Effects of adding high- vs low-intensity resistance training to endurance training in patients with heart failure: preliminary results of a randomized controlled trial

Abstract

Background In current ESC/EAPC guidelines, adding resistance training to endurance training is advised for patients with heart failure (HF), but the optimal intensity of the resistance training is unknown (40–80% of 1RM is advised). Purpose To investigate the effects of high- vs low-intensity resistance training as an adjunct to endurance training on: aerobic capacity (primary outcome), walking capacity, muscle strength and quality of life in patients with HF. Methods Forty patients with HF were consecutively recruited in the cardiac rehabilitation center of the Hospital East-Limburg in Belgium. Patients were block-randomized (by age and sex) by an independent researcher to receive maximally 45 supervised sessions (3x/week) of high-intense (HI: 3 exercises, 3x12 repetitions, 55–70%1RM) or low-intense resistance training (LI: 3 exercises, 3x22 repetitions, 35–40%1RM) as an adjunct to endurance training (30 min/session; 50–75% VO2max). The aerobic capacity (VO2max) was measured by a blinded assessor with a ramp cardiopulmonary cycling test (+5–30W/min). Walking distance was assessed with a 6-minute walk test (6MWT), maximal strength with 1RM (leg-press, pull-down and dip), and quality of life with the Minnesota questionnaire. An unpaired t-test, Mann-Whitney U test or ANCOVA were used for between-group analysis, and paired t-test or Wilcox sign-rank test for the within-group analysis. Results Both groups had similar baseline characteristics and training adherence (HI vs LI; 20 vs 20 subjects; Age: 62±9 vs 59±13 years; Sex: 76% vs 79%male; BMI: 27±58 vs 29±4 kg/m2; LVEF: 35±10 vs 38±6%; Adherence: 33±10 vs 36±10 sessions; p>0.05). There were no adverse events. Both groups had significant within-group improvements in aerobic and walking capacity (VO2max: LI (n=20) vs HI (n=19), p≤0.010; 6MWT distance: p≤0.007) (Figure 1), but these improvements did not differ between groups (VO2max: p=0.855; 6MWT distance: p=0.854). The LI group improved significantly more in muscle strength than the HI group (dip and leg-press: p<0.001). Although the LI group significantly improved in the quality of life (Minnesota score reduction: p=0.028), the quality of life did not differ between groups (Minnesota score: p=0.756). Conclusions Both low-and high-intense resistance training are similarly beneficial for improving aerobic and walking capacity in patients with HF. Surprisingly, low-intense resistance training seems superior to high-intense training in improving muscle strength. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University

Resistance Training in Cardiac Rehabilitation

“…28 Similar RT approach was also recently replicated in patients with HF, whereas the study has demonstrated similar improvements in CRF, maximal muscle strength, and quality of life following HL-RT and LL-RT, with no adverse CV events. 29 These novel findings provide a complimentary evidence to those presented in the review by Bjarnason-Wehrens et al, 18 and extend the possibilities of using different RT approaches to optimize the exercise-based CR directly from the enrollment with a possibility to readjusting RT load according to improvement during the CR. 26,29,30 On the basis of the novel evidence, experts in preventive cardiology have developed a digital training and decisive support system (Exercise Prescription in Everyday practice & Rehabilitative Training tool) to enable clinicians to optimize RT prescription in patients with CAD and HF and to finally reach international consensus among leading preventive cardiology organizations.…”

“…29 These novel findings provide a complimentary evidence to those presented in the review by Bjarnason-Wehrens et al, 18 and extend the possibilities of using different RT approaches to optimize the exercise-based CR directly from the enrollment with a possibility to readjusting RT load according to improvement during the CR. 26,29,30 On the basis of the novel evidence, experts in preventive cardiology have developed a digital training and decisive support system (Exercise Prescription in Everyday practice & Rehabilitative Training tool) to enable clinicians to optimize RT prescription in patients with CAD and HF and to finally reach international consensus among leading preventive cardiology organizations. 31 Apart from the optimization of RT in the majority of patients enrolled in CR (eg, patients with CAD and HF), there are also other populations of patients with CVD, which would benefit from the enrollment into RT but were not presented in the present review.…”

“…Individualized Approach to Prescription of ResistanceTraining in Cardiac Rehabilitation12,24,26,29,33 …”