Resistance training procedures for cardiac rehabilitation

There are several benefits of resistance training for all populations. Muscle atrophy and strength loss are known to occur with age. Muscle atrophy as we age is well documented and presents health concerns to an aging population regarding quality of life and health status. Age related decrements in health are decreased energy expenditure, increased body fat, and reduced in insulin sensitivity. Quality of life is affected by reduced strength, endurance, and difficulty in being physically active. Strength, muscle mass, muscle quality, power, energy expenditure, body composition, and ability to complete daily tasks are benefitted by resistance training for older adults. This document will discuss procedures for resistance training in the cardiac rehabilitation segment of the population. 

Heart disease is responsible for one in seven deaths in the U.S. and 790,000 have heart attacks each year. There are 92.1 million people currently living with heart disease or after effects of a stroke. Patients who have a heart attack or discovered to have heart disease may have to undergo some type of intervention. Intervention strategies often include bypass surgery or angioplasty with stent placement and medication. After this interventional strategy is completed, many patients engage in a supervised cardiac rehabilitation program at a medical facility. The program consists of risk factor modification education, stress management, and monitored exercise program. 

A monitored exercise program usually lasts three months. The first month of exercise focuses on healing and getting heart dynamics improved to an acceptable level. If the patient's heart dynamics are stable, resistance training is beneficial for many patients. All organizations site absolute contraindications for cardiac rehab patients to engage in resistance training include unstable angina, uncontrolled dysrhythmias, recent history of congestive heart failure, severe stenotic or regurgant valvular disease, and hypertrophic cardiomyopathy. Relative contraindications include poor left ventricular function, angina or ischemia at low workloads of less than five METs. The cardiologist generally decides if the patient is healthy enough to engage in resistance training. Upon approval, the patient must complete some instruction and evaluation with an exercise physiologist. 

Proper technique and breathing is important for all populations, but especially important here. The exercise professional should demonstrate proper form for every exercise in the circuit. Circuits are a series of exercises done one after another with little or no rest between exercises. Circuits are generally used to elevate and maintain a desired target heart rate. The patient is taught to do all movements slow and controlled. The negative is when the weight is coming down and should last approximately four seconds. The positive is when the weight is going up and should last approximately two to three seconds. The patient should inhale on the negative and exhale on the positive. The patient must never hold his or her breath to avoid the Valsalva maneuver. The Valsalva maneuver occurs when someone forcefully expires against a closed glottis which increases intrathoracic that affects venous return, cardiac output, arterial pressure, and heart rate. 

After or during the circuit of exercises demonstration, the patient is asked to complete a two-repetition maximum to evaluate strength for determining the proper amount of weight to be used at the start of the resistance training program. The patient completes a two-repetition maximum on each exercise in the circuit. The two-rep max represents ninety percent of a true maximum. The correction is made yielding a maximum value for each exercise. Sixty-five percent of this maximum value is used as the starting weight for the circuit of approximately twelve to fifteen exercises. The patient will complete twenty repetitions on lower body and fifteen repetitions on upper body exercises with relatively light weight. During the first training session, the patient should have a health professional go through the circuit with the patient while another assesses heart rate and rhythm per EKG monitor. The medical professional must obtain a blood pressure during a resistance training exercise. The easiest is usually the leg extension because it uses a large muscle group in a seated position making it very convenient. Resistance training intensity is based on rate pressure product (RPP). Rate pressure product is the heart rate multiplied by systolic blood pressure. This value for resistance training should not exceed the RPP for the cardiovascular exercise completed during the sessions. 

Resistance training provides many benefits for many populations. Many Americans live with cardiovascular disease that may benefit from using every muscle of the body to improve strength, balance, body composition, circulation, and bone mineral density as well the cardiovascular system. Please visit tpnbodyperfect.com or view our demonstration at https://youtu.be/sDaxW961Mn0