Moderate-intensity isometric wall squats in CAD patients significantly increased systolic blood pressure compared to low-intensity squats (196 vs 162 mmHg at Set 2; p<0.01).
RCT (n=12)
Randomized crossover
Does moderate-intensity isometric wall squat compared to low-intensity isometric wall squat affect hemodynamic responses in patients with coronary artery disease?
Isometric wall squats are well tolerated in CAD patients but induce substantial, intensity-dependent increases in systolic blood pressure, highlighting the need for careful intensity prescription in cardiac rehabilitation.
Absolute Event Rate: 196% vs 162%
p-value: p=< 0.01
Abstract Background Isometric resistance training (RT), such as handgrip, wall squat, and plank exercises, effectively lowers resting systolic blood pressure (SBP), often exceeding aerobic and dynamic RT effects. Despite its proven safety and efficacy in hypertensive adults, dynamic RT remains standard in cardiac rehabilitation. No specific guidelines exist for isometric RT in coronary artery disease (CAD). Further research is warranted to establish the safety and potential incorporation of isometric RT into exercise prescriptions for this population. Purpose To compare hemodynamic responses to two intensities of isometric wall squat (IWS). Methods In this prospective, randomized crossover trial, CAD patients performed IWS at 135° (IWS-Low) and 115° (IWS-Mod) knee angles in random order. Each modality comprised two 90-s bouts with 2-min rests. A washout period of at least 30 minutes was implemented between modalities. Participants were instructed to breathe normally during exercise to avoid the Valsalva manoeuvre. Hemodynamics (SBP, DBP, pulse rate) were continuously and non-invasively recorded using a vascular unloading technique. Data are presented as median (IQR) and analyzed via two-way ANOVA with Bonferroni correction (p 0.05). Results Twelve participants (83% male; age: 68.5 65.5–73.5 years; height: 1.75 1.70–1.80 m; weight: 86.5 73.5–91.8 kg, 6MWD: 646 582–700 m; LVEF: 57.0 54.5–62.5 %) completed all IWS bouts without any adverse events or complications. A significant time effect (F(4,110)=8.85; p0.001) and intensity × time interaction for SBP (F(4,110)=4.10; p0.01) were observed. In both conditions, SBP increased significantly over time. IWS-Low: from Baseline: 132 130–140 mmHg to Set 1: 157 148–173 mmHg (p 0.05) and Set 2: 162 151–181 mmHg (p 0.01). IWS-Mod: from Baseline: 129 124–134 mmHg to Set 1: 180 175–210 mmHg (p 0.001) and Set 2: 196 181–222 mmHg (p 0.001). SBP was significantly higher in IWS-Mod compared to IWS-Low at both Set 1 (180 175-210 mmHg vs. 157 148-173 mmHg; p 0.01) and Set 2 (196 181-222 mmHg vs. 162 151-181 mmHg; p 0.01). The highest individual SBP values were observed during IWS-Mod, reaching 229 mmHg in Set 1 and 238 mmHg in Set 2. A significant increase in DBP was observed only in IWS-Mod (from Baseline 72 66–75 mmHg to Set 1: 85 74–95 mmHg, p 0.05; and Set 2: 84 76–91 mmHg, p 0.05). No significant differences were found in pulse rate (PR). Conclusion Two bouts of 90-s IWS at both angles were well tolerated in CAD patients. However, SBP increased substantially in an intensity-dependent manner, with individual peak values exceeding 220 mmHg during the 115° condition. Further research is warranted to establish safe intensity thresholds and optimize training parameters (knee joint angle, number of sets, bout duration) for clinical application.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Schmidt et al. (Mon,) conducted a rct in Coronary artery disease (n=12). Isometric wall squat at 115° knee angle (IWS-Mod) vs. Isometric wall squat at 135° knee angle (IWS-Low) was evaluated on Systolic blood pressure at Set 2 (p=< 0.01). Moderate-intensity isometric wall squats in CAD patients significantly increased systolic blood pressure compared to low-intensity squats (196 vs 162 mmHg at Set 2; p<0.01).