Hemodynamic response to dynamic leg press resistance training in patients with coronary artery disease: preliminary data from hemodyret study

Background/Introduction Dynamic resistance training (RT) is a key component of exercise therapy in patients with cardiovascular disease and is widely recommended in current guidelines. However, uncertainty persists regarding the optimal training modalities. While higher intensities yield greater strength gains, concerns about potential hemodynamic overload remain. Emerging evidence suggests that high-intensity RT with short exercise durations may even induce lower hemodynamic stress compared to moderate-intensity RT with longer exercise duration. Still, data in this field remain limited. Purpose Compare the acute hemodynamic responses to two different intensities of dynamic leg press (DLP) RT in patients with coronary artery disease (CAD). Methods In this prospective, single-centre, randomized crossover trial, adults with CAD performed two DLP protocols: three sets of 15 reps at 40% 1RM (DLP-Low) and three sets of 8 reps at 80% 1RM (DLP-High) (Fig 1). All sets were executed at a fast speed (1.5 s concentric/eccentric) with 90-second rest between sets. To avoid the Valsalva maneuver, participants were instructed to exhale during the concentric phase and inhale during the eccentric phase. A washout period of at least 30 minutes was implemented between modalities. Continuous, non-invasive hemodynamic monitoring (SBP, DBP, pulse rate) was performed using a vascular unloading technique. Data are reported as median (IQR) and analyzed by two-way ANOVA with Bonferroni correction (p < 0.05). Results Twelve participants were included (age 68.5 [65.5–73.5] years; 83% male; BMI 26.8 [23.0–30.2] kg/m²; LVEF 57.0 [54.5–62.5] %). The 1RM at leg press was 154 [123–177] kg, with training loads of 61 [49–70] kg (DLP-Low) and 114 [99–142] kg (DLP-High). All participants completed both protocols without any complications. A significant time effect on SBP was found (F(6,154)=6.82; p<0.001). SBP increased significantly during both DLP-Low (Baseline: 141 [124–144] mmHg to Set 1: 171 [153–173], Set 2: 166 [154–173], Set 3: 167 [157–174]; all p < 0.01) and DLP-High (Baseline: 138 [134–143] mmHg to Set 1: 171 [160–184], Set 2: 181 [171–195], Set 3: 190 [181–202]; all p < 0.001). SBP was higher in DLP-High (190 [181-202] mmHg) vs. DLP-Low (167 [157-174] mmHg) at Set 3 (p < 0.05). DBP increased significantly only in DLP-High (Baseline: 67 [66–69] mmHg to Set 2: 89 [80–102], Set 3: 90 [76–102]; both p < 0.001) (Fig 2). No significant changes were observed in pulse rate. The highest individual SBP values during DLP-High reached 206 mmHg (Set 1), 241 mmHg (Set 2), and 242 mmHg (Set 3). Conclusion DLP was well tolerated by all participants, even at higher intensities. However, it induced marked, intensity-dependent elevations in blood pressure, predominantly in SBP and most pronounced during the high-load protocol (80% 1RM). Individual peak SBP values exceeded 220 mmHg, indicating considerable cardiovascular stress in this patient group.Acute blood pressure response DLP-HighFor image description, please refer to the figure legend and surrounding text. Acute SBP response DLP-Low vs. DLP-HighFor image description, please refer to the figure legend and surrounding text.