Re: Exercise in the Age of Evidence-Based Medicine

[Guest guest]

Well, my intent was to wake up this forum from a long winter's nap and

apparently it worked <grin>.

no, I don't hate doctors nor consider them my enemy generally. Sorry to

disappoint anyone who wanted it that way <grin>. Doctors saved my dad's life

and gave us Mel for years, during which I got to know him as a friend. I happen

to hold the medical community, police, firefighters, and the military in high

regard as they do jobs I could never do. However I will continue to run my life

in a fashion where I'll do my best not to be a burden to any of those honored

groups. <grin>.

Thank you for the other perspective, Dr. Ralph - and thank you Lucy for the full

article, again, it appears the true enemy of information and its completeness is

the media...it was not made clear that this discussion originally was about

people in less than generally able shape! But as the portions deleted were

truly relevant to the meaning, I think you can see why I had the reaction I did,

as well as Brett. (Although Brett may not have had cabin fever as I did when I

wrote the last line...mea maxima culpa!)

However, in reading Dr. Ralph's discussion, I have to ask why his colleagues

have a tendency not to lift weights themselves? but to do primarily cardio

workouts by his observation? Does this result in a hesitant attitude in

recommending weight training, as displayed by the original doctors in the

discussion? They seem to think there's " not enough research " . And why hasn't

NSCA stepped in (and other weight training orgs) to try to help make this more

available and not perceived preserve of expensive personal trainers? Is there

not some reasoning to reaching out to the medical community and making training

less mysterious and more affordable? Offer low cost videos to doctors,

informative seminars on how to go about recommending resistance training, to

their patients who ask or might most benefit? What other steps would help change

this perspective? I'm just wondering based on that 80% who do work out...

People don't generally require a trainer to start a treadmill, and perhaps it's

this very oddity that turns them toward something they can ask another person to

show them in 10 seconds. The media too encourages cardio activity but seems to

still have the notion we'll all get instantly maimed if we lift more than a pink

plastic db.coupled with trainers who tell me " oh you'll hurt your back " and

other nonsense if you DO use a gym.....the same notion that still suggests to

parents that their kids might get hurt lifting - when it's MUCH more likely to

be football, hockey, basketball etc that injures them! Haven't heard anyone's

doctor at the high school tell him not to play football either!

How then can we get weight training to be fashionable among doctors and everyone

else too? I thought when everyone suddenly liked Hamilton's new arms in

the Terminator we'd see more people trying weight training, and more women? I

read of Hollywood stars in a women's mag this week, who train with weights,

heck, one starlet claims she pulls a sled! and is swinging kettlebells! But

yet we fight the whole Arnold thing....? first words out of a lot of gal's

mouths are they don't " want to get bulky " ?? and the workout feature of the month

was all stretching, fitball, and no weights?

Where then is the gap between the " evidence based medicine " and the reality to

be closed? And if the doctors in the article were hesitant about weight

training, how much more evidence does there need to be? Mel's experience and

that of other patients in rebounding from extreme disability should be

sufficient to start developing more of a guideline to aid in making such

choices? How can they not claim that weight training would be a wise idea if one

wanted to gain skeletal muscle mass???

I have to say I also cringed and then kinda got mad at the grouping of " women,

the elderly, and diabetics. " Ahem. Yes, women should weight train. To the

extent they desire and for good health overall. But that is what set me off,

that particular " special populations " GROUPING! sheesh! it was odd to class 1

gender, 1 age group, and 1 medical condition....I don't think of being female as

a condition that should impede me from lifting...and we had that discussion

about " elderly " and it's meaning a few months ago too lol. I think there's a

great many medical conditions you could assist by skeletal muscle

gain...anorexia being one I can think of quickly? but being female isn't a

medical condition one can alter solely by skeletal muscle gain, nor one's

chronological age ...whereas diabetes can be aided by such clearly...<grin>

Hence my comment, Dr. Ralph!

As I see it, there are two populations who don't actively do any sort of

workout. There's group one, of the persons capable of walking a grocery store

but failing to really take any proactive stance on their health - capable of

working out but simply balking at the notion, usually coupled with a lassez

faire notion of food intake... and then there's group two who have usually been

to a doctor for illness, of some sort, and those of other disability or

impedance, by work or other circumstance. Group two being impeded by no fault

of their own.

I was a member of group two until I took matters into my own hands and changed

it, no thanks to my doctor by the way. After years of his trying to discourage

me from powerlifting, I finally had to let him go in that he was out of shape,

and gave me such gems as " your female parts will fall out " . That's a direct

QUOTE. He used to play soccer on the weekends, but failed to care for himself

and when he got a slight ankle roll, he simply quit workouts completely and got

steadily fatter.... He then hounded ME about losing weight...based ONLY on my

chart and bmi...NOT my health. Meanwhile, I continued to lift heavy and gain

muscle, lose bodyfat, and lose blood pressure points and cholesterol, despite a

50 hour a week job that was the all the stress you could ever want buffet from

hell..during which I actually started competing powerlifting! After years of

trying to change my DOCTOR " S attitude after successfully becoming an athlete, i

finally was forced to change doctors.

Another member of group two, my friend in Colorado Springs was told to give up,

sit down and be a good girl, take the drugs...by her DOCTORS, her arthritis was

too bad, etc. She was badly out of shape and very overweight. In two years she

turned her life around in her 50's by lifting weights..! and aiming at

strength...and now as she approaches age 60 next year, she's a competing Olympic

lifter and qualified for the master worlds. Had she listened, her health would

be hopeless by now. Where there's a will, there's a way.

If anything, group two may actually be more LIKELY to act in their own

defense....! the mystery still being why group one fails to even try....?

beyond the usual new year's resolutions and their fracture before February

elapses? we see them every year....

And so Dr. Ralph, it appears you're in a very select minority there both as a

lifter and as an athlete who can encourage your clients to work out and offer

them aid in doing so. I salute you as such, I hope I'm still lifting at your

age. I wish you could change the minds of your colleagues though overall with

regard to weight training. It may be as simple as we need more DOCTORS WHO

LIFT. Maybe someone affiliated with a good medical school could try to turn

that around for the future?

As far as the gyms go, we in the United States are spoiled. There ARE a great

many low cost gyms, videos, books, you name it. Most people know SOMEONE who

works out or can ask to help them learn. If anything exists here it is

opportunity. The idea that weight training requires a pricey trainer should be

dispelled, if necessary, one person at a TIME. When people ask me in the gym, I

do my best to help them, right then and there. After all, I couldn't have got

where I am without such help! I will say that if they want a FULL coaching job

of it though (say nutrition, me working with you individually for 2 hours at a

time, a complete coaching job...), yes, i will have to decline to provide that

for free...but sure, ask me a quick question on form, or how to improve your

bench? not a problem!

The comment that not all have gyms is accurate. But not all things of the

weight training world require a gym. There are kegs, tires, cars, rocks,

landscaping jobs, and any number of ways. Perhaps part of the trick to this is

cutting out some of the fancy whiz bang wobbly boards and cutting to the real

notion of moving a weight a distance, with proper movement, and doing so with

progressively more over time. Reminding people they can not only walk or run,

without equipment, but do resistance work too.... if you aren't careful, you'll

find all your friends want you to help them move....

But we can do weight workouts that do not require fancy gyms, and trainers. A

friend of mine in Scotland used to just pick up the biggest rocks he could find.

Apparently Scotland has this natural gym full of Atlas Stones..and he got one

helluva workout doing just THAT! He eventually started a gym.....

There's also that simply fabulous hay bale tossing workout out there

too....gives GPP a new meaning lol. Here we have the Snow Shovel workout for

the next three days. Won't faze my muscles (I had to get gym workouts in with

more weight, yes) but I'm sure there will be some DOMS handed out all

around...plus there will be the added bonus of the car pushes in some select

locations here... the problem is to get people to do more in a fashion that

makes this less a " danger " when the opportunity for the Snow Shovel workout

arises! (the media's warning about that snow shoveling and the hospitals are

full of people who have had mishaps with the first storm apparently...) I guess

the biggest problem being the weekend shovelers?

I wrote a workout for an on line friend in Australia that was weight training in

nature but used things she had at home. It involved her cement steps on her

home, handled beverage jugs, canned goods, and a number of other things. She

found it challenging and quite useful, did it for two months until she could

acquire her own bench and db set. She now lifts with her sons.

After all, didn't Africans who didn't even own shoes beat the world at distance

running? Where there's a will, there's a way. The pursuit of strength is not

limited to gyms.

Anyway there's my points for the continuing discussion and as usual, thank you

Brett, Dr. Ralph, Lucy, for your input so far and I look forward to reading this

more. After all, this forum may be a way to work toward a world where weight

training is something people don't think of with fear, but with a future.

The Phantom

aka Schaefer, CMT, CSCS, competing powerlifter

Snowed in, Denver, Colorado, USA...

[Guest guest]

This review article may shed some light on this topic.

Ralph Giarnella MD

Southington Ct, USA

*************************************************************

Safety and Efficacy of Resistance Training in Patients

With Chronic Heart Failure: Research-Based Evidence

J. Benton, MSN, RN, APRN, BC 

Prog Cardiovasc Nurs.  2005; 20 (1): 17-23.  ©2005 Le

Jacq Communications, Inc.

Abstract and Introduction

Abstract

Although a rich body of research exists regarding the

safety and efficacy of resistance training, health

care providers continue to caution patients with heart

failure not to engage in this type of exercise.

Research studies utilizing resistance training

demonstrate improvements in muscular strength and

endurance, New York Heart Association functional

class, and quality of life. Despite the hemodynamic

changes which occur during resistance exercise, no

negative outcomes have been reported. The purpose of

this paper is to review the most current research

regarding the use of resistance training with heart

failure patients to provide assistance to clinicians

and enable them to provide education and appropriate

recommendations to their patients.

Introduction

Evidence for the safety and efficacy of resistance

training with congestive or chronic heart failure

(CHF) patients is well documented in the literature,

yet clinical recommendations from health care

providers still include cautions against this type of

exercise training. This may be due to lack of

familiarity with or understanding of the research

which has been done in this area. The American Heart

Association has published an extensive statement for

health professionals regarding exercise and physical

activity for individuals with cardiovascular (CV)

disease.[1] Unfortunately, it fails to include any

discussion of resistance training. A paper prepared

for the American Heart Association by Pollock et

al.[2] discusses the benefits of resistance training

for individuals with coronary artery disease (CAD),

but does not discuss CHF, except as a contraindication

for this type of training. The authors' summary states

that the lack of data precludes their recommending the

routine use of resistance training in

moderate-to-high-risk cardiac patients.[2] It is the

purpose of this paper to summarize for interested

clinicians the most current research regarding the

efficacy and safety of resistance exercise in CHF

patients. Nurses, because of their frequent contact

with patients and other members of the

interdisciplinary team, and the high regard in which

they are held by members of the public, are ideally

suited to provide health-care education.

Background

A search of the PubMed database was conducted using

the search terms heart failure and resistance training

or strength training. Nineteen research-based journal

articles published since 1996 were identified as

applicable to CHF. Sixteen of those articles reported

original research ( Table ), and three were review

papers. The most recent review, by Kindermann et

al,[19] was published in German, and only the abstract

is available in English. Of the studies discussed in

the other two review articles by King[20] and

Meyer[21] only that by Meyer et al.[3] examined the

effect of resistance training on CHF patients and was

published within the time frame of the literature

search. The results of the 16 original research

articles identified in the literature search will be

reviewed here.

Demographics

A total of 379 patients with CHF were studied. Study

participants included both men and women. Ages

typically ranged from 40-75 years. The majority of

participants had left ventricular ejection fractions

(EFs) ?40% and were in New York Heart Association

(NYHA) functional class II (slight limitation) or

class III (marked limitation). Three studies[3,15,16]

(n=56) did not report NYHA class. Three studies[12-14]

(n=64) reported only broad ranges from class I-IV. The

remainder of participants were classified as class I

(n=1), class I-II (n=42), class II (n=53), class

II-III (n=85), class III (n=49), class III-IV (n=28)

and class IV (n=1). Only three studies[4,5,13]

enrolled participants from class IV (inability to

carry on any physical activity without discomfort).

Study Design

Resistance training programs generally fell within two

categories: resistance training alone or in

combination with endurance training. Although the

majority of studies (n=287) measured the effect of

resistance training on CV or muscular function, two

recent studies examined the effect of combined

resistance and endurance training on insulin

sensitivity (n=77) and glucose uptake (n=15) in

individuals with CHF.[6,7] This evolution reflects the

acceptance resistance training has achieved in this

population. Research to study other chronic diseases

such as diabetes is now being designed to include

patients with CHF, reflecting assumptions of the

safety of resistance training for these patients.

Resistance training is being used just as any other

intervention would be to evaluate its effect on

metabolic conditions such as insulin resistance.

Resistance Training Alone

Three studies evaluated the effects of resistance

training alone.[3,4,8] Magnussen et al.[4] enrolled 11

male and female patients with NYHA class II-IV CHF and

EFs from 5%-39% in an 8-week, three times per week

program of knee extensor training. Resistance training

consisted of four sets of 6-10 repetitions at 80% of

maximal voluntary contraction (1RM—the maximal amount

of weight that can be lifted only once[22]) with 2

minutes rest between sets. Single leg training was

used to minimize the size of the active muscle group.

The control group engaged in endurance training

(single-legged cycling). This study demonstrated the

safety of high-intensity resistance training when only

one muscle group was activated, as well as its

effectiveness (40% increase in dynamic strength)

compared with endurance training alone (no change in

dynamic strength).

Meyer et al.[3] enrolled nine men with EFs <30% to

study the effects of an acute bout of leg press

exercise at 60% and 80% of 1RM. Four sets of 12

repetitions were performed at each intensity in random

order. Each set lasted 1 minute, followed by a

2-minute rest. Between each series of sets (60% and

80% of 1RM) participants rested for 5 minutes.

Participants were compared with controls with CAD

without evidence of CHF. During exercise bouts at both

levels of intensity hemodynamic changes occurred,

including increased heart rate and arterial blood

pressure, which were well tolerated by CHF patients.

Although sets at 80% of 1RM resulted in a greater CV

load and a greater decrease in oxygen saturation than

was observed at 60%, the increase in arterial blood

pressure was similar to that seen at 60% and was

combined with a significantly decreased systemic

vascular resistance.[3] The authors attributed this to

the ability of the failing heart to adapt to

resistance training due to the rhythmic, short-term,

isometric muscle contractions involved in the leg

press exercises which assisted venous return and

reduced peripheral resistance.[3]

More recently, Pu et al.[8] enrolled 16 women over the

age of 65 with NYHA class I-II CHF and EFs ?45% in 10

weeks of resistance training. Participants completed

three sets of eight repetitions for five exercises

(seated leg press, chest press, knee extension,

triceps, and knee flexion) three times per week. The

control group consisted of 80 women over the age of 70

with other chronic diseases and similar physical

impairments, but without CHF, who participated in a

placebo program of stretching exercises two times per

week. Although women with CHF had significantly less

strength initially than controls, they achieved

significant strength gains in all muscle groups

tested. There were no significant changes in the

control group. In addition, peripheral muscle

performance as measured by 6-minute walk distance

improved significantly in the resistance-training

group vs. controls.

Combined Resistance and Endurance Training

Non-Controlled Studies

The majority of studies with CHF patients have

utilized a combined training protocol of resistance

and endurance exercises. Of these, two studies did not

include control groups.[9,10] Delagardelle et al.[9]

studied 14 individuals aged 41-68 years with NYHA

class II-III CHF and EFs ?44%. Treadmill walking,

cycling, and six low-intensity resistance exercises

were combined in an interval fashion with increasing

intensities three times per week over a 6-month

period. The six resistance exercises, involving leg

flexion and extension, and shoulder and abdominal

muscles, were performed for three sets of 15

repetitions. Intensity progressed from 60% of 10 RM

(the maximal amount of weight that can be lifted 10

times) to 80% of 10 RM at the end of the 6-month study

period. Only slight strength increases were found.

This may have been due to the use of only

low-intensity resistance training in combination with

the endurance training. Of interest, however, was that

two participants were hospitalized during the study

period—one for acute heart failure due to atrial

fibrillation and the other for anemia. Both were

stabilized and resumed the study without further

problems.

Hare et al.[10] conducted an 11-week noncontrolled

study of nine elderly men with NYHA class II-III CHF

and EFs ?32%. The circuit-type training program

combined 1-2 minutes of stair climbing, stationary

cycling, and arm ergometry with three resistance

exercises (chest and shoulder push-pull and knee

flexion-extension) lasting 30-60 seconds each. Limited

information was provided regarding intensity, but the

authors reported that the number of circuits and

resistance levels were gradually increased over the

study period. Training resulted in significant

increases in chest push-pull and knee

flexion-extension strength. Despite the fact that only

six participants were in normal sinus rhythm during

the study, there were no adverse events.

Controlled Studies

Controls Not Trained. Three studies utilized

nontrained CHF patients as controls for circuit

training exercise programs.[11-13] Participants in all

three studies were similar, including men and women

ranging in age from 50-70 years and NYHA class I-III

CHF. EFs were not consistently reported. Study periods

were 2,[12] 3,[13] and 5[11] months.

Although all reported a circuit-type training

protocol, distinct differences were noted. Cider et

al.[11] (n=24) utilized functional activities such as

chair stands and heel lifts combined with weights and

pulley exercises for the upper and lower body.

Intensity was reported to be 60% of 1RM with two sets

of an unreported number of repetitions lasting 1

minute, with 15 seconds rest between sets. No

significant changes were observed in isokinetic or

isometric strength measurements following this

exercise regimen, although the intervention group

demonstrated an improvement in ability to lift heavier

weights after 5 months of training.[11]

Both the 2-month[12] and 3-month[13] studies utilized

similar training protocols involving upper and lower

body resistance exercises alternating with short bouts

(30 seconds-2 minutes) of endurance exercise (stair

climbing or arm or leg cycling); however, outcome

measures differed. Maiorana et al.[12] (n=12) reported

that in 2 months, trained subjects demonstrated

significant improvements in vascular function,

specifically vasodilation, compared with nontrained

controls. Most importantly, vascular improvements

occurred in nontrained muscle (forearm), suggesting

that benefits of training may be generalized rather

than specific to the muscle group being trained.[12]

Selig et al.[13] (n=39) reporting on 3 months of

circuit training, found significant increases (21%

average) in skeletal muscle strength and muscular

endurance in trained subjects, while there was no

change in the untrained control group. In addition,

improvements in (forearm) blood flow were also

documented.

In a fourth study Conraads et al.[5] compared the

effect of combined endurance and resistance training

on inflammatory markers in 23 CHF patients with either

CAD or idiopathic dilated cardiomyopathy. Eighteen

nontrained, matched CHF patients served as controls.

Participants were men and women aged 27-80 years with

NYHA class I-IV disabilities and EFs ?45%. Exercise

training was performed three times per week for 4

months. Each session included 20 minutes of cycling or

jogging and 30 minutes of resistance training at 50%

of 1RM for two sets of 10 repetitions of nine upper

and lower body and torso exercises (not specified). At

baseline, plasma cytokines were significantly elevated

in all CHF patients. After training, both the CAD and

idiopathic dilated cardiomyopathy groups showed an

improvement in submaximal exercise performance

resulting in improved NYHA functional class. A total

of eight individuals improved from class II-IV to

I-II. However, cytokine levels (tumor necrosis

factor-? and interleukin-6) decreased significantly

only in individuals with CHF due to CAD. Individuals

with CHF as a result of idiopathic dilated

cardiomyopathy did not demonstrate these changes. The

authors' interpretation of this phenomenon was that

the same mechanism which was responsible for reduction

in inflammatory markers in the CAD group was also

responsible, at least in part, for the overall

improvements in work efficiency and performance noted

in all CHF patients as a result of exercise

training.[5]

Crossover Controls. Maiorana et al.[14] reported a

crossover, controlled study that involved 13 men aged

58-62 years with NYHA class I-III CHF. Participants

were separated into two training groups that

alternated 8 weeks of circuit training with 8 weeks of

rest. Training sessions lasted 1 hour, 3 days per week

and consisted of seven resistance exercises (leg

press, hip extension, chest, shoulders, abdominal, and

leg flexion exercises) performed for sets of 15

repetitions lasting 45 seconds and alternating with

equal bouts of cycling. Intensity was reported as

progressing from 55% to 85% of 1RM during the study

period. Results demonstrated significant increases in

isotonic strength for both groups after training. Most

importantly, this study used a crossover design to

determine whether improvements were maintained after

cessation of circuit training. Although strength

increases were not completely lost after 8 weeks of

detraining, overall strength was less in the group

which trained first, suggesting that regular exercise

must be continued to retain strength gains.[14]

Endurance-Trained Controls. Two studies reported

combined resistance and endurance exercise training

programs with endurance-exercise-only control

groups.[15,16] Both studies included similar

participants: men from 40-70 years of age, with EFs

?30%. Neither study reported NYHA class. Barnard et

al.[15] trained participants three times per week for

8 weeks. All participants performed 30 minutes of

combined cycling and treadmill exercise during each

training session. In addition, the resistance exercise

group completed two sets of five upper and lower body

resistance exercises 2 days per week. Intensity was

initially 60% of 1RM for 12 repetitions and was

increased by Weeks 3-4 to 80% of 1RM for eight

repetitions. Thereafter, resistance was increased to

ensure a maximum of eight repetitions for each set.

The combined resistance and endurance exercise group

not only demonstrated significant increases in

strength compared with the endurance-only control

group, but despite the high-intensity training, no CV

abnormalities were observed.

Delagardelle et al.[16] reported a longer, 10-week

program with more frequent resistance training (three

times per week) at a lower intensity (60% of 1RM).

Each training session lasted 40 minutes, with the

control group using the full training period for

cycling. The combined training group cycled for only

20 minutes and then performed 20 minutes of six

resistance exercises (leg extension, leg curl, seated

arm press, lateral pull down, rowing, and lateral arm

abduction) in three series of sets of 10 repetitions

at 60% of 1RM. Results of this study included

significant strength increases in the combined

resistance/endurance training group compared with the

endurance-only training group. In addition, the

combined training group gained body weight while the

endurance-only training group lost body weight. This

was interpreted to be the result of an increase in

muscle mass accompanying strength gains.[16]

Healthy Controls. A study by Karlsdottir et al.[17]

compared a total of 36 individuals with CHF, CAD, and

healthy volunteers during an acute bout of combined

endurance and resistance exercise. CHF and CAD

participants were comparable in age (60-70 years old)

while the healthy subjects were 20-40 years old. All

three groups were composed of men and women. CHF

patients were NYHA class I-II status with EFs <45%.

Participants completed a 15-minute cycling protocol

followed by a 5-minute rest period. They then

performed one set of 10 repetitions of three

resistance exercises (seated leg press, shoulder

press, biceps curls) at 60%-70% of 1RM. Outcome

measures compared CV responses of all three groups.

Similar hemodynamic and left ventricular responses

were found in the CHF group as in the CAD and healthy

control groups.[17] Based on these results, it was the

authors' recommendation that CHF patients could be

safely enrolled in cardiac rehabilitation programs,

including resistance training, with expectations that

they would receive benefits similar to those obtained

by CAD patients.[17]

Home-Based Training

One home-based training study was identified. Oka et

al.[18] examined the effect of a home-based walking

and resistance training program on 20 men and women

aged 30-76 years. All had NYHA class II-III heart

failure. EFs were not reported. Twenty other

individuals with similar characteristics served as a

" usual care " control group. The 3-month exercise

program consisted of walking 3 days per week for 40-60

minutes at 70% maximal heart rate, in addition to 2

days per week of resistance exercises at an intensity

which was gradually increased over the initial 2-3

weeks of the study period to approximately 75% of

1RM.[18] No details of 1RM testing or specifics

regarding the resistance training protocol were

included. Treadmill testing was used to evaluate

exercise endurance and CV response. Improvements in

quality of life were measured by questionnaire. The

exercise program resulted in improvements in quality

of life and reduced fatigue and dyspnea.[18] Although

only minimal, nonsignificant changes in physical

fitness were identified, the home-based program

resulted in no negative outcomes or adverse effects.

Exercise adherence was described as excellent.[18]

1RM Testing

Of particular interest was the inclusion of 1RM

testing as a preliminary step in the development of

resistance training programs. Strength testing using

1RM is the gold standard for resistance training. It

involves determining the heaviest weight that can be

lifted only once using good form.[22] As an

alternative, 6 RM or 10 RM can be used as measures of

muscular fitness, but are less accurate for assessment

of strength. Magnusson et al.[4] used 1RM testing for

single-knee extensor strength in a 1996 study designed

to minimize simultaneous activation of large muscle

groups. Subsequently, 1RM testing was utilized with

progressively larger and more complex muscle groups

and exercises.[3,8,14,15,17] Even a resistance

exercise program to be implemented in the home without

direct supervision used 1RM testing.[18] In the

studies reviewed for this paper, no negative CV or

musculoskeletal consequences were reported as

associated with determining 1RM in patients with CHF.

Despite its safe and effective application in the

studies reviewed here, 1RM testing remains

unrecognized and not recommended for exercise testing

in individuals with CHF.[23]

Recommendations

Within the last 10 years, numerous studies of varying

lengths and intensities have reported the safety and

efficacy of resistance training with CHF patients.

Outcomes have included increased strength and

functional ability and improved hemodynamic function.

In these studies, no negative CV consequences have

been reported either in a clinical/institutional or

in-home setting. Participants who became ill or

decompensated received treatment and continued with

the training program. In addition, 1RM testing for

maximal voluntary contraction has been consistently

and safely included as a measurement technique in this

population. Again, no negative outcomes have been

reported in these studies. The studies reviewed here

support the application of resistance exercise as a

safe and effective strategy that patients should

continue over time to retain its benefits. Clinicians

need to increase their understanding of resistance

exercise training to ensure that it is routinely

considered for inclusion in therapeutic exercise

programs for patients with CHF.

Table. Resistance Training and Chronic Heart Failure:

Research Evidence

1.

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2. Pollock ML, lin BA, Balady GJ, et al. AHA

Science Advisory. Resistance exercise in individuals

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the Committee on Exercise, Rehabilitation, and

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Heart Association; position paper endorsed by the

American College of Sports Medicine. Circulation.

2000;101:828-833.

3. Meyer K, Hajric R, Westbrook S, et al. Hemodynamic

responses during leg press exercise in patients with

chronic congestive heart failure. Am J Cardiol.

1999;83:1537-1543.

4. Magnusson G, Gordon A, Kaijser L, et al. High

intensity knee extensor training in patients with

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Acknowledgements

The author wishes to thank J. Stone, PhD,

Chair of the Department of Exercise and Wellness at

Arizona State University for his comments and feedback

on the initial draft of this manuscript.

Reprint Address

Address for correspondence: J. Benton, MSN,

RN, CNS, APRN, BC, Department of Exercise and

Wellness, Arizona State University East, 7350 East

Unity, Mesa, AZ 85212. E-mail: melissa.benton@...

J. Benton, MSN, RN, APRN, BC , Department of

Exercise and Wellness, Arizona State University East,

Mesa, AZ