Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Heart Failure Reviews

Open Access 15-04-2024 | Heart Failure | Review

Resistance is not futile: a systematic review of the benefits, mechanisms and safety of resistance training in people with heart failure

Authors: Bradley A. Morris, Ronak Sinaei, Neil A. Smart

Published in: Heart Failure Reviews

Login to get access

Abstract

Exercise offers many physical and health benefits to people with heart failure (CHF), but aerobic training (AT) predominates published literature. Resistance training (RT) provides additional and complementary health benefits to AT in people with CHF; we aimed to elucidate specific health benefits accrued, the mechanism of effect and safety of RT. We conducted a systematic search for RT randomised, controlled trials in people with CHF, up until August 30, 2023. RT offers several benefits including improved physical function (peak VO2 and 6MWD), quality of life, cardiac systolic and diastolic function, endothelial blood vessel function, muscle strength, anti-inflammatory muscle markers, appetite and serious event rates. RT is beneficial and improves peak VO2 and 6MWD, partly restores normal muscle fibre profile and decreases inflammation. In turn this leads to a reduced risk or impact of sarcopenia/cachexia via effect on appetite. The positive impact on quality of life and performance of activities of daily living is related to improved function, which in turn improves prognosis. RT appears to be safe with only one serious event reported and no deaths. Nevertheless, few events reported to date limit robust analysis. RT appears to be safe and offers health benefits to people with CHF. RT modifies the adverse muscle phenotype profile present in people with CHF and it appears safe. Starting slowly with RT and increasing load to 80% of 1 repetition maximum (RM) appears to offer optimal benefit.
Literature
1.
Smart NA, King N, Lambert JD, Pearson MJ, Campbell JL, Risom SS et al (2018) Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials. Open Heart 5(2):e000880PubMedPubMedCentralCrossRef
2.
Larsen AI, Lindal S, Aukrust P, Toft I, Aarsland T, Dickstein K (2002) Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity. Int J Cardiol 83(1):25–32PubMedCrossRef
3.
Gielen S, Adams V, Mobius-Winkler S, Linke A, Erbs S, Yu J et al (2003) Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 42(5):861–868PubMedCrossRef
4.
Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM (2007) A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. J Am Coll Cardiol 49(24):2329–2336PubMedCrossRef
5.
Koch M, Douard H, Broustet JP (1992) The benefit of graded physical exercise in chronic heart failure. Chest 101(5 Suppl):231S-S235PubMedCrossRef
6.
Jewiss D, Ostman C, Smart NA (2016) The effect of resistance training on clinical outcomes in heart failure: a systematic review and meta-analysis. Int J Cardiol 221:674–681PubMedCrossRef
7.
Sarullo FM, Fazio G, Brusca I, Fasullo S, Paterna S, Licata P et al (2010) Cardiopulmonary exercise testing in patients with chronic heart failure: prognostic comparison from peak VO2 and VE/VCO2 slope. Open Cardiovasc Med J 4:127–134PubMedPubMedCentralCrossRef
8.
Fisher S, Smart NA, Pearson MJ (2022) Resistance training in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 27(5):1665–1682PubMedCrossRef
9.
Levinger I, Bronks R, Cody DV, Linton I, Davie A (2005) The effect of resistance training on left ventricular function and structure of patients with chronic heart failure. Int J Cardiol 105(2):159–163PubMedCrossRef
10.
Maiorana A, O’Driscoll G, Cheetham C, Collis J, Goodman C, Rankin S et al (2000) Combined aerobic and resistance exercise training improves functional capacity and strength in CHF. J Appl Physiol 88(5):1565–1570PubMedCrossRef
11.
Selig SE, Carey MF, Menzies DG, Patterson J, Geerling RH, Williams AD et al (2004) Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow. J Card Fail 10(1):21–30PubMedCrossRef
12.
Sabelis LW, Senden PJ, Te Boekhorst BC, Hulzebos HJ, Van De Wiel A, Van Haeften TW et al (2004) Does physical training increase insulin sensitivity in chronic heart failure patients? Clin Sci (Lond) 106(5):459–466PubMedCrossRef
13.
Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC et al (2024) Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation 149(3):e217–e231PubMedCrossRef
14.
Smart NA, Steele M (2010) Systematic review of the effect of aerobic and resistance exercise training on systemic brain natriuretic peptide (BNP) and N-terminal BNP expression in heart failure patients. Int J Cardiol 140(3):260–265PubMedCrossRef
15.
Smart NA, Meyer T, Butterfield JA, Faddy SC, Passino C, Malfatto G et al (2012) Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure. Eur J Prev Cardiol 19(3):428–435PubMedCrossRef
16.
Ismail H, McFarlane JR, Dieberg G, Smart NA (2014) Exercise training program characteristics and magnitude of change in functional capacity of heart failure patients. Int J Cardiol 171(1):62–65PubMedCrossRef
17.
Maiorana AJ, Naylor LH, Exterkate A, Swart A, Thijssen DH, Lam K et al (2011) The impact of exercise training on conduit artery wall thickness and remodeling in chronic heart failure patients. Hypertension 57(1):56–62PubMedCrossRef
18.
Edelmann F, Gelbrich G, Dungen HD, Frohling S, Wachter R, Stahrenberg R et al (2011) Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 58(17):1780–1791PubMedCrossRef
19.
Lee CT, Chen LW, Chien MY (2017) Effects of exercise training on anabolic and catabolic markers in patients with chronic heart failure: a systematic review. Heart Fail Rev 22(6):723–730PubMedCrossRef
20.
Andreae C, Arestedt K, Evangelista L, Stromberg A (2019) The relationship between physical activity and appetite in patients with heart failure: a prospective observational study. Eur J Cardiovasc Nurs 18(5):410–417PubMedPubMedCentralCrossRef
21.
Smart N, Steele M (2011) Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 16(7):626–632PubMed
22.
StataCorp (2019) Stata statistical software: release 16. StataCorp LLC, College Station, TX
23.
Wells G, Beaton D, Shea B, Boers M, Simon L, Strand V et al (2001) Minimal clinically important differences: review of methods. J Rheumatol 28(2):406–412PubMed
24.
Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C, Cornelissen V et al (2015) Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc 13(1):9–18PubMedCrossRef
25.
Cider A, Tygesson H, Hedberg M, Seligman L, Wennerblom B, Sunnerhagen KS (1997) Peripheral muscle training in patients with clinical signs of heart failure. Scand J Rehabil Med 29(2):121–127PubMed
26.
Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J (2007) Is strength training the more efficient training modality in chronic heart failure? Med Sci Sports Exerc 39(11):1910–1917PubMedCrossRef
27.
Groennebaek T, Sieljacks P, Nielsen R, Pryds K, Jespersen NR, Wang J et al (2019) Effect of Blood Flow Restricted Resistance Exercise and Remote Ischemic Conditioning on Functional Capacity and Myocellular Adaptations in Patients With Heart Failure. Circ Heart Fail 12(12):e006427PubMedCrossRef
28.
Grosse T, Kreulich K, N.gele H, Reer R, Petersen B, Braumann K et al (2001) Peripheres Muskelkrafttraining bei schwerer Herzinsuffizienz. Deutsche Zeitschrift für Sportmedizin 52(1)
29.
Jakovljevic DG, Donovan G, Nunan D, McDonagh S, Trenell MI, Grocott-Mason R et al (2010) The effect of aerobic versus resistance exercise training on peak cardiac power output and physical functional capacity in patients with chronic heart failure. Int J Cardiol 145(3):526–528PubMedCrossRef
30.
Lan NS, Lam K, Naylor LH, Green DJ, Minaee NS, Dias P et al (2020) The impact of distinct exercise training modalities on echocardiographic measurements in patients with heart failure with reduced ejection fraction. J Am Soc Echocardiogr 33(2):148–156PubMedCrossRef
31.
Munch GW, Rosenmeier JB, Petersen M, Rinnov AR, Iepsen UW, Pedersen BK et al (2018) Comparative effectiveness of low-volume time-efficient resistance training versus endurance training in patients with heart failure. J Cardiopulm Rehabil Prev 38(3):175–181PubMedCrossRef
32.
Palevo G, Keteyian SJ, Kang M, Caputo JL (2009) Resistance exercise training improves heart function and physical fitness in stable patients with heart failure. J Cardiopulm Rehabil Prev 29(5):294–298PubMedCrossRef
33.
Pu CT, Johnson MT, Forman DE, Hausdorff JM, Roubenoff R, Foldvari M et al (2001) Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. J Appl Physiol 90(6):2341–2350PubMedCrossRef
34.
Redwine LS, Wilson K, Pung MA, Chinh K, Rutledge T, Mills PJ et al (2019) A randomized study examining the effects of mild-to-moderate group exercises on cardiovascular, physical, and psychological well-being in patients with heart failure. J Cardiopulm Rehabil Prev 39(6):403–408PubMedPubMedCentralCrossRef
35.
Sadek Z, Ahmaidi S, Youness M, Joumaa W, Awada C, Ramadan W (eds) (2018) Impact of resistance training in patients with chronic heart failure. The Seventh International Conference on Global Health Challenges, Athens, Greece
36.
Tyni-Lenn R, Dencker K, Gordon A, Jansson E, Sylv.n C, (2001) Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. Eur J Heart Fail 3(1):47–52CrossRef
37.
Xu D, Wang B, Hou Y, Hui H, Meng S, Liu Y (2002) The effects of exercise training on plasma tumor necrosis factor-alpha, blood leucocyte and its components in congestive heart failure patients. Zhonghua Nei Ke Za Zhi 41(4):237–240PubMed
38.
39.
Ciani O, Piepoli M, Smart N, Uddin J, Walker S, Warren FC et al (2018) Validation of exercise capacity as a surrogate endpoint in exercise-based rehabilitation for heart failure: a meta-analysis of randomized controlled trials. JACC Heart Fail 6(7):596–604PubMedCrossRef
40.
Smart NA, Larsen AI, Le Maitre J, Ferraz A, Marwick TH (2005) Does exercise training reduce inflammatory cytokines in patients with systolic heart failure? A multi-centre trial. Eur Heart J 26:180
41.
Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO (2013) Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail 1(2):93–102PubMedCrossRef
42.
Smart N, Marwick T (2004) Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 116(10):693–706PubMedCrossRef
43.
Myers J (2003) Cardiology patient pages. Exercise and cardiovascular health Circulation 107(1):e2-5PubMed
44.
Norton K, Norton L, Sadgrove D (2010) Position statement on physical activity and exercise intensity terminology. J Sci Med Sport 13(5):496–502PubMedCrossRef
45.
Levinger I, Bronks R, Cody DV, Linton I, Davie A (2005) Resistance training for chronic heart failure patients on beta blocker medications. Int J Cardiol 102(3):493–499PubMedCrossRef
46.
Wood G, Murrell A, van der Touw T, Smart N (2019) HIIT is not superior to MICT in altering blood lipids: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 5(1):e000647PubMedPubMedCentralCrossRef
47.
Chan E, Giallauria F, Vigorito C, Smart NA (2016) Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis. Monaldi Arch Chest Dis 86(1–2):759PubMed
48.
Brubaker PH, Nicklas BJ, Houston DK, Hundley WG, Chen H, Molina AJA et al (2023) A randomized, controlled trial of resistance training added to caloric restriction plus aerobic exercise training in obese heart failure with preserved ejection fraction. Circ Heart Fail 16(2):e010161PubMed
49.
50.
Meyer K (2006) Resistance exercise in chronic heart failure—landmark studies and implications for practice. Clin Invest Med 29(3):166–169PubMed
51.
Chen YC, Chen W-C, Liu C-W, Huang W-Y, Lu I, Lin CW et al (2023) Is moderate resistance training adequate for older adults with sarcopenia? A systematic review and network meta-analysis of RCTs. Eur Rev Aging Phys Act 20(1):22PubMedPubMedCentralCrossRef
52.
Sasaki K, Fukumoto Y (2022) Sarcopenia as a comorbidity of cardiovascular disease. J Cardiol 79(5):596–604PubMedCrossRef
53.
Grgic J, Schoenfeld BJ, Orazem J, Sabol F (2022) Effects of resistance training performed to repetition failure or non-failure on muscular strength and hypertrophy: a systematic review and meta-analysis. J Sport Health Sci 11(2):202–211PubMedCrossRef
54.
Robertson RJ, Goss FL, Rutkowski J, Lenz B, Dixon C, Timmer J, Frazee K, Dube J, Andreacci J (2003) Concurrent validation of the OMNI perceived exertion scale for resistance exercise. Med Sci Sports Exerc 35(2):333–341PubMedCrossRef
55.
Naclerio F, Rodríguez-Romo G, Barriopedro-Moro MI, Jiménez A, Alvar BA, Triplett NT (2011) Control of resistance training intensity by the omni perceived exertion scale. JSCR 25(7):1879–1888
56.
Gearhart RFJ, Lagally KM, Riechman SE, Andrews RD, Robertson RJ (2009) Strength tracking using the OMNI resistance exercise scale in older men and women. JSCR 23(3):1011–1015
57.
58.
59.
Grgic J, Lazinica B, Schoenfeld BJ, Pedisic Z (2020) Test–retest reliability of the one-repetition maximum (1RM) strength assessment: a systematic review. Sports Medicine - Open 6(1):31PubMedPubMedCentralCrossRef
60.
Ellis R, Holland AE, Dodd K, Shields N (2019) Reliability of one-repetition maximum performance in people with chronic heart failure. Disabil Rehabil 41(14):1706–1710PubMedCrossRef
Metadata
Title
Resistance is not futile: a systematic review of the benefits, mechanisms and safety of resistance training in people with heart failure
Authors
Bradley A. Morris
Ronak Sinaei
Neil A. Smart
Publication date
15-04-2024
Publisher
Springer US
Keyword
Heart Failure
Published in
Heart Failure Reviews
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI
https://doi.org/10.1007/s10741-024-10402-0

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits