Resistance exercise: training adaptations and developing a safe exercise prescription

The safety and efficacy of resistance exercise training (RT) in patients with chronic heart failure (CHF) are critically reviewed. Evidence-based recommendations for designing safe RT programs are also presented to help clinicians and rehabilitation professionals formulate exercise prescriptions for their patients. To the extent possible, the separate and independent effects of RT on patients with CHF are discussed. Clinical prognosis (i.e. risk stratification) and exercise capacity in patients with CHF are determined by the mitigating effects of both central hemodynamics and peripheral pathophysiology. Despite the well-described skeletal muscle wasting and myopathy in heart failure, aerobic exercise remains by far the most prescribed training modality in patients with CHF. This article presents evidence that improvement of skeletal muscle phenotype (muscle mass, fiber morphology, and histochemistry) should be a fundamental goal of rehabilitation in patients with CHF. Moreover, RT may be the preferred exercise modality when targeting the periphery for muscle phenotype adaptation.