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.
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Krakoff LR. Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive management. Curr Atheroscler Rep. 2013;15(4):317.
Lacombe SP, Goodman JM, Spragg CM, Liu S, Thomas SG. Interval and continuous exercise elicit equivalent postexercise hypotension in prehypertensive men, despite differences in regulation. Appl Physiol Nutr Metab. 2011;36(6):881–91.
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American College of Sports Medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36(3):533–53.
O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23.
Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35(42):2929.
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.
Fleig L, Lippke S, Pomp S, Schwarzer R. Intervention effects of exercise self-regulation on physical exercise and eating fruits and vegetables: a longitudinal study in orthopedic and cardiac rehabilitation. Prev Med. 2011;53(3):182–7.
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.
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.
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.
Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: is there an international consensus? Eur J Prev Cardiol. 2016;23(16):1715–33.
Marzolini S. Integrating individuals with stroke into cardiac rehabilitation following traditional stroke rehabilitation: promoting a continuum of care. Can J Cardiol. 2018;34(10S2):S240–6.
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.
Brovold T, Skelton DA, Bergland A. Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity. J Am Geriatr Soc. 2013;61(9):1580–5.
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.
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.
Marzolini S, Oh PI, Brooks D. Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a meta-analysis. Eur J Prev Cardiol. 2012;19(1):81–94.
Xanthos PD, Gordon BA, Kingsley MI. Implementing resistance training in the rehabilitation of coronary heart disease: a systematic review and meta-analysis. Int J Cardiol. 2017;1(230):493–508.
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.
American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2013.
American College of Sports Medicine. American College of Sports Medicine position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.
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.
MacDonald HV, Johnson BT, Huedo-Medina TB, Livingston J, Forsyth KC, Kraemer WJ, et al. Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: a meta-analysis. J Am Heart Assoc. 2016;5(10):e003231. https://doi.org/10.1161/jaha.116.003231.
Crisafulli A. The impact of cardiovascular diseases on cardiovascular regulation during exercise in humans: studies on metaboreflex activation elicited by the post-exercise muscle ischemia method. Curr Cardiol Rev. 2017;13(4):293–300.
MacDonald JR, MacDougall JD, Hogben CD. The effects of exercise duration on post-exercise hypotension. J Hum Hypertens. 2000;14(2):125–9.
Mach C, Foster C, Brice G, Mikat RP, Porcari JP. Effect of exercise duration on postexercise hypotension. J Cardiopulm Rehabil. 2005;25(6):366–9.
Alderman BL, Arent SM, Landers DM, Rogers TJ. Aerobic exercise intensity and time of stressor administration influence cardiovascular responses to psychological stress. Psychophysiology. 2007;44(5):759–66.
Jones H, George K, Edwards B, Atkinson G. Is the magnitude of acute post-exercise hypotension mediated by exercise intensity or total work done? Eur J Appl Physiol. 2007;102(1):33–40.
Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MW, et al. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Neth Heart J. 2015;23(1):6–17.
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.
Moe GW, Ezekowitz JA, O’Meara E, Howlett JG, Fremes SE, Al-Hesayen A, et al. The 2013 Canadian Cardiovascular Society Heart Failure management guidelines update: focus on rehabilitation and exercise and surgical coronary revascularization. Can J Cardiol. 2014;30(3):249–63.
Selig SE, Levinger I, Williams AD, Smart N, Holland DJ, Maiorana A, et al. Exercise & Sports Science Australia position statement on exercise training and chronic heart failure. J Sci Med Sport. 2010;13(3):288–94.
Sharman JE, Stowasser M. Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport. 2009;12(2):252–7.
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.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Verrill D, Shoup E, McElveen G, Witt K, Bergey D. Resistive exercise training in cardiac patients: recommendations. Sports Med. 1992;13(3):171–93.
Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873–934.
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.
Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MW, et al. Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline. Neth Heart J. 2013;21(10):429–38.
Jurgens CY, Goodlin S, Dolansky M, Ahmed A, Fonarow GC, Boxer R, et al. Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circ Heart Fail. 2015;8(3):655–87.
Rhea MR, Alvar BA, Burkett LN, Ball SD. A meta-analysis to determine the dose response for strength development. Med Sci Sports Exerc. 2003;35(3):456–64.
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.
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.
Mitchell JH, Payne FC, Saltin B, Schibye B. The role of muscle mass in the cardiovascular response to static contractions. J Physiol. 1980;309:45–54.
MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol. (1985). 1985;58(3):785–90.
Fleck SJ, Kraemer WJ. Designing resistance training programs. 4th ed. Champaign (IL): Human Kinetics; 2014.
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.
Adams J, Cline MJ, Hubbard M, McCullough T, Hartman J. A new paradigm for post-cardiac event resistance exercise guidelines. Am J Cardiol. 2006;97(2):281–6.
Monteiro W, Simão R, Farinatti P. Manipulation of exercise order and its influence on the number of repetitions and effort subjective perception in trained women. Rev Bras Med Esporte. 2005;11(2):5.
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.
Simao R, Farinatti Pde T, Polito MD, Viveiros L, Fleck SJ. Influence of exercise order on the number of repetitions performed and perceived exertion during resistance exercise in women. J Strength Cond Res. 2007;21(1):23–8.
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.
de Salles BF, Simao R, Miranda F, Novaes Jda S, Lemos A, Willardson JM. Rest interval between sets in strength training. Sports Med. 2009;39(9):765–77.
Ratamess NA, Falvo MJ, Mangine GT, Hoffman JR, Faigenbaum AD, Kang J. The effect of rest interval length on metabolic responses to the bench press exercise. Eur J Appl Physiol. 2007;100(1):1–17.
The authors thank Dr. Roberto Potton for his support during the article search.
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.
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Fidalgo, A.S.F., Farinatti, P., Borges, J.P. et al. Institutional Guidelines for Resistance Exercise Training in Cardiovascular Disease: A Systematic Review. Sports Med 49, 463–475 (2019). https://doi.org/10.1007/s40279-019-01059-z