1. 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

2. 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

4. Evidence for strength training

5. Evidence for strength training

7. Evidence for strength training

8. Evidence for strength training

9. Evidence for strength training

10. 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….

12. Strength training: how?

13. Strength training: how?
<70% 1RM
>70% 1RM

14. Strength training: how?

15. Strength training: how?

16. Strength training: how?
DeGroot et al. Arch Phys Med Rehabil 1998; 79:

17. Strength training: how?
Lamotte M, et al. Eur J Cardiovasc Prev Rehabil 2005; 12: 12-7

18. Strength training: how?

19. 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

20. Strength training: how?

21. Strength training: how?

22. Strength training: setting the intensity
1 RM testing
Not of use…
Handgrip strength testing
Dynamometry

23. 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….

24. 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….

25. Strength training: setting the intensity
<10 reps

26. Strength training: how?
Marzolini et al. Med Sci Sports Exerc 2008; 40:

27. Strength training: how?
Concentric contraction
Isometric contraction
Eccentric contraction

28. 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

29. 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