Is blood flow restriction resistance training the missing piece in cardiac rehabilitation of frail patients?

Exercise-based cardiac rehabilitation (CR) is an effective component of secondary preventive management of patients with cardiovascular diseases (CVD), especially with coronary artery disease (CAD) and heart failure (HF).1 Exercise training structure has evolved from unistructural aerobic training (AT) to a combination of AT and resistance training (RT), with balance training, coordination, and inspiratory muscle training as additional adjunct modalities per patients’ specific needs.1,2 With ageing population, increasing numbers of frail and sarcopenic older individuals with CAD are enrolled in CR,3 which requires tailored and individualized exercise training, with special emphasis to maintain or to increase muscle strength and hypertrophy.4 Despite recent advances regarding RT,2 we are still lacking established training intervention for frail patients.3 Most patients with frailty are unable to participate in regular moderate-to-vigorous intensity RT [40–80% of one repetition maximum (1-RM)] as recently recommended in the guidelines2; alternative...