Institutional Guidelines for Resistance Exercise Training in Cardiovascular Disease: A Systematic Review
Institutional position stands are useful for practitioners when designing exercise routines for specific populations. Resistance training has been included in programs for patients with cardiovascular disease.
The objective of this systematic review was to analyze institutional guidelines providing recommendations for resistance training applied to cardiovascular disease.
PubMed, Web of Science, and Scopus databases were searched from inception until 30 April, 2018.
Of 994 articles initially found, 13 position stands were retained. Consensual indications occurred only for number of sets (one to three sets) and training frequency (two to three sessions/week). Recommendations concerning other major training variables were discordant regarding workload (none or loads ranging from < 30% up to 80% 1 repetition maximum) and exercise order (none or vaguely indicating alternation of muscle groups or circuit format), or insufficient regarding intervals between sets and exercises or number and type of exercises. Overall, guidelines lack recommendations of specific procedures for each type of disease at different severity levels, cardiovascular risk during exercise, or criteria for training progression.
Recommendations provided by institutional guidelines appear to be insufficient to support adequate resistance training prescription in the context of cardiovascular disease.
The authors thank Dr. Roberto Potton for his support during the article search.
Compliance with Ethical Standards
This study was partially funded by grants from the Brazilian Council for Technological and Research Development (CNPq) and the Carlos Chagas Foundation for the Research Support at the Rio de Janeiro State (FAPERJ).
Conflict of interest
Andressa Santoro Faber Fidalgo, Paulo Farinatti, Juliana Pereira Borges, Tainah de Paula, and Walace Monteiro have no conflicts of interest that are directly relevant to the content of this study.
- 6.Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010;17(1):1–17.CrossRefGoogle Scholar
- 8.Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41(1):159–68.CrossRefGoogle Scholar
- 9.Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40(7):1366–74.CrossRefGoogle Scholar
- 10.Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44(3):671–719.CrossRefGoogle Scholar
- 13.Tomas-Carus P, Ortega-Alonso A, Pietilainen KH, Santos V, Goncalves H, Ramos J, et al. A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients. J Sports Med Phys Fitness. 2016;56(5):572–8.Google Scholar
- 15.Fortuno-Godes J, Guerra-Balic M, Cabedo-Sanroma J. Health-related quality of life measures for physically active elderly in community exercise programs in Catalonia: comparative analysis with sedentary people. Curr Gerontol Geriatr Res. 2013;2013:168482. https://doi.org/10.1155/2013/168482 Epub 2013 Dec 24.Google Scholar
- 16.Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. 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. Circulation. 2007;116(5):572–84.CrossRefGoogle Scholar
- 19.Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2017;24(12):1242–59.CrossRefGoogle Scholar
- 20.American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2013.Google Scholar
- 22.Pollock ML, Franklin BA, Balady GJ, Chaitman BL, Fleg JL, Fletcher B, et al. AHA science advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation. 2000;101(7):828–33.CrossRefGoogle Scholar
- 30.Bjarnason-Wehrens B, Mayer-Berger W, Meister ER, Baum K, Hambrecht R, Gielen S, et al. Recommendations for resistance exercise in cardiac rehabilitation: recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2004;11(4):352–61.CrossRefGoogle Scholar
- 34.Dobbins M, Cockerill R, Barnsley J, Ciliska D. Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions. Int J Technol Assess Health Care. 2001;17(4):467–78.Google Scholar
- 38.Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Z, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19(5):1005–33.CrossRefGoogle Scholar
- 42.Wolfe BL, LeMura LM, Cole PJ. Quantitative analysis of single- vs. multiple-set programs in resistance training. J Strength Cond Res. 2004;18(1):35–47.Google Scholar
- 43.Peterson MD, Rhea MR, Alvar BA. Applications of the dose-response for muscular strength development: a review of meta-analytic efficacy and reliability for designing training prescription. J Strength Cond Res. 2005;19(4):950–8.Google Scholar
- 46.Fleck SJ, Kraemer WJ. Designing resistance training programs. 4th ed. Champaign (IL): Human Kinetics; 2014.Google Scholar
- 47.Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand: quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.CrossRefGoogle Scholar
- 50.Simao R, Farinatti Pde T, Polito MD, Maior AS, Fleck SJ. Influence of exercise order on the number of repetitions performed and perceived exertion during resistance exercises. J Strength Cond Res. 2005;19(1):152–6.Google Scholar
- 52.Willardson JM. A brief review: factors affecting the length of the rest interval between resistance exercise sets. J Strength Cond Res. 2006;20(4):978–84.Google Scholar