Resistive exercise training in cardiac patients. Recommendations.

Resistive exercise training has recently gained popularity in cardiopulmonary rehabilitation programmes. Improvement in muscular strength is important to facilitate return to daily vocational and recreational activities after a cardiac event. Resistive exercise has been shown to be haemodynamically safe for selected individuals with cardiovascular impairment, even at relatively high workloads. This form of training may enhance muscular strength and endurance, body composition, blood lipid and lipoprotein levels, and cardiovascular endurance, although further research is needed in cardiac populations. Patients should be clinically screened and perform a symptom-limited maximal graded exercise test prior to resistive training. Patients who have characteristics associated with an increased risk of cardiac event during exercise should avoid heavy resistive training. Free weights, cuff and hand weights, isotonic/isokinetic machines, elastics, and other resistive modalities may be used for exercise of major muscle groups in cardiopulmonary rehabilitation. Resistive training workloads may be determined by gradual acclimatisation or 1 repetition maximum testing. Heart rate, blood pressure, rate-pressure product and rating of perceived exertion should be determined during lifting movements. Circuit weight-training has been recommended and has been reported to improve strength, lean body mass, self-efficacy, and may decrease risk factors for coronary artery disease. Nonsustained isometric or combined dynamic/isometric exercises have also been recommended for cardiac patients since many vocations involve lifting/pushing movements or frequent isometric muscle contraction. There appears to be considerable benefit and minimal risk of resistive exercise training for patients with cardiovascular impairment. This mode of exercise may allow patients to perform daily strength tasks safely, more efficiently, and with greater self-confidence.