Effects resistance training in combination with endurance training in CHF
| Study | Design | Sample | Exercise interventions | Outcome variables | Results |
| Delagardelle et al (2002)62 | RCT comparing endurance training with and without resistance training | Randomised, n = 20 patients with CHF (only men); completed programme, n = 20; E, n = 10; C, n = 10 | E: supervised progressive resistance training programme at 60% of 1RM (3×10 repetitions) alternating between upper and lower body in combination with leg cycling for 20 min at 50–75% of peak Vo2 using intervals of 2 min, 3/week for 13 weeks | CPET on cycle ergometer, lower limb peak muscle strength and endurance, cardiac function, NYHA classification | Mean changes in LVEF (18.0 vs −11.4%, p = 0.009), LVDD (−3.2 vs 4.4%, p = 0.004) and fractional shortening (10.2 vs −11.1%, p = 0.043) were higher in E than in C |
| Setting: Department of Cardiac Rehabilitation of Centre Hospitalier in Luxembourg, Luxembourg | Age (E/C): 56/60 years† BMI (E/C): 27.8/27.7 years?† LVEF (E/C): 26.7/30.7%† Vo2 (E/C): 19.3/16.7 ml/min/kg NYHA class (whole group): II/III Ischaemic aetiology: n = 17 (85%) | C: leg cycling for 40 min at 50 to 75% of peak Vo2 using intervals of 2 min, 3×/week for 13 weeks | Mean changes in body weight, NYHA classification, peak power output, peak Vo2, peak capillary lactate, peak RER, isokinetic knee extensor and flexor strength at 180°/s, and isokinetic knee extensor and flexor endurance at 180°/s were not significantly different | ||
| Barnard et al (2002)63 | RCT comparing endurance training with and without resistance training | Randomised, n = 21 patients with CHF (only men); completed programme, n = 21; E, n = 14; C, n = 7) | E: supervised progressive resistance training programme at 60–80% of 1RM (2×12 to 2×8 repetitions) alternating between upper and lower body, 2×/week for 8 weeks in combination with leg cycling for 15 min at 60–80% of peak heart rate reserve and treadmill walking for 15 min at 60–80% of peak heart rate reserve, 3×/week for 8 weeks | Upper and lower body peak muscle strength, cardiovascular and muscle soreness response to peak muscle strength tests | Mean changes in peak horizontal squat (18.3 vs 2.0%, p<0.05), peak leg extension (31.6 vs 6.0%, p<0.05), peak shoulder press (32.6 vs 1.0%), peak lat pull-down (23.2 vs 1.0%, p<0.05), peak biceps curl (25.5 vs 1.0%, p<0.05) and mean post-training systolic blood pressure immediately after 1RM (153.0 vs 126.6 mm Hg, p<0.05) were higher in E than in C |
| Setting: Cardiac Rehabilitation Centre of River Cities Cardiology in Jeffersonville, USA | Age (E/C): 60 (10)/55 (14) years BMI (E/C): 29.7/30.1 kg/m2* LVEF (E/C): 25.0 (6.8)/22.9 (10.7)% Vo2 (E/C): 22.9 (12)/15.0 (6) ml/min/kg NYHA class: not reported Ischaemic aetiology: n = 14 (66.7%) | C: leg cycling for 15 min at 60–80% of peak heart rate reserve and treadmill walking for 15 min at 60–80% of peak heart rate reserve, 3×/week for 8 weeks | Mean post-training heart rate, diastolic blood pressure and rate pressure product immediately after 1RM and muscle soreness 2 and 7 days after 1RM were not significantly different | ||
| Haykowsky et al (2005)‡61 | RCT comparing endurance training with and without resistance training followed by 12 weeks of unsupervised training§ | Randomised, n = 20 patients with CHF (only women); completed programme, n = 17; E, n = 10; C, n = 7 | E: supervised progressive resistance training programme at 50–70% of 1RM (1– 2 sets, number of repetitions not reported) alternating between upper and lower body in combination with leg cycling for 15– 42 min at 60–70% of heart rate reserve, 2×/week for 12 weeks | CPET on cycle ergometer, upper and lower limb peak muscle strength, quality of life | Mean change in isotonic peak vertical row strength (23 vs 0%, p<0.05) was higher in E than in C |
| Setting: Not specified, Edmonton, Canada | Age (whole group): 72 (8) BMI (whole group): 27.7 kg/m2* LVEF: not reported Vo2: not reported NYHA class (whole group): I/II/III Ischaemic aetiology: n = 8 (40%) | C: leg cycling for 15–42 min at 60–70% of heart rate reserve, 2×/week for 12 weeks | No statistical comparisons have been reported between E and C for mean changes in isotonic peak leg press, peak Vo2, peak power output and total score of the Minnesota Living with Heart Failure Questionnaire | ||
| Beckers et al (2008)59 | RCT comparing endurance training with and without resistance training | Included, n = 60 patients with CHF (43 men); completed, n = 58; E, n = 28; C, n = 30 | E: supervised progressive resistance training programme at 50–60% of 1RM (1×10 to 2×15 repetitions) alternating between trunk and upper and lower body in combination with leg cycling and treadmill walking/jogging for 8–15 min at a heart rate achieved at 90% of the anaerobic threshold, 3×/week for 23 weeks | Steady-state workload, CPET on treadmill, biomarkers of left ventricular diastolic wall stress, NYHA classification, upper and lower limb muscle strength, respiratory strength, quality of life, body composition§ | Mean changes in steady-state workload (24.8 vs 15.6 W, p = 0.007) and heart rate over steady-state ratio (1.43 vs 0.47, p = 0.002), T½Vo2 (−89 vs −12 s), upper limb isotonic muscle strength (13.2 vs 5.7 kg, p = 0.003) and maximal expiratory pressure (12.5 vs −8.6% predicted, p = 0.03), and the number of patients who reported a significant decrease on Health Complaints Scale (60 vs 28%, p = 0.03) were higher in E than in C |
| Setting: Cardiac Rehabilitation Centre of University Hospital in Antwerp, Belgium | Age (E/C): 58 (11)/59 (11) years BMI (E/C): 25.7 (5.0)/26.2 (4.8) kg/m2 LVEF (E/C): 26 (7)/23 (9)% Vo2 (E/C): 18.1 (5)/21.3 (6) ml/min/kg NYHA class (whole group): II/III Ischaemic aetiology: n = 34 (58.6%) | C: supervised leg cycling, treadmill walking/jogging, stair or step, arm cycling, and half recumbent or reclined cycling for 8–15 min at a heart rate achieved at 90% of the anaerobic threshold, 3×/week for 23 weeks | Mean changes in peak Vo2, peak power output, peak heart rate, (submaximal) work economy, VE/Vco2 slope, circulatory power, lower limb isokinetic measurements, lower limb isotonic muscle strength, maximal inspiratory pressure, NYHA classification, NT-proBNP, LVEF, LVEDD, LVESD, body fat percentage, fat mass, fat-free mass, BMI and waist-hip ratio were not significantly different | ||
| Degache et al (2007)60 | NRCT comparing endurance training with and without resistance training | Included, n = 24 patients with CHF (19 men); completed programme, n = 23; E, n = 12; C, n = 11 | E: supervised progressive resistance training programme at 70% of 1RM (10×10 repetitions) on a isotonic concentric leg extensor bench in combination with leg cycling for 30 min at 65% of peak Vo2, 3×/week for 8 weeks | CPET on cycle ergometer, lower limb peak muscle strength, NYHA classification | Mean change in isokinetic knee extensor strength at 60°/s (0.14 vs −0.06 Nm/kg, p<0.03) and 180°/s (0.13 vs −0.06 Nm/kg, p<0.04) were higher in E than in C |
| Setting: Cardiopulmonary Rehabilitation Unit, Department of Clinical Physiology of University Hospital in St. Etienne, France | Age (E/C): 50 (13)/55 (10) years BMI (E/C): 27.5/25.7 kg/m2* LVEF (whole group): 32 (5)% VO2 (E/C): 17.8 (5)/18.6 (4) ml/min/kg NYHA classification: II/III Ischaemic aetiology: n = 10 (43.5%) | C: leg cycling for 45 min at 65% of peak Vo2, 3×/week for 8 weeks | Mean change peak Vo2 was not significantly different No statistical comparisons were reported between E and C for mean changes in NYHA classification, isokinetic knee flexor strength at 60°/s and 180°/s, peak power output, peak heart rate, peak systolic blood pressure and Vo2 at ventilatory threshold |
Values are reported as mean (standard deviation), unless stated otherwise.
*Mean value derived from numbers reported in article (actual number not reported by authors); †standard deviation/standard error of the mean not reported; ‡Haykowsky and colleagues61 did not reply to our queries sent twice by email; §the authors provided the data by email.
BMI, body mass index; BNP, brain natriuretic peptide; C, control group; CHF, chronic heart failure; CPET, cardiopulmonary exercise test; E, experimental group; E:A ratio, ratio of early to atrial filling during diastole; LVDD, LVDD, left ventricle diastolic diameter; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; NRCT, non-randomised controlled trial; NYHA class, New York Heart Association classification; RCT, randomised controlled trial; RER, respiratory exchange ratio; 1RM, one-repetition maximum; T½Vo2, peak aerobic capacity half time; Vo2, peak aerobic capacity.