Weightlifting training in cardiac patients. Considerations

Cardiovascular disease is the leading cause of morbidity and mortality in most of the industrialised nations in the world. Many treatment strategies are used for patients with coronary artery disease. One of these strategies is the use of cardiac exercise rehabilitation. The traditional approach to cardiac exercise rehabilitation has been the training of large muscle groups using aerobic activities such as cycling or walking. These types of activities have been demonstrated to improve maximal exercise performance and endurance. However, although aerobic performance is improved it does not address another very important component of exercise rehabilitation--namely muscular strength. Weightlifting training has been demonstrated to improve muscular strength in healthy individuals. Until recently this form of exercise training of patients with cardiac disease has been avoided due to the haemodynamic response observed during isometric (static) exercise. Weightlifting has recently been demonstrated not to be a pure isometric exercise and a different haemodynamic response has been found even in patients with cardiac disease. For this reason studies of weightlifting training have been performed in selected groups of patients with coronary artery disease. The results of these studies in this limited group of patients have demonstrated the activity is safe and beneficial in terms of improving the patient's functional capacity. Weightlifting training may also favourably affect the risk factors for coronary artery disease. Based on studies reviewed in this paper, recommendations can be made for the weightlifting training of patients with coronary artery disease. These include restriction to patients who are asymptomatic or only mildly symptomatic; initiation of training only after a period of aerobic training; the use of single limb activities; a maximum intensity no greater than 60% of 1 repetition maximum; patients train at their own rate; initially performed in a medically supervised programme; periodic reassessment of the exercise prescription; and patients should record their heart rate and response to exercise.