1. BELLARMINE UNIVERSITY, LOUISVILLE, KY Eccentric Training and CAD Michael Beavin, Jason Copelin, Madelaine Nolan, and Kaitlyn Stahl

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY Eccentric Training: Is it safe and effective in patients with CAD?

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY Why is it relevant? Strength training previously contraindicated in CAD (Steiner, 2004) Safety and Efficiency? Lack of research on eccentric training in persons with CAD –Not commonly implemented in practice

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY Background 1 in every 4 deaths is attributed to CAD (CDC, accessed November 19, 2013)CDC Physical activity can delay progression of CAD (Steiner, 2004) Aerobic exercise and concentric training has been the foundation for treatment of cardiac patients Steiner, 2004) Eccentric training in cardiac patients has not been studied as a method of therapeutic exercise

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY Study Designs 2 Randomized Controlled Trials (Meyer, 2008) (Steiner, 2004) 1 Quasi-Experimental Study (Gremeaux, 2010) 1 Systematic Review (Roig, 2008) 1 Meta-analysis (Roig, 2009)

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Subjects Meyer, 2008: n=13, males age 40-66 Roig, 2008: 9 Studies (3 CAD), n= 12-20, ages 40-66 Gremeaux, 2010: n=14, males age 40-65 Steiner, 2004: n=13, males age 42-66 Roig, 2009: 20 studies, n=10-70, ages 21-33

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Methods/Interventions Meyer, 2008 and Steiner, 2004: Eccentric Bike Ergometer –3x weekly for 30mins. Intensity set at 60% VO2max or 85% max HR. –Identical increase in workload across groups until week 5, kept constant for last 3 weeks.

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Methods/Interventions cont. Roig, 2008: Interventions in the 3 CAD studies used Eccentric Cycling for treatment group Gremeaux, 2010: Eccentric Cycling 3x weekly for 15 sessions. Roig, 2009: Studies selected compared eccentric and concentric training

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results Roig, 2009 Eccentric is more effective in promoting muscle mass than concentric Increased strength http:// www.telegraph.co.uk /

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results cont. Meyer, 2008: Max power output was 4x that of concentric. O2 uptake and blood lactate were significantly lower. RPE was similar. Roig, 2008: Increased work output at lower intensities. Does not increase muscle discomfort or fatigue. Reduces arterial compliance.

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results cont. Gremeaux, 2010: Ankle plantar flexor strength improved Steiner, 2004: Leg muscle mass increased in both groups Eccentric group had greater gain in peak torque RPE was equally low in both groups

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusions Meyer, 2008: Uncoupling of skeletal muscle load and cardiovascular stress during eccentric training Hemodynamically safe in CAD Roig, 2008: Strength gains at a reduced metabolic level

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusions cont. Gremeaux, 2010: As efficient as concentric Less oxygen demand and workload on the heart Steiner, 2004: Increased muscular strength and function Roig, 2009: Eccentric training is effective for increasing strength

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Limitations All males, Ages 40-66 Small sample sizes Complicated patients were not included Short 5 week ramp up period Normal motion includes both concentric and eccentric actions Difficult to isolate eccentric

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY Future Research Longitudinal studies Implement eccentric training at higher workload Safety in patients with advanced cardiac disease Creation of standardized protocols based on patient characteristics Effects on gait cycle and ambulation

16. BELLARMINE UNIVERSITY, LOUISVILLE, KY Implications For low-risk middle aged male patients with mild CAD, eccentric training can be recommended as a safe, feasible, and well tolerated approach to strength training.

17. BELLARMINE UNIVERSITY, LOUISVILLE, KY Questions? http://www.riskmanagement365.com/tag/cardiac-rehab/

18. BELLARMINE UNIVERSITY, LOUISVILLE, KY References 1. Gremeaux V. Does eccentric endurance training improve walking capacity in patients with coronary artery disease? A randomized controlled pilot study. Clinical Rehabilitation [serial online]. July 2010;24(7):590-599. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. Accessed September 21, 2013. 2. Meyer K, Steiner R, Hoppeler H, et al. Eccentric exercise in coronary patients: central hemodynamic and metabolic responses. Medicine & Science In Sports & Exercise [serial online]. July 2003;35(7):1076-1082. Available from: CINAHL, Ipswich, MA. Accessed September 21, 2013.Roig M, Shadgan B, Reid W. 3. Roig M, Shadgan B, Reid W.D.. Eccentric Exercise in Patients with Chronic Health Conditions: A Systematic Review. Physiotherapy Canada. 2008; 60: 146-160 4. Roig M, O'brien K, Kirk G, et al. The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. Br J Sports Med. 2009;43(8):556-68. 5. Steiner R., Meyer K., Lippuner K., Schmid J.-P., Saner H., Hoppeler H. Eccentric endurance training in subjects with coronary artery disease: a novel exercise paradigm in cardiac rehabilitation? Eur J Appl Physiol. 2004;(91):572–578.