderate load resistance training group (MD 21.90 Nm, 95 % CI 17.46-26.34 Nm, p < 0.00001; MD 5.80 kg, 95 % CI 3.87-7.73 kg, p < 0.00001). A significant difference was observed in the change in 6 MWT (six minute walk test) distance (favoring low-moderate load) and VO2peak (peak oxygen uptake) (favoring high load) in the high load resistance training group compared to the low-moderate load resistance training group (MD -16.90 m, 95 % CI -29.76- -4.04 m, p < 0.010; MD 3.10 ml/kg/min, 95 % CI 2.65-3.55 ml/kg/min, p < 0.00001).

CONCLUSION

This systematic review and meta-analysis demonstrated that both high-load and low-moderate load resistance training increased muscle strength and might increase exercise capacity.

High-Intensity Small Muscle Mass Training in Patients With Heart Failure: Rationale and Design of a Randomized Controlled Trial

OBJECTIVE

Small muscle mass training localized to the quadriceps femoris muscle group has been proposed as an intervention to reverse heart failure-related skeletal muscle impairments. Although this training paradigm has demonstrated efficacy in heart failure, it remains to be evaluated in a conventional clinical context. Hence, the aim of this proposed study is to determine the effects of integrating high-intensity small muscle mass training (HISMT) isolated to the knee extensor muscles within a standard heart failure rehabilitation program.

METHODS

This single-blind, randomized controlled trial will aim to recruit 70 participants with heart failure. Participants will be randomized to either (1) standard training: combination of upper and lower extremity cardiovascular and resistance-based exercises, or (2) HISMT plus modified standard training: bilateral knee extensor HISMT and a modified version of the standard training, so that the total volume of work will be similar to standard training alone. The training interventions will be undertaken twice weekly for 12 weeks in an outpatient clinical setting. Outcome measurements will be performed at baseline and after the 12-week intervention period. The primary outcome will be exercise capacity (6-Minute Walk Test), with secondary outcomes being physical performance measures, muscle strength, and health-related quality of life. Data will be analyzed using the intention-to-treat principle.

IMPACT

This study will address a gap in the literature regarding the efficacy of small muscle training under routine clinical conditions for individuals with heart failure. The findings will also provide insight into the effects of HISMT within a heart failure rehabilitation program, thus enabling the optimization of exercise prescription for this patient population.