AHA Statement
07/16/2007

Resistance training is a good, safe addition for heart patients

American Heart Association Scientific Statement

DALLAS, July 17 – Once taboo for people with heart problems, resistance weight training actually has significant benefits for people with cardiovascular disease (CVD), according to an American Heart Association scientific statement published in Circulation: Journal of the American Heart Association.

The statement, Resistance Exercise in Individuals With and Without Cardiovascular Disease, is an update to a statement published in 2000.

“Just like we once learned that people with heart disease benefited from aerobic exercise, we are now learning that guided, moderate weight training also has significant benefits,” said Mark Williams, Ph.D., the statement writing group chair and professor of medicine in the Division of Cardiology at Creighton University School of Medicine in Omaha, Neb.

Williams said resistance (weight) training should be viewed as a complement to aerobic exercise, not a replacement for it.  There is extensive evidence of the benefits of aerobic exercise training on the modulation of cardiovascular risk factors, he said.

“Resistance training not only enhances the benefits of aerobic fitness, but it appears to provide the added benefit of increased functional capacity and independence.  It helps people better perform tasks of daily living – like lifting sacks of groceries.”

The health benefits of resistance training include increased strength and muscular coordination, more muscle mass and higher bone density in men and women of all ages.   An increase in muscle mass contributes to a higher basal metabolic rate, which can help in weight control.  In addition, resistance training can help improve quality of life.  In people whose fitness level compromises their daily physical functioning, both endurance exercise and resistance training may improve quality of life — allowing patients to do what they enjoy and remain independent.

The statement discusses appropriate techniques for resistance training and the potential impact of straining.  Recommendations focus on performing lifts rhythmically, balancing upper and lower body exercises, and establishing a proper breathing pattern.  “The emphasis at the early stage of training is to allow time for the muscles to adapt and to practice good technique, thus reducing the potential for excessive muscle soreness and injury,” Williams said.

In the past, low weight limits were set for the amount CVD patients could lift.  Williams said that’s appropriate during recovery from a cardiac event or procedure, but “when prescribed appropriately, patients can often do more to train safely and benefit significantly.”

Recommendations for the initial prescription of resistance training are:

Resistance training should be performed:

• in a rhythmical manner at a moderate-to-slow controlled speed;
• through a full range of motion, avoiding breath-holding and straining by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase; and
• alternating between upper and lower body work, to allow for adequate rest between exercises.

The initial resistance or weight load should:

• allow for, and be limited, to 8–12 repetitions per set for healthy sedentary adults, or 10–15 repetitions at a low level of resistance, (e.g., < 40 percent of 1 repetition maximum), for older (more than 50–60 years of age), more frail persons, or cardiac patients;.
• be limited to a single set, performed two days per week, and involve the major muscle groups of the upper and lower extremities, e.g., chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower back extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise.

While traditional prescriptions for weight training have involved performing three sets of repetitions, the writing group found that single and multiple set programs provide nearly the same relative improvement in muscular strength during the initial training period.  For the average person beginning strength training, single-set programs at least two days per week are recommended over multiple-set programs because they are highly effective, less time consuming, and promote adherence, according to the statement.  For people with cardiovascular disease, the level of resistance should be reduced and number of repetitions increased, resulting in a lower relative effort and reducing the likelihood of breath-holding and straining.  Thus, a comprehensive program of eight to 10 exercises can be accomplished in 15–20 minutes and should be done after the aerobic component, which will ensure an adequate warm-up.

As a person progresses, the exercise level can be increased by changing any variable in the fitness program: increasing resistance or weight; increasing repetitions per set; increasing the number of sets per exercise; and, decreasing the rest period between sets or exercises.  The statement recommends increasing the number of repetitions before increasing resistance or weight.

There are certain conditions (unstable heart disease, uncontrolled hypertension or arrhythmias, infections in and around the heart, Marfan’s syndrome, etc.) where resistance training would not be recommended.  However, for people at low risk for cardiac events, extensive cardiovascular screening is probably not necessary, although a graded approach is recommended.  For people at moderate- to high-risk of cardiac events, resistance training can be safely undertaken with proper preparation and guidance by a physician.

“This statement allows health care providers to give input to their cardiovascular patients and allow them to participate in this type of activity with confidence,” Williams said.  “Patients who have had cardiac events are often apprehensive about returning to this type of activity, or doing things in their daily lives that might be perceived as strenuous.  This helps physicians and patients understand what they should be doing and what they should avoid.  Now we know that they can return to the active things they enjoy doing.”

Editor’s note: The American Heart Association’s Choose To Move is a free 12-week program that helps busy women increase physical activity and build healthy habits into their daily lives — without creating new routines that take a lot of time and money. Program registrants receive an easy, step-by-step poster for coordinating resistance training into any fitness routine. Call 1-800-AHA-USA1 or visit choosetomove.org to begin the program today.

NR07 – 1166 (Williams)

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