AHA Says Weight Training May Benefit Cardiac Patients

DALLAS, July 17 -- For cardiac patients, weight training twice a week may be a good adjunct to aerobic conditioning, according to an updated scientific statement from the American Heart Association.

The statement, published online by Circulation, Journal of the American Heart Association, recommends one set of 10 to 15 repetitions for those with cardiovascular disease versus the usual prescription of three sets of 10 repetitions given to healthy adults.

Exercises can include chest press, shoulder press, triceps extension, bicep curl, lower-back extension, abdominal crunch/curl, quad extension, leg press, and calf raises.

Traditionally cardiac rehabilitation has focused on aerobic training, but the AHA issued recommendations for resistance training in 2000. This updated statement acknowledged that weight training has benefits such as increased strength and improved bone mineral density that may reduce disability associated with heart disease. But, the AHA pointed out that weight training should be considered as an adjunct to aerobic conditioning, not a substitute.

The training should be done in a "rhythmical manner at a moderate to slow controlled speed," wrote Mark A. Williams, Ph.D., of Creighton University in Omaha, who co-chaired the AHA committee that wrote the statement.

Among the recommendations:

• Exercises should include a full range of motion, avoiding breath holding and straining by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase.
• Alternate upper and lower body work to allow for adequate rest between exercises.
• Limit initial weight load to eight to 10 repetitions per set for healthy sedentary adults; and 10 to 15 repetitions at a low level of resistance for cardiac patients.
• Limit workout to a single set, two days per week.

But the use of resistance training in cardiac patients will require "good clinical judgment and close monitoring," according to the AHA statement.

There are, for example, a number of absolute and relative contraindications to weight training.

Absolute contraindications are not surprising-- unstable coronary heart disease, decompensated heart failure, uncontrolled arrhythmias, mean pulmonary arterial pressure of more than 55 mm Hg, severe and symptomatic aortic stenosis, acute myocarditis, endocarditis, or pericarditis, uncontrolled hypertension or more than 180/110 mm Hg, and Marfan's syndrome.

Additionally high intensity resistance training is absolutely contraindicated in patients with proliferative retinopathy or moderate nonproliferative diabetic retinopathy.

The AHA said relative contraindications-meaning that the patient should consult a physician before starting a weight training program--included diabetes, pacemaker and ICD patients, patients with uncontrolled hypertension of more than 160/100 mmHg and patients who have major risk factors for coronary disease.