Since the mid-1980s resistance training has become an accepted part of
the exercise rehabilitation process for patients eligible for traditi
onal cardiac rehabilitation programs. A growing number of studies have
demonstrated the safety of resistance training in Phase III/IV progra
ms (Phase III-community based, beginning 6-12 wk posthospital discharg
e; a typical patient would be clinically stable with a functional capa
city of greater than or equal to 5 METs; Phase IV-long-term maintenanc
e) and more recently in Phase II (beginning within 3 wk posthospital d
ischarge and lasting up to 3 months). Evidence is consistent that this
form of training provokes fewer signs and symptoms of myocardial isch
emia than aerobic testing and training, perhaps because of a lower hea
rt rate (IIR) and higher diastolic pressure combining to produce impro
ved coronary artery filling. The major role of resistance training in
heart disease patients is to promote increased dynamic muscle strength
. Increases in muscular strength have been associated with increased p
eak exercise performance, improved submaximal endurance, and reduced r
atings of perceived leg effort. Two studies show that resistance train
ing may result in improved self-efficacy for strength and exercise tas
ks and improved quality of life parameters such as total mood disturba
nce, depression/dejection, fatigue/inertia, and emotional health domai
n scores. The data on risk factor modification are somewhat equivocal.
Studies on blood lipid profiles have mostly been contaminated by conf
ounders, and the effects on blood pressure (BP) are inconsistent. Ther
e are encouraging reports that resistance training may increase glucos
e tolerance and insulin sensitivity, independent of changes in body fa
t or aerobic capacity. Future studies are needed in patients with cong
estive heart failure and orthotopic heart transplantation; muscle weak
ness is common in these groups and makes them excellent candidates to
benefit from this form of exercise.