Resistance Training

Muscle strength, endurance and aerobic function are required for a fully active lifestyle (Pollock, et al., 2000). Muscle strength is defined as the ability of a muscle or muscle group to produce maximal force at a given velocity of movement. Muscle endurance is the ability of a muscle or muscle group to perform repeated muscle actions against a sub-maximal resistance (ACSM, 2001).

Resistance exercise (RE) incorporates all types of strength and weight training and will lead to improvements in both muscle strength and endurance. RE has many proven health benefits, including increases in lean muscular mass, and it has been shown to complement aerobic exercise in the maintenance of basal metabolic rate, important for weight management (Pollock, et al., 2000). In addition, RE can reduce the risk of falling by improving muscular strength and balance (ACSM, 2001). Favourable effects on bone density are associated with resistance exercise (Bjarnason-Wehrens, et al., 2004). Many women in CR, if they are older, will be post-menopausal, and for this group prevention and treatment of osteoporosis are added benefits.

Many activities of daily living and occupational tasks require an equal amount, if not more, of upper body strength than aerobic fitness (Lindsay and Gaw, 1997). After a cardiac event people are often afraid to lift or to attempt resistance-based activities. Therefore, including supervised RE within a cardiac rehabilitation programme may help to resolve anxieties by providing advice on technique and prescription.

The incidence of coronary heart disease increases with age and after the menopause (BHFS, 2004). This coincides with an age-related decline in muscular strength and fat-free mass after the age of 50 (ACSM, 2001). RE has been shown to prevent decline in muscle strength and has shown favourable improvements in lean muscle mass (Pollock, et al., 1998).These benefits support the inclusion of RE within a comprehensive cardiac rehabilitation programme.

Traditionally, cardiac rehabilitation focused on aerobic exercise due to concerns that BP increases during RE would increase cardiovascular complications. However, AACVPR (1999), the ACSM (2001) and SIGN (2002) now recommend RE as part of a comprehensive rehabilitation programme. With appropriate screening and supervision, fewer cardiovascular complications have been associated with RE than with aerobic endurance exercise (Bjarnason-Wehrens, et al., 2004).

Most research on RE in the CR setting has been carried out on men with low to moderate cardiac risk. There is sparse evidence on the effects of RE on the higher-risk patient groups or on women. Previous studies suggested that the isometric component caused reduced ejection fraction, left ventricle wall motion abnormalities and increased incidence of arrhythmias (BACR, 2000). However, due to the lack of evidence, there is reluctance to include RE in the cardiac rehabilitation setting for high-risk patient groups (Pollock, et al., 2000).

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