Improving Strength: Heart Disease and Resistance Training

The American Heart Association came out with updated guidelines for resistance training for people with and without heart disease.

Resistance training is any exercise which causes muscular contraction against an external force.

Resistance training (RT) not only benefits muscle physiology and function but also improves cardiovascular health and reduces the risk of heart disease.

The first important statement the updated guidelines mention is that resistance training is safe in populations with or without cardiovascular disease.

Evidence has shown consistent participation in RT will prolong your life and lower your risk of cardiovascular death. For example, it can lower your risk of overall death by 15% and cardiovascular death by 17%. All it takes is 30-60 minutes of resistance training per week.

Unfortunately, less than 28% of the US population takes part in the recommended 2 days per week of resistance training.

There are primary risk factors for cardiovascular disease and if we do not manage these can lead to negative health outcomes.

Blood pressure, blood sugars, lipid levels and body composition

Research has shown that Resistance Training (RT) lowers blood pressures. Albeit small declines in blood pressures, but this can still have the same effects as taking blood pressure medications.

We relate lower circulating blood glucose levels with a healthy metabolism. RT improves insulin sensitivity and reduces the incidence of Diabetes.

I closely relate body composition to the well-known effect of RT. Increased lean body mass and reduction in fat mass, both which are associated with improved cardiovascular health. These changes in body composition proved to more beneficial for older individuals and those with poor metabolic health.

Secondary Risk factors

Shown to reduce inflammatory markers

Improvement in endothelial function. The endothelium lines the coronary vessels which, when damaged, lead to heart attacks.

For mental health, we have proven RT reduces the symptoms related to depression and anxiety. Along with improved mental health, individuals saw an increase in their overall quality of life.

For sleep, studies have shown improved sleep quality but had no effects on sleep duration.

The biggest questions most people have are which forms of exercise have the greatest reduction in Cardiovascular Disease (CVD) risk. Resistance training vs aerobic training or both.

Combination training with resistance and aerobic training show larger reductions in cardiovascular risk because it reduces obesity, diabetes and hypercholesterolemia. Turns out it is more beneficial than either RT or Aerobic training (AT) alone.

Combining both RT and AT in fact lowers your risk of cardiovascular disease by 46% in contrast to RT 18% and aerobic training 29%.

Chronic disease and resistance training.

Older adults

One of the biggest myths is resistance training is unsafe in older individual. Resistance training slows the age related decline in muscle mass, function and strength in older individuals > 65 years old.

Researchers showed that RT in adults with heart failure improves cardiac risk factors. They noted more beneficial associations with increased training volumes and higher intensities compared with lower volumes and intensity.

Heart failure

Patients who have stable heart failure would benefit from both RT and AT.

In individuals who have heart failure and cannot take part in AT, then starting RT would be ideal.

The physiologic changes with each individual may be difficult to assess but are associated with improved quality of life, strength, endurance and cardiorespiratory fitness.

Chronic Kidney Disease

AHA statement shows RT is safe in all stages if CKD, including people who are on dialysis. Individuals with chronic kidney disease have reduced function and muscle mass.

RT improves muscle mass, function, and reduced fat. Some people with CKD will require special program because they have an increased risk of tendon rupture, bone fracture and diabetes. Highly tailored programs need to be implemented for safety reasons in order to prevent serious injury.

RT prescription

Using free weights like dumbbells is one example of RT. Body weight exercises like pushups and squats. Machine weights and resistance bands

For healthy individuals, 8-10 different exercises using the major muscle groups with 1-3 sets of 8-10 repetitions moderate intensity 2x per week is a starting point.

Paced Progression is important

Progressive overload after initiating 40-60% of maximal strength.

Over time, you can increase the number of reps, intensity, number of sets, and times per week.

Putting it all together

We can customize the safety profile of resistance training to fit the individual, regardless of age, gender, or chronic disease. We can achieve beneficial improvements in cardiovascular outcomes by augmenting the traditional risk factors of blood pressure, blood glucose, body composition, and lipid profiles minimum 2x per week with moderate intensity session will improve and prolong quality of life.