Resistance training for chronic heart failure patients on beta blocker medications

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Abstract

Background

Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients. However, there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption (peak VO2) of chronic heart failure patients treated with beta-blocker. This study examined the effect of resistance training on hemodynamics, peak aerobic capacity, muscle strength and quality of life of chronic heart failure patients on beta-blockers medication.

Methods

Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group. At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life questionnaires.

Results

The resistance training group demonstrated a significant increase of walking time and peak VO2 by 11.7% (p=0.002) and ~19% (p<0.05), respectively Peak VO2 was significantly correlated with both walking time (r=0.54, p=0.038) and change in total weight lifted (r=0.55, p=0.034). Quality of life significantly increased by 87% (p=0.030). The improvement in quality of life was correlated with post training peak VO2 (r=0.58, p=0.025) and total weight lifted during the post maximal strength test (r=−0.52, p=0.047).

Conclusions

The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity, skeletal muscle strength and most importantly, an improvement in the quality of life, which is the main goal of cardiac rehabilitation programs. Furthermore, with appropriate supervision, it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible.

Introduction

A reduction of aerobic capacity and a decrease of skeletal muscle mass and strength are characteristics of chronic heart failure patients [1], [2]. It is widely accepted that changes in skeletal muscle structure, such as muscle atrophy and muscle fiber alteration [1], and in metabolism, such as a reduction in oxidative enzymes activities and early anaerobic metabolism [3], [4], are major contributors to these phenomena. The role of resistance training in heart disease patients is to promote dynamic skeletal muscle strength [5] with an associated decrease in the numbers of falls and injuries related to falls with an improved functional ability of elderly and chronic heart failure patients [6], [7], [8].

Beta-blocker therapy is considered a standard therapy for people with chronic heart failure [9]. It was shown that beta-blocker therapy reduces the clinical progress of the disease [10], decreases the heart rate and blood pressure and increases the ejection fraction and improves the quality of life [11], [12]. However, despite these improvements peak oxygen consumption (peak VO2) and exercise capacity has not consistently improved following beta-blocker therapy [13], [14].

Previous studies demonstrated a correlation between peak VO2 and muscle mass (r between 0.57 and 0.71) [15], [16], [17] which suggests that resistance training may improve the aerobic capacity of people with chronic heart failure [1]. However, studies that examined the effect of resistance training on peak VO2 of chronic heart failure patients on beta-blocker medications are limited and the data available for other cardiac populations is inconclusive [18], [19], [20], [21]. The inconsistencies between the studies regarding the effect of resistance training on peak VO2 may be as a result of the different types of training protocols used (intensities, length and duration of the program) and the different types of cardiac patients. Hence, the purpose of this study was to examine the effect of resistance training on peak aerobic capacity, muscle strength and quality of life of chronic heart failure patients on beta-blocker medication.

Section snippets

Method

Fifteen men with mean (±SD) age 57.0±10.2 years diagnosed with chronic heart failure (ejection fraction=34.7±7.2) and treated with beta-blockers for at least 3 months volunteered to participate in the study. Subjects were matched to either a resistance training program (n=8) or non-training control group (n=7) according to their age and ejection fraction. The study protocol was approved by the Human Research Ethics Committee, Southern Cross University (ECN-02-110) and John Flynn Private

Baseline comparison

No differences were found between the groups at baseline for age, weight, height, ejection fraction, peak VO2 and total weight lifted in the maximal strength test (groups' clinical characteristics are shown in Table 1). The beta-blocker doses were slightly changed in two subjects during the study. All subjects completed 8 weeks of training without injuries or muscle soreness. No adverse effects were recorded during and for 24 h after the tests or during the training. Four subjects did not

Discussion

There is limited data in the literature reporting the effect of progressive resistance training on chronic heart failure patients in general and for those on beta-blocker medication in particular. Studies that examined the effect of resistance training on cardiac and chronic heart failure patients also involved some degree of aerobic training (such as circuit weight training) [27], [28]. Although these studies demonstrated significant improvement in the patient's strength and functional

Acknowledgments

This study was partly funded by Roche Products NSW, Australia. The authors wishes to thank Elite Fitness Group, Australia for contributing the resistance equipment. Ms. Karen Gosper for her assistance in recruiting the subjects and Mrs. Debbie Humphreys for her assistance during the testing procedures.

References (55)

  • N. McCartney

    Role of resistance training in heart disease

    Med. Sci. Sports Exerc.

    (1998)
  • J.F. Nichols et al.

    Effects of resistance training on muscular strength and functional abilities of community-dwelling older adults

    J. Aging Phys. Act.

    (1995)
  • M. Brochu et al.

    Effects of resistance training on physical function in older disabled women with coronary heart disease

    J. Appl. Physiol.

    (2002)
  • P.G. MacRae et al.

    A 1-year exercise program for older women: effects on falls, injuries and physical performance

    J. Aging Phys. Act.

    (1996)
  • B.J. Gersh

    Mayo clinical heart book

    (2000)
  • W.S. Colucci et al.

    Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure

    Circulation

    (1996)
  • M. Arumanayagam et al.

    Antioxidant properties of carvedilol and metoprolol in heart failure: a double-blind randomized controlled trail

    J. Cardiovasc. Pharm.

    (2001)
  • Effect of carvedilol, a vasodilator-ß-blocker, in patients with congestive heart failure due to ischemic heart disease

    Circulation

    (1995)
  • R.S. Engelmeier et al.

    Improvement in symptoms and exercise tolerance by metoprolol in patient with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial

    Circulation

    (1985)
  • M.R. Bristow et al.

    Dose–response of chronic ß-blocker treatment in heart failure from either idiopathic dilated or ischemic cardiomyopathy

    Circulation

    (1994)
  • M. Volterrani et al.

    Muscle wasting is a determinant of maximal oxygen consumption in patients with chronic heart failure

    Eur. Heart J.

    (1993)
  • J.L. Fleg et al.

    Role of muscle loss in the age-associated reduction on VO2max

    J. Appl. Physiol.

    (1988)
  • W.L. Westcott

    Circuit training

  • A.J. Maiorana et al.

    A controlled trail of circuit weight training on aerobic capacity and myocardial oxygen demand in men after coronary artery bypass surgery

    J. Cardiopulm. Rehabil.

    (1997)
  • L.S. Hempel et al.

    Cardiorespiratory cost of the nautilus express circuit

    Phys. Sportsmed.

    (1985)
  • S.J. Fleck et al.

    Resistance training: physiological responses and adaptations (part 2 of 4)

    Phys. Sportsmed.

    (1988)
  • N.B. Schiller et al.

    Recommendations for quantitation of the left ventricle by two-dimensional echocardiography

    J. Am. Soc. Echocardiogr.

    (1989)
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