ROLE OF RESISTANCE TRAINING IN HEART-DISEASE

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.