Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta-analysis of randomised clinical trials

OBJECTIVE

To compare the effects of aerobic training combined with muscle strength training (hereafter referred to as combined training) to aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease (CAD).

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL, SPORTDiscus, Scopus, trial registries and grey literature sources were searched in February 2024.

ELIGIBILITY CRITERIA

Randomised clinical trials comparing the effects of ≥4 weeks of combined training and aerobic training alone on at least one of the following outcomes: cardiorespiratory fitness (CRF), anthropometric and haemodynamic measures and cardiometabolic blood biomarkers in patients with CAD.

RESULTS

Of 13 246 studies screened, 23 were included (N=916). Combined training was more effective in increasing CRF (standard mean difference (SMD) 0.26, 95% CI 0.02 to 0.49, p=0.03) and lean body mass (mean difference (MD) 0.78 kg, 95% CI 0.39 kg to 1.17 kg, p<0.001), and reducing per cent body fat (MD -2.2%, 95% CI -3.5% to -0.9%, p=0.001) compared with aerobic training alone. There were no differences in the cardiometabolic biomarkers between the groups. Our subgroup analyses showed that combined training increases CRF more than aerobic training alone when muscle strength training was added to aerobic training without compromising aerobic training volume (SMD 0.36, 95% CI 0.05 to 0.68, p=0.02).

CONCLUSION

Combined training had greater effects on CRF and body composition than aerobic training alone in patients with CAD. To promote an increase in CRF in patients with CAD, muscle strength training should be added to aerobic training without reducing aerobic exercise volume.

Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study

Background

The core of cardiac rehabilitation (CR) is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25% increases cardiorespiratory fitness but the number of outpatients CR centers in Saudi Arabia (SA) is very limited and there is a need to establish outpatient CR (Phase III) in SA. Furthermore, the awareness of outpatient CR in SA is unknown.

Aim

To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA.

Methods

A cross-sectional study survey was conducted between March - July 2021 among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Frequencies and percentages were used to report the variables.

Results

Of the 141 participants who completed the online survey, our findings showed that 131 (93%) were aware of CR but only 29 (21%) were aware of the four phases of CR. There were three main barriers to establishing CR: lack of appropriate CR 135 (96%); lack of awareness among healthcare professions of CR and its benefits 134 (95%) and the lack of healthcare providers trained in CR 133 (94%). There was a significant relationship between physiotherapists and cardiologists' responses on agreeing to all barriers to establishing CR in SA (r=0.69, P =0.03).

Conclusion

To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.

[Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease]

INTRODUCTION AND OBJECTIVES

The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome.

TRIAL DESIGN

Randomised clinical trial.

METHODS

Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months.

RESULTS

Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (-50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039).

CONCLUSIONS

A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.

Combined resistance and aerobic training is more effective than aerobic training alone in people with coronary artery disease

OBJECTIVE

To review the evidence as to whether combined aerobic and resistance training is as effective as aerobic training at improving body composition, fitness, strength and quality of life in people with coronary artery disease.

DATA SOURCES

Cochrane Controlled Trials Register, Embase, Medline, PreMedline, SportDiscus and CINAHL, searched up to October 2009. This search was supplemented by citation tracking.

STUDY SELECTION

Randomised controlled trials involving people with coronary artery disease (including people who had undergone coronary artery surgery or percutaneous intervention) in which aerobic training was compared to combined aerobic and resistance training. Outcome measures were measures of cardiovascular fitness, body composition measured by dual energy X-ray absorptiometry, muscular strength, healthrelated quality of life and self efficacy. Trials involving only patients with heart failure were excluded.

DATA EXTRACTION

Two reviewers determined eligibility and one reviewer extracted data. Methodological quality was assessed using the PEDro scale and the Jadad scale.

DATA SYNTHESIS

Of 271 studies initially identified by the search, 12 studies with a total of 504 patients met the selection criteria and were included in the review. Study quality ranged from 4 to 8 out of 10 on the PEDro scale, and 2 to 3 out of 5 on the Jadad scale. Based on the quantitative pooling of the available data from these trials, the combined training induced significantly greater improvements than aerobic training on most outcomes. Peak exercise capacity was better by a standardised mean difference of 0.88 (95% CI 0.45 to 1.31), fat free mass improved by 0.9kg more (95% CI 0.4 to 1.4) and percent body fat improved by 2% more (95% CI 1 to 4). Trunk fat and upper and lower limb strength were also significantly better after combined training than after aerobic training. Data for quality of life and self efficacy could not be pooled quantitatively, but all the studies that measured these outcomes reported improvements either in both groups or in the combined training group only. The adverse events noted were typically mild cardiovascular changes or musculoskeletal pain. In subgroup analyses, the study duration and the intensity of the resistance were not associated with an altered treatment effect.

CONCLUSION

Combined aerobic and resistance training is more effective than aerobic training in improving body composition, strength and cardiovascular fitness, probably improving quality of life and self efficacy as well.