American Heart Association updates statement on resistance training for patients with

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July 17, 2007

The American Heart Association has issued an update on resistance exercise in individuals with and without cardiovascular disease, which follows up its first scientific advisory on the topic published in 2000. The new advisory, issued on July 16, updates the information, discusses the benefits of resistance training in targeted populations, describes how to evaluate patients for participation in the training, and offers specific training methods.

Elderly men and women in nursing homes can benefit from resistance training (RT), as can patients with heart failure, according to the update. Moreover, RT generally has been shown to have at least some benefit in patients with diabetes, hypertension, obesity, and dyslipidemia, although for some conditions, the benefit is dependent on patient age and/or the duration of the training.

The AHA’s initial advisory reviewed the evidence showing a benefit for RT on various measures of cardiovascular health (Circulation 2000;101:828-33) in the general population.

The advisory discusses evidence that RT can be beneficial even in nursing home populations, as long as adjustments are made for “certain individuals and health limitations.” It notes that in one such population, with a mean age of 87 years, an increase in thigh-muscle girth was associated with improvements in strength, gait, and stair-climbing ability. RT also increases muscle mass across all age groups, though less so for women than for men. Findings regarding the effect of weight training on bone have been mixed, showing either no change or an increase in bone mineral density, the statement authors reported (Circulation 2007;epub ahead of print; DOI 10.1161/circulationaha.107.185214).

Likewise, RT has been associated with improvements in nearly all of the conditions mentioned in the statement. In patients with diabetes, RT has been associated with increased glucose uptake and insulin sensitivity, the authors wrote, although it has not been shown to prevent type 2 diabetes or to affect glucose tolerance or glycemic control in normal individuals. RT also has been shown to achieve modest but clinically significant decreases in blood pressure, according to two meta-analyses; the effect was smaller (yet still significant) for older persons than for middle-age persons.

Moreover, elderly women (as well as men) have been shown to achieve higher daily energy expenditure with RT. Resistance training also can prevent or reverse age-associated fat increases. Current findings on the effect of RT on cardiovascular disease remain equivocal; in one study of 8,499 men, only those who engaged in RT for at least 4 hr/wk showed a reduced risk for hypercholesterolemia. However, RT combined with aerobic exercise has shown clear benefit, particularly in older people, the statement said.
For women specifically, RT has been associated with improvements in daily activities, strength, balance and coordination, and walking, according to the statement. Findings also have shown that RT increases resting energy expenditure and metabolic rate in older women.

A notable conclusion of the new statement is its discussion of RT for persons with heart failure. Despite concerns that RT in such persons may exacerbate their condition because of potential adverse left ventricular modeling in the lifting phase, the new statement concludes that, “at the intensity of RT performed by patients with [heart failure], the hemodynamic responses do not exceed levels attained during standard exercise testing. ... Thus, it appears that RT can be incorporated safely into rehabilitation programs for patients with HF, although further study of this important area is needed.”

Resistance training generally is safe, the statement’s authors concluded, and has not been linked to increases in anginal symptoms, ST-segment depression, or complex ventricular arrhythmias. This suggests that RT is “safe in clinically stable men with [coronary heart disease] who are actively participating in a supervised rehabilitation program.” Recent data also suggest the same for women, the authors reported.

The new statement, unlike the 2000 version, does not discuss RT for recent recipients of coronary artery bypass grafts.
Screening patients for RT helps identify those patients with contraindications and further identify whether the contraindications are absolute–such as unstable coronary heart disease, uncontrolled arrhythmias, and severe or symptomatic aortic stenosis–or relative–such as diabetes, uncontrolled hypertension, or having an implanted pacemaker or defibrillator–and tailor the RT regimen to an individual patient’s ability and tolerance.

For example, patients with recent MI or those who have had recent open heart surgery are advised to exercise in a supervised cardiac rehabilitation program, while patients with cardiovascular disease who have stable symptoms and acceptable functional capacity could undertake low- to moderate-intensity RT. All patients should be advised to stop exercise and seek medical attention in case of chest discomfort or shortness of breath while performing RT.

The initial RT prescription should be limited to a single set performed 2 days/week limited to no more than 8-12 repetitions for healthy sedentary adults or 10-15 repetitions at a lower level of resistance for cardiac or more frail patients. After the initial training period, patients can gradually increase the weight load and perform RT 3 days/week. RT should involve the major muscle groups of the upper and lower extremities and include exercises such as the shoulder press and biceps curl and the leg press and calf raise.

In an interview, Mark Williams, Ph.D., director of cardiovascular disease prevention and rehabilitation at Creighton University, Omaha, Neb., and a cochair of the writing committee, said the new version “provides a much broader approach to the topic than the report from 7 years ago, when fewer data were available. He emphasized that, “while RT is a valuable modality for any number of reasons, it is to be used as a complement to, rather than replacement for, aerobic exercise such as walking, cycling, and swimming.”


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Details of Original Article
Circulation. 2007 Jul 16

Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update. A Scientific Statement From the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism.

Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ.

Abstract--Prescribed and supervised resistance training (RT) enhances muscular strength and endurance, functional capacity and independence, and quality of life while reducing disability in persons with and without cardiovascular disease. These benefits have made RT an accepted component of programs for health and fitness. The American Heart Association recommendations describing the rationale for participation in and considerations for prescribing RT were published in 2000. This update provides current information regarding the (1) health benefits of RT, (2) impact of RT on the cardiovascular system structure and function, (3) role of RT in modifying cardiovascular disease risk factors, (4) benefits in selected populations, (5) process of medical evaluation for participation in RT, and (6) prescriptive methods. The purpose of this update is to provide clinicians with recommendations to facilitate the use of this valuable modality.