Resistance Training: Simple and Effective

It has been since 2007 that the American Heart Association (AHA) last published a scientific statement focused on resistance training and cardiovascular disease (CVD) (1). The December 2023 statement is an update emphasizing the accumulating evidence of the safety and effectiveness of resistance training in a wide variety of individuals at risk for and who have established CVD (2). The strong writing group includes esteemed clinical exercise physiologist Dr. Barry Franklin and ranges across the breadth of specialty interests including clinical cardiology, nursing, stroke care, and peripheral vascular disease. They begin by mentioning that resistance training is part of the AHA initiative known as Life's Essential 8 (which replaced the Simple 7) which are general recommendations aimed at lowering primary and secondary CVD risk. Like cardiorespiratory training benefits, the largest benefit of those along the spectrum of dose of resistance training is realized when moving from no resistance training to very modest amounts.Importantly, this document provides a concise review of the literature supporting resistance training as part of a well-rounded regular exercise routine for individuals of all ages, regardless of sex, and for those with a variety of chronic clinical diseases or conditions (e.g., chronic kidney disease, peripheral artery disease, human immunodeficiency virus, Alzheimer's/dementia). The benefits include modifying or controlling traditional risk factors (i.e., blood pressure, blood glucose, blood lipids, and body composition) and what is termed in the paper as nontraditional risk factors (i.e., endothelial function/arterial stiffness, chronic inflammation, cardiorespiratory fitness, mental health including depression and anxiety, and sleep habits).In the United States, many exercise training recommendations and implementation provided by clinical exercise physiologists are delivered in the setting of a cardiac ­rehabilitation program. The American Association of Cardiovascular and Pulmonary Rehabilitation guidelines emphasize that "cardiorespiratory endurance training should be the foundation of most exercise routines for adults with or at risk for CVD" (3). Although not mandated by insurance coverage, it is likely for this reason that the exercise therapy primarily delivered in most cardiac rehabilitation programs in the US is focused on aerobic modes of exercise. Programs may attempt to incorporate forms of resistance training, but time allotment for patient care, lack of dedicated equipment or space, and patient-related issues (e.g., frailty and inexperience, a finite amount of time available, reluctance, unawareness of potential benefits) are often at the core of reasons resistance training efforts are abandoned. This segment of the population is also known to have the lowest rates of resistance training participation.As a practicing clinical exercise physiologist, I strongly suggest you read this AHA update to re-engage with the prospect of designing and implementing a feasible and sustainable resistance training option for patients who are often frail, experiencing declining skeletal muscle quality (tone, strength, and range of motion reductions), and who are also at risk of falls and injury due to inadequate strength and balance. The update emphasizes using body weight and resistance bands when machine and free weights are not an option (along with a nice figure with suggested exercises involving body weight, bands, and dumbbells). The authors do not make a distinction between benefits based on resistance training mode, suggesting similar benefit regardless of mode. The paper also emphasizes that sessions can be short (15–20 minutes maximum), involving a single set (8–12 repetitions of a moderate resistance intensity) of 8–10 different exercises using the major muscle groups. A focus on resistance training for our clients and patients can result in both clinical and quality-of-life benefits, the latter of which is often most important to an individual.