Hemodynamic and Hemostatic Response to Blood Flow Restriction Resistance Exercise in Coronary Artery Disease: A Pilot Randomized Controlled Trial.

BACKGROUND: Blood flow-restricted resistance training (BFR-RT) has been proven to be safe and efficacious in healthy older adults, but not in cardiovascular disease. OBJECTIVE: The aim of this study was to investigate the acute and training induced effects of BFR-RT on hemostatic and hemodynamic responses in patients with coronary artery disease (CAD). METHODS: Stable patients with CAD were randomized to 8 weeks of BFR-RT (30%-40% 1-repetition maximum unilateral knee extension) combined with aerobic training or aerobic training alone (control group). At baseline and after 4 and 8 weeks, blood samples were taken before and after BFR exercise, whereas hemodynamic parameters were monitored throughout the exercise. RESULTS: Twenty-four patients (12 per group; mean age, 60 ± 2 years; mostly male [75%]) completed the study. The BFR-RT significantly improved systolic blood pressure (-10 mm Hg; P = .020) and tended to lower diastolic blood pressure (-2 mm Hg; P = .066). In contrast, no posttraining alterations were observed in N-terminal prohormone B-type natriuretic hormone, fibrinogen, and D-dimer values. During BFR exercise, all hemodynamic variables significantly increased after the first and second set, whereas blood pressure immediately lowered after the cuff was released in the third set. Last, significant interaction was only observed for repetitions × intensity (P < .001; partial η2 = 0.908) of diastolic blood pressure at higher exercise intensity (40% 1-repetition maximum). CONCLUSIONS: The BFR-RT was proven to be safe, with favorable hemodynamic and hemostatic responses in patients with CAD, and can be recommended as an additional exercise modality in cardiac rehabilitation.Trial Registration:ClinicalTrial.gov Identifier: NCT03087292.

Physical activity and sedentary behaviour following combined aerobic and resistance training in coronary artery disease patients: A randomised controlled trial.

BACKGROUND: Effective training modalities and potential determinants to induce favourable changes in physical activity (PA) and sedentary behaviour (SB) remains elusive in patients with coronary artery disease. AIMS: This study aimed to investigate the effects of high-load resistance training and low-load RT combined with aerobic training in comparison to aerobic training alone on PA and SB, and whether baseline level of SB modifies PA outcomes in coronary artery disease patients. METHODS: We randomised 79 patients to aerobic training, low-load resistance training and aerobic training or high-load resistance training and aerobic training. PA and SB were measured using triaxial accelerometer at baseline and post-training for 8 days. RESULTS: There was no difference between training modalities in post-training PA and SB. When stratified by baseline SB, the very sedentary patients improved SB (-52 min/day, p = 0.001) and light intensity PA (+27 min/day, p = 0.009) following intervention. The improvement in PA was greater in the very sedentary patients (SB: +27%, p = 0.002; light intensity PA: +24%, p = 0.004) and in sedentary patients (SB: +24%, p = 0.009) compared to the very active patients. CONCLUSIONS: Post-training improvement in PA and SB was determined by baseline SB, while the addition of low-load or high-load resistance training provided no further benefits in coronary artery disease patients. CLINICAL TRIALS REGISTRATION NUMBER: NCT04638764.

Insulin resistance, lipids and body composition in patients with coronary artery disease after combined aerobic training and resistance training: a randomised, controlled trial.

BACKGROUND: The effect of resistance training (RT) in cardiac rehabilitation (CR) on insulin resistance remains elusive. We examined whether the addition of high-load (HL) or low loads (LL) RT has any effect on the levels of insulin resistance and lipids versus aerobic training (AT) alone in patients with coronary artery disease (CAD). METHODS: Seventy-nine CAD patients were randomised to HL-RT [70-80% of one repetition maximum (1-RM)] and AT, LL-RT (35-40% of 1-RM) and AT or AT (50-80% of maximal power output), and 59 patients [75% males, 15% diabetics, age: 61 (8) years, left ventricular ejection fraction: 53 (9) %] completed the study. Plasma levels of glucose, insulin, blood lipids [total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL)] cholesterol and body composition were measured at baseline and post-training (36 training sessions). RESULTS: Training intervention had only time effect on lean mass (p = 0.002), total and LDL cholesterol levels (both p < 0.001), and no effects on levels of glucose and insulin resistance (homeostatic assessment 2-insulin resistance). Total and LDL cholesterols levels decreased following AT [mean difference (95% confidence interval); total cholesterol: - 0.4 mmol/l (- 0.7 mmol/l, - 0.1 mmol/l), p = 0.013; LDL: - 0.4 mmol/l (- 0.7 mmol/l, - 0.1 mmol/l), p = 0.006] and HL-RT [total cholesterol: - 0.5 mmol/l (- 0.8 mmol/l, - 0.2 mmol/l), p = 0.002; LDL: - 0.5 mol/l (- 0.7 mmol/l, - 0.2 mmol/l), p = 0.002]. No associations were observed between post-training change in body composition and post-training change in blood biomarkers. CONCLUSIONS: RT when combined with AT had no additional effect beyond AT alone on fasting glucose metabolism, blood lipids and body composition in patients with CAD. Trial registration number NCT04638764.

Biomechanical Adjustments of the Basketball Jump Shot Performed Over Differently High Opponents.

Biomechanical adjustments of the jump shot in presence of an opponent and their associations with shooting efficiency remain to be determined in elite basketball. The aim of this research was to examine the selected biomechanical determinants of the jump shot when shooting over opponents of different height. Nineteen elite basketball players, age 22 ± 3 years, performed three trials of 20 basketball shots in a crossover, randomised manner: over an obstacle of the height of standing reach (RH), over reach height with additional 20 cm (RH+20 cm), over reach height with additional 40 cm (RH+40 cm), and the maximum height jump shot without an obstacle (JSmax). Jump height, the ball entry angle, and shooting efficiency were measured on each trial. Jump height when shooting over RH+40 cm was significantly higher than RH+20 cm (+0.022 m, p = 0.030) and RH (+0.023 m, p = 0.029). Similarly, the ball entry angle was greater at RH+40 cm compared to RH (+7.19 °, p < 0.001) and RH+20 cm (+2.90°, p < 0.001). In contrast, shooting efficiency decreased significantly when shooting over RH+40 cm compared to RH (-10.79%, p = 0.048) and RH+20 cm (-8.95%, p = 0.015). We recorded the highest jump height (0.35 ± 0.08m, p < 0.001) and the lowest angle of entry (39.16 ± 1.19°, p < 0.001) when participants performed JSmax. Shooting over higher opponents should be prioritised in training to significantly improve shooting efficiency. Future research is needed to determine additional potential biomechanical determinants of a successful jump shot in elite basketball.

Combined resistance training with aerobic training improves physical performance in patients with coronary artery disease: A secondary analysis of a randomized controlled clinical trial.

Background: The efficacy of combined resistance training (RT) and aerobic training (AT) compared with AT alone is well established in cardiac rehabilitation (CR); however, it remains to be elucidated whether RT load (high load [HL] vs. low load [LL]) modifies the outcomes. The aim of our study was to investigate the effects of HL-RT and LL-RT combined with AT in comparison to AT alone on body composition and physical performance in patients with coronary artery disease (CAD) enrolled in phase II CR. Methods: We randomized 79 patients with a stable CAD to 12 weeks of lower limb LL-RT + AT (35-40% of one repetition maximum [1-RM]; n = 28), HL-RT + AT (70-80% of 1-RM; n = 26), or AT (n = 25). Fifty-nine patients (75% men) with mean (standard deviation) age 61 (8) years and left ventricular ejection fraction 53 (9)% completed LL-RT (n = 19), HL-RT (n = 21) and AT (n = 19). Body composition and physical performance (upper and lower submaximal muscle strength, flexibility, balance, and mobility) were measured at baseline and post-training. Results: Training intervention had no significant impact on time × group interaction in the body composition measures. There was a significant time × group interaction for the gait speed test, chair sit-and-reach test, arm curl test, Stork balance test, up and go test, STS-5, and 6-min walk distance (p-values ≤ 0.001-0.04) following the training intervention. After the training intervention, HL-RT improved gait speed (+12%, p = 0.044), arm curl (+13%, p = 0.037), and time of Up and Go test (+9%, p < 0.001) to a greater extent compared with AT group, while there was a greater improvement in time of Up and Go test (+18%, p < 0.001) and time of five sit-to-stand tests (+14%, p = 0.016) following LL-RT when compared with AT. There were no differences between HL-RT and LL-RT in post-training improvement in any of the physical performance measures. Conclusion: The combination of AT with HL-RT or LL-RT promoted similar improvements in physical performance, which were superior to AT. Therefore, both types of combined AT and RT can be applied to patients with CAD. Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT04638764] Identifier [NCT04638764].

High-Load and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: Feasibility and Safety of a Randomized Controlled Clinical Trial.

Resistance exercise (RE) remains underused in cardiac rehabilitation; therefore, there is insufficient evidence on safety, feasibility, and hemodynamic adaptations to high-load (HL) and low-load (LL) RE in patients with coronary artery disease (CAD). This study aimed to compare the safety, feasibility of HL-RE and LL-RE when combined with aerobic exercise (AE), and hemodynamic adaptations to HL and LL resistance exercise following the intervention. Seventy-nine patients with CAD were randomized either to HL-RE (70−80% of one-repetition maximum [1-RM]) and AE, LL-RE (35−40% of 1-RM) and AE or solely AE (50−80% of maximal power output) as a standard care, and 59 patients completed this study. We assessed safety and feasibility of HL-RE and LL-RE and we measured 1-RM on leg extension machine and hemodynamic response during HL- and LL-RE at baseline and post-training. The training intervention was safe, well tolerated, and completed without any adverse events. Adherence to RE protocols was excellent (100%). LL-RE was better tolerated than HL-RE, especially from the third to the final mesocycle of this study (Borgs' 0−10 scale difference: 1−2 points; p = 0.001−0.048). Improvement in 1-RM was greater following HL-RE (+31%, p < 0.001) and LL-RE (+23%, p < 0.001) compared with AE. Participation in HL-RE and LL-RE resulted in a decreased rating of perceived exertion during post-training HL- and LL-RE, but in the absence of post-training hemodynamic adaptations. The implementation of HL-RE or LL-RE combined with AE was safe, well tolerated and can be applied in the early phase of cardiac rehabilitation for patients with stable CAD.

Four Weeks of Power Optimized Sprint Training Improves Sprint Performance in Adolescent Soccer Players.

PURPOSE: This study compared the effects of heavy resisted sprint training (RST) versus unresisted sprint training (UST) on sprint performance among adolescent soccer players. METHODS: Twenty-four male soccer players (age: 15.7 [0.5] y; body height: 175.7 [9.4] cm; body mass: 62.5 [9.2] kg) were randomly assigned to the RST group (n = 8), the UST group (n = 10), or the control group (n = 6). The UST group performed 8 × 20 m unresisted sprints twice weekly for 4 weeks, whereas the RST group performed 5 × 20-m heavy resisted sprints with a resistance set to maximize the horizontal power output. The control group performed only ordinary soccer training and match play. Magnitude-based decision and linear regression were used to analyze the data. RESULTS: The RST group improved sprint performances with moderate to large effect sizes (0.76-1.41) across all distances, both within and between groups (>92% beneficial effect likelihood). Conversely, there were no clear improvements in the UST and control groups. The RST evoked the largest improvements over short distances (6%-8%) and was strongly associated with increased maximum horizontal force capacities (r = .9). Players with a preintervention deficit in force capacity appeared to benefit the most from RST. CONCLUSIONS: Four weeks of heavy RST led to superior improvements in short-sprint performance compared with UST among adolescent soccer players. Heavy RST, using a load individually selected to maximize horizontal power, is therefore highly recommended as a method to improve sprint acceleration in youth athletes.

Hemodynamic Response to High- and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: A Randomized, Crossover Clinical Trial.

Low-load resistance exercise (LL-RE) is recommended as an adjunct therapy to aerobic exercise during cardiac rehabilitation in patients with coronary artery disease. The safety and hemodynamic response to high-load (HL) RE remain unknown. The aim of this study was to evaluate the hemodynamic response during both HL-RE and LL-RE prior to cardiac rehabilitation. Forty-three patients with coronary artery disease and/or percutaneous coronary intervention performed three sets of leg-press exercise using HL-RE (eight repetitions at the intensity of 80% of one repetition maximum (1-RM)) and LL-RE (16 repetitions at the intensity of 40% 1-RM) in a randomized crossover sequence. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and rating of perceived exertion were measured at baseline, after each set of RE and post-exercise. No clinically relevant changes in HR and BP or in patient-reported symptoms were recorded during HL-RE or LL-RE. Compared with baseline, HR and SBP increased during LL-RE (from 66 bpm to 86 bpm, time effect: p < 0.001; from 129 mmHg to 146 mmHg, time effect: p < 0.001) and HL-RE (from 68 bpm to 86 bpm, time effect: p < 0.001; from 130 mmHg to 146 mmHg, time effect: p < 0.001). Compared with HL-RE, the increase in HR was greater after the final set of LL-RE (32% vs. 28%, p = 0.015), without significant differences in SBP and DBP between LL-RE and HL-RE. Rating of perceived exertion was higher after the 1st set of HL-RE compared with LL-RE (median (interquartile range): 6 (5-7) vs. 6 (5-6), p = 0.010). In patients with coronary artery disease, both HL-RE and LL-RE were safe and well-tolerated. Hemodynamic changes were similar and within the physiological response to RE.

Objectively Measured Physical Activity in Patients with Coronary Artery Disease: A Cross-Validation Study.

Physical activity (PA) and sedentary behavior (SB) levels in healthy adults are predominately based on self-reporting measures, which generally overestimate PA but underestimate SB. Patients with coronary artery disease (CAD) eligible for cardiac rehabilitation (CR) follow an individualized program; thus, objective assessment of physical performance and regular daily activity is required. This study aimed to compare self-reported and objectively measured PA and SB in patients with CAD prior to out-patient CR. We included 91 patients with CAD and assessed their PA with an accelerometer for 8 days prior to CR, along with the short form of the international physical activity questionnaire. We found that most patients were sedentary (61%, ~8 h/day), and on average performed 63 min/day of moderate-to-vigorous-intensity physical activity (MVPA). Males performed less daily light-intensity physical activity (-5%, p = 0.011) and performed more MVPA (+2%, p = 0.002) compared to females. Maximal aerobic capacity was significantly associated with MVPA (Spearman rho = 0.483, p < 0.001) and MVPA > 10 min bouts (Spearman rho = 0.391, p < 0.001). Self-reported measures overestimated MVPA (total MVPA, +108 min/day, p < 0.001; MVPA > 10 min bouts, +152 min, p < 0.001) and underestimated SB (-174 min/day, p < 0.001) compared to objective measures. There was no significant correlation between methods in MVPA (Spearman rho = 0.147, p = 0.165)), MVPA > 10 min bouts (Spearman rho = -0.059, p = 576), and SB (Spearman rho = 0.139, p = 0.187). Quantitative analysis demonstrated the huge proportional bias for MVPA, MVPA > 10 min bouts, and SB. Our findings demonstrate that self-reported physical activity provides inaccurate estimates of MVPA and SB in patients with CAD entering the ambulatory CR. This strongly supports the more objective assessments of daily PA, preferably using an accelerometer.

Effects of high-load and low-load resistance training in patients with coronary artery disease: rationale and design of a randomised controlled clinical trial.

INTRODUCTION: Resistance training (RT) combined with aerobic training (AT) enhances the effects of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). However, it remains to be investigated which type of RT (high loads (HLs) vs low loads (LLs)) is more efficacious in improving exercise performance, cardio-metabolic health and quality of life. METHODS AND ANALYSIS: A randomised, controlled, clinical trial will enrol 20 patients with CAD into each of three study arms (total 60 patients): HL-RT (70%-80% of one repetition maximum (1-RM)) combined with AT; LL-RT (30%-40% of 1-RM) combined with AT and AT alone as standard care. Primary outcomes (maximal aerobic capacity, maximal leg isometric strength) will be assessed at baseline and after 36 training sessions. Other outcomes will include acute haemodynamic responses to LL-RT and HL-RT, body composition, physical performance, blood biomarkers (lipids, glucose metabolism, inflammation, growth factors), physical activity and quality of life. The intention-to-treat principle will be used to analyse the data. ETHICS AND DISSEMINATION: The study design and protocol have been approved by the National Medical Ethics Committee of Slovenia (registration number: 0120-573/2019/15). The study will be conducted in accordance with the Declaration of Helsinki. The results of the study will be published as peer-reviewed manuscripts and congress presentations, communicated with patients and the clinical community, and shared through posts on social media. The findings of the study will be disseminated among the national CR clinical community (CR centres, Slovenian association of coronary clubs) with active participation of the patients enrolled in the study. This study will expand our knowledge of RT in combination with AT in CR. We expect to find different effects of HL-RT versus LL-RT, with implications for RT strategies in rehabilitation of patients with CAD. TRIAL REGISTRATION NUMBER: NCT04638764.

Reproducibility of isokinetic knee testing using the novel isokinetic SMM iMoment dynamometer.

Isokinetic dynamometry is the gold standard for testing maximal strength in elite sport and rehabilitation settings. To be clinically useful, such tests should be valid and reliable. Despite some evidence regarding the relative test vs retest reliability of knee dynamometry, there is still a paucity of research regarding the absolute reliability parameters. The purpose of this study was to assess the absolute and relative intra-device reproducibility of isokinetic knee flexion and extension using the novel SMM iMoment dynamometer. A total of 19 participants (13 males and 6 females, aged 24 (2) years, height 178 (9) cm and weight 76 (11) kg) performed two identical knee isokinetic tests with at least a week of rest between measurements. Peak torque of knee extension and flexion were determined at 60°/s. Moderate (0.892) to excellent (0.988) relative reliability using the intraclass correlation coefficient (ICC) was obtained for peak knee torque. Absolute reliability assessed with a standard error of measurement (SEM %) was low, ranging from 2.54% to 6.93%, whereas the smallest real difference (SRD %) was moderate, ranging from 7.04% to 19.22%. Furthermore, there were no significant correlations between means and differences of two measurements, and Bland-Altman plots also showed no signs of heteroscedasticity. Our measurement protocol established the moderate to excellent reliability of the novel SMM iMoment isokinetic dynamometer. Therefore, this dynamometer can be applied in sport rehabilitation settings to measure maximal knee strength.