No conflict of interest Presciption of strength training for cardiac rehabilitation Cardiovascular Rehabilitation Training Course 22-23 March 2018, Lviv/Ukraine Dominique Hansen, FESC No conflict of interest
Learning objectives To obtain an understanding of the clinical benefits of strength training in CR To know how to maximize the medical safety of strength training in CR To know how to prescribe strength training in CR To know what remains to be studied in this field
Evidence for strength training
Evidence for strength training
Evidence for strength training
Evidence for strength training
Evidence for strength training
There is a lot of evidence in support of strength training in CR…. Interim conclusion There is a lot of evidence in support of strength training in CR….
Strength training: how?
Strength training: how? <70% 1RM >70% 1RM
Strength training: how?
Strength training: how?
Strength training: how? DeGroot et al. Arch Phys Med Rehabil 1998; 79: 838-41
Strength training: how? Lamotte M, et al. Eur J Cardiovasc Prev Rehabil 2005; 12: 12-7
Strength training: how?
Strength training: how? Optimisation of medical safety Prevent Valsalva manoeuvre Exhale during contraction Check for orthopedic symptoms Monitoring of ‘cardiovascular’ symptoms Diziness, dyspnea, angina, heart rythm disturbances, hypertension, etc. Guaruantee correct execution Supervision is important Provide warming up Use correct equipment Fysiocam system
Strength training: how?
Strength training: how?
Strength training: setting the intensity 1 RM testing Not of use… Handgrip strength testing Dynamometry
Strength training: setting the intensity 1 RM testing: approach 1 Warm-up with light weight Stretching of targeted muscle Set 5 repetitions Increase weight every set until just 5 repetitions can be reached (2-5 min break between sets) Calculate 1 RM from 5 repetitions Disadvantage: time-consuming….
Strength training: setting the intensity 1 RM testing: approach 2 Warm-up with light weight Stretching of targeted muscle Execute as many repetitions as possible Calculate 1 RM from those repetitions Advantage: less time-consuming….
Strength training: setting the intensity <10 reps
Strength training: how? Marzolini et al. Med Sci Sports Exerc 2008; 40: 1557-64
Strength training: how? Concentric contraction Isometric contraction Eccentric contraction
Strength training: how? Allow the muscle to recover from strength training 2-3 days/week, with at least 24-48h recovery Muscle soreness is to be expected Especially after eccentric strength training
Conclusions Strength training is an important exercise modality Clinically effective and medically safe Strength training must be executed under strict conditions to optimise medical safety Many strength training modalities remain to be studied in greater detail in cardiac patients 1 RM must be assessed in systematic manner