New AHA Statement Totes Benefits of Resistance Training for Cardiovascular Health

July 20, 2007 — A new AHA scientific statement summarizing recommendations for resistance training in people with and without cardiovascular disease (CVD) should serve as a reminder to clinicians that there are "singular" benefits to improving muscular strength in addition to regular aerobic exercise, experts say. Dr Mark Williams (Creighton University, Omaha, NE) who led the writing group, told heartwire that there is important new information in the statement, that updates the original resistance training guidelines of 2000.
Despite this being the second set of recommendations on this topic to come from the American Heart Association (AHA), Williams says physicians may still overlook resistance exercise — lifting weights, or exerting force against resistance — as part of cardiovascular (CV) fitness regimen.
"Telling someone to exercise typically does either directly or indirectly suggest that they should be doing more walking," he told heartwire. "I don't think resistance training is frequently thought of as part of an overall exercise program."
The statement was published in a rapid access issue of Circulation, July 16, 2007.
Resistance Training Additive to Aerobic Exercise
The statement reviews the health benefits of resistance training and its impact on the CV function. It also summarizes the role of resistance training in modifying CVD risk factors, its benefit in specific CVD populations, and provides recommendations on evaluating patients prior to starting a resistance training regimen and suggestions for how such a regimen could be prescribed.
Williams highlighted a table in the AHA statement that compares the effects of aerobic activities and resistance training on different parameters, noting that some clinicians may be unaware of the differential effects. For example, while aerobic exercise can have moderate effects on percent body fat, compared with merely a small effect of resistance training, resistance training has moderate effects on lean body mass, and major effects on muscle strength, while aerobic exercise has no effect, and minimal effects, respectively. By contrast, both aerobic and resistance exercise produce similarly small effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, while aerobic exercise has greater effects than resistance training on triglycerides. Importantly, both forms of exercise can have similar effects on quality of life.
Williams pointed out that the importance of resistance training is now fairly well recognized in cardiac rehabilitation programs, but its benefits are less commonly appreciated in primary prevention. He also highlighted the role of resistance training in groups where it has been used the least: in older women, the elderly, and in patients with heart failure.
"People with heart failure have significantly dysfunctional hearts and as a result of that, their peripheral musculature and their ability to get around and do the things they need to do is significantly and negatively impacted by the fact that they have heart failure," Williams said. "We have been including patients with heart failure in our aerobic cardiac rehabilitation programs, but now there are data to suggest that patients, under appropriate evaluation and supervision, can improve functional capacity, physical strength, endurance, and quality of life by incorporating some resistance training into their exercise programs, too."
Just Do It — Correctly
Proper instruction and technique is essential for anyone beginning resistance training for the first time, but it is especially important for people with existing cardiovascular disease, Williams noted.
"Patients who come into cardiac rehabilitation programs typically get that kind of instruction, but people who are not participating in those formal kinds of programs should get in touch with an exercise specialist, or a physical therapist to provide some input on how to be doing resistance training properly. And the key there is that patients who do have cardiovascular disease need to identify themselves as such, so people don't assume they are healthy and give them instructions that would be inappropriate."
Of note, Williams added, in all of the research to date, there are almost no reports of significant adverse effects of resistance training, although these were all supervised, controlled studies where risk is minimized. "The downsides are there, but the upsides are greater, and the downsides appear mostly to be related to the fact that people do things they shouldn't be doing, or don't seek advice or evaluation prior to starting," he said.
The authors have disclosed no relevant financial relationships.
Circulation. Published online July 16, 2007.