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Progressive Resistance Training
 

Progressive Resistance Training

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    Progressive Resistance Training Progressive Resistance Training Presentation Transcript

    • Progressive Resistance Training Use in Cardiovascular Disease and Safety Considerations Professor Maria A. Fiatarone Singh, MD, FRACP
    • Introduction and Background
      • Progressive resistance training may be used in individuals at high risk for cardiovascular disease
      • Progressive resistance training may be used in individuals with coronary artery disease, hypertension, congestive heart failure, cardiac rehabilitation following heart surgery, and cardiac transplantation
    • Benefits of PRT in Cardiovascular Disease
      • Reduction in cardiac risk factors:
        • hypertension,
        • visceral obesity,
        • hyperinsulinemia,
        • insulin resistance,
        • dyslipidemia,
        • sedentariness
    • Benefits of PRT in Cardiovascular Disease
      • Improvement in ischemic symptoms:
        • claudication
        • angina
      • Less need for medications:
        • angina
        • diabetes
        • hypertension
        • lipid lowering agents
        • depression
    • Benefits of PRT in Cardiovascular Disease
      • Improvement in peripheral skeletal muscle morphology and function:
        • mass,
        • strength,
        • oxidative capacity,
        • glycogen storage,
        • glucose transport
        • blood flow,
        • amino acid uptake and protein synthesis,
        • A/V O 2 extraction
    • Benefits of PRT in Cardiovascular Disease
      • Improvement in functional and exercise capacity:
        • increased submaximal and maximal cardiovascular exercise capacity
        • increased anerobic threshold
        • decreased double product (HR x SPBP)
        • decreased perceived exertion
        • improved performance of activities of daily living
    • Benefits of PRT in Cardiovascular Disease
      • Antidote to glucocorticoid side-effects in organ transplant recipients:
        • myopathy
        • osteopenia
    • PRT after cardiac transplantation: effect on muscle mass Braith, MSSE 30:483-89 1998
    • Benefits of PRT in Cardiovascular Disease
      • Improvement in psychological function:
        • depressive symptoms,
        • self-efficacy
    • Permanent cardiovascular contraindications to PRT
      • End stage congestive heart failure
      • Inoperable critical aortic stenosis
      • Uncontrolled malignant arrhythmias
      • Unstable angina at rest
      • Inoperable aortic or cerebral aneurysm
      • Severe proliferative diabetic retinopathy
    • Potential cardiovascular risks of PRT
      • Hypertension
      • Hypotension
      • Arrhythmias
      • Ischemia
      • Aneurysm leak or rupture
      • Hemorrhage
      • Retinal hemorrhage, worsening of proliferative retinopathy
    • Potential cardiovascular risks of PRT
      • Hypertension
        • Acutely , PRT increases systolic and diastolic BP, MAP, Total peripheral resistance
        • Chronically PRT has a sustained effect to reduce systolic and diastolic BP for at least 24 hrs post-exercise
        • PRT may be initiated in controlled hypertensives in concert with other RX
        • Uncontrolled hypertension should be treated prior to the initiation of PRT
    • Blood pressure monitoring during leg press 1RM: 72 yo with type 2 diabetes
    • Blood pressure monitoring during seated row 1RM: 72 yo with type 2 diabetes
    • Blood pressure response to PRT
      • Rapid rise in systolic and diastolic blood pressure with onset of isometric or concentric contraction
      • Fall in blood pressure during eccentric contraction; to baseline or below within 1-2 seconds of release of contraction
      • Normal levels during rest intervals between sets
    • Magnitude of blood pressure response to PRT
      • Increase proportional to:
        • Relative load (%MCV or %1RM)
        • Size of muscle mass involved (variable)
        • Duration of contractions
        • Onset of muscular fatigue
        • Use of isometric handgrip
        • Use of Valsalva maneuver (attempting to exhale against a closed glottis)
    • Potential cardiovascular risks of PRT
      • Hypotension during exercise
        • May reflect left main coronary artery disease, dehydration, venous pooling, autonomic neuropathy, cardiac denervation, cardiac failure, critical aortic stenosis, bradycardia, heart block, drug effect
        • Do not start or continue PRT if this occurs until consultation with physician
    • Prevention of Hypotension during PRT
      • Dehydration
      • Venous pooling
        • Cardiac transplant
        • Autonomic neuropathy
        • Diabetes
        • Drugs
      • Maintain fluid intake
      • Walk between exercises;alternate arms and legs; maintain normal breathing pattern; perform standing calf raises, avoid overhead press; end session with 5-min cool down walk
    • Potential cardiovascular risks of PRT
      • Arrhythmias:
        • Ventricular or atrial arrhythmias may occur with increased myocardial oxygen demand (double product)
        • Lower HR during PRT compared to aerobic exercise may reduce relative risk
        • May indicate ischemia, electrolyte disturbance, fluid imbalance, heart failure, other systemic disease
    • Potential cardiovascular risks of PRT
      • Ischemia:
        • Elevation of diastolic pressure and modest increase in heart rate may reduce risk relative to aerobic exercise:
          • Coronary perfusion pressure maintained during diastole (better supply)
          • Myocardial oxygen demand lower than during aerobic exercise (such as stairclimbing)
    • No cases of myocardial infarction, angina, or sudden death in literature during PRT (including CAD and CHF patients) Over 26,000 subjects undergoing 1RM testing every 2 years at Cooper Clinic and Univ Florida: No cardiovascular events
    • Strong Medicine Unit Balmain Hospital, Sydney 1999-2002
      • Over 8,000 individual training sessions in elderly subjects with chronic disease
      • No significant cardiovascular events
      • 2,000 muscle strength testing sessions
      • No significant injury
      • 3 falls, no fracture, one heart block on testing
    • Potential cardiovascular risks of PRT
      • Aneurysm leak or rupture:
        • Rise in mean arterial pressure predisposes to dissection/rupture
        • Aortic aneurysm which is > 5cm in transverse diameter is at greatest risk of rupture
        • Repaired aneurysms not a contraindication to exercise training (aerobic or resistive)
        • Case reports of subarachnoid hemorrhage associated with weight lifting may have been intracerebral aneurysms (1% of population)
    • Potential cardiovascular risks of PRT
      • Hemorrhage
        • Patients at risk:
          • anticoagulation/aspirin for atrial fibrillation, valve replacement, stroke, venous thrombosis, cardiac prophylaxis or surgery
        • Soft tissue injury due to pressure of weight machines or free weights
        • Fall
        • Muscle or ligament tear during contraction
    • Potential cardiovascular risks of PRT
      • Retinal hemorrhage, worsening of proliferative retinopathy:
        • Position stands proscribe strenuous aerobic activity or weight lifting in severe proliferative diabetic retinopathy
        • Case reports of hemorrhage or retinal detachment; no rigorous studies
        • Intraocular pressure proportional to mean arterial pressure (MAP)
    • Minimizing risk of ocular complications, elevated intraocular pressure
      • Avoid direct trauma to eye
      • Keep head above level of heart
      • Avoid high impact, jarring activities
      • Minimize IOP by lowering load, avoiding sustained isometric contractions, Valsalva maneuver
      • No strenuous exercise early after laser or other ocular surgery (? 2 wks)
    • General PRT training principles to minimize cardiovascular risks
      • No Valsalva maneuver during lifts
      • No breath holding
      • No isometric contractions
      • No sustained contractions
      • Increase rest intervals between repetitions
      • Keep load between 60 and 80% of 1RM
      • No sets “to fatigue”
    • PRT training principles to minimize cardiovascular risk
      • No training if:
        • New onset chest pain
        • Unstable angina
        • Uncontrolled arrhythmias
        • Uncontrolled hypertension
        • Untreated aortic or other aneurysm
        • Overanticoagulation
        • Recent MI or cardiac surgery until cleared
        • Recent intracerebral hemorrhage until cleared
        • Severe proliferative retinopathy
        • Recent ophthalmologic surgery until cleared
    • Summary
      • PRT is indicated in the prevention and treatment of cardiovascular disease
      • Stable patients with CAD, CHF, Hypertension, Peripheral vascular disease, Diabetes, Stroke, Organ transplant are candidates for PRT
      • Standard PRT principles which should be used in all individuals minimize cardiovascular risk