Table 2 The basic characteristics of articles included in the systematic review
Author (s)/year/type/ | Zhang et al. [1]/2018/MA of RCTs Grade quality of evidence in a score out of 10, NA |
Aim | To review the effects of three exercise modalities (AT, RT, and CT) on central hemodynamics, arterial stiffness, and cardiac function in CVD |
Participants’ characteristics | The 38 included articles covered 2089 adult patients with CVD. Patients’ age ranged from 44 to 70 years |
Intervention/comparison group | AT, RT, and CT |
Outcome measure (s) | Central hemodynamics and arterial stiffness (parameters: Aortic systolic (ASP) and diastolic blood pressure (ADP), cardiac output (CO) left ventricular ejection fraction (LVEF) and carotid-femoral pulse wave velocity (cf-PWV) |
Duration | 4–24 weeks |
Author (s)/year/type | Yamamoto et al. [2]/2016/MA of RCTs Grade quality of evidence in a score out of 10, NA |
Aim | Investigate the effects of RT on exercise capacity, muscle strength, and mobility in middle-aged and elderly patients with CAD |
Participants’ characteristics | The total number of participants from the 22 studies was 1095. Studies included post-MI patients, patients undergoing cardiac surgery. Patients were middle-aged (55–60 years) and elderly (61–79 years). Studies included middle-aged patients were 17 (n = 804 patients) |
Intervention/comparison group | Exercise group: RT or CT. The intensity of RT ranged from 50 to 69% of 1 repetition maximum (1RM) (1RM: heaviest weight lifted once). Mode of exercise: weight training Control group: Usual care or AT. The meta-analysis compared the RT with the usual care or the CT (AT + RT) with the AT alone |
Outcome measure (s) | Lower extremity muscle strength (Isometric and isokinetic knee extension torque), upper extremity muscle strength (the 1-RM of chest press, or bicep curl), exercise capacity (Peak oxygen consumption (peak VO2) or exercise time (the sum of exercise time excluding rest and warm-up periods) during symptom-limited cardiopulmonary exercise testing (CPX), mobility (household physical activity and functional mobility scores from continuous-scale physical performance tests) |
Duration | Training duration in the middle-aged group ranged from 4–8 weeks. 2–5 times/week |
Author (s)/year/type | Marzolini et al. [37]/2011/MA of RCTs Grade quality of evidence in a score out of 10, NA |
Aim | To examine effects of combined training (CT) of RT + AT versus AT alone in CAD |
Participants’ characteristics | Out of the 12 studies included, 229 patients received AT and 275 patients received CT. Age ranged from 49 to 71 years |
Intervention/comparison group | The CT groups prescribed 8–60 min of AT, 2–4 times/week at 40–85% of peak heart rate. The RT prescription consisted of 2–4 sets, of 2–10 exercises at an intensity of 40–80% of the 1 RM |
Outcome measure (s) | Body composition, exercise capacity (VO2 peak), strength, and health-related quality-of-life (HRQOL) |
Duration | 4–29 weeks, 2–3 times/week |
Author (s)/year/type | V Gremeaux Pole et al. [39]/2010/RCT |
Aim | To compare the effects between concentric and eccentric RT on exercise capacities in patients with CAD |
Participants’ characteristics | Fourteen patients aged between 40 and 65 years with stable CAD after percutaneous coronary intervention |
Intervention/comparison group | Patients performed two 30-min sessions of two different AT (bicycle and arm cycling). Patients then performed 3 sets of 12 contractions in 30 s for each group, followed by a 30-s rest period, with a load corresponding to 50% of 1RM. In the concentric group, bicycle work was performed three times a week, on a standard cycle ergometer In the eccentric group subjects also trained three times a week, but on a specifically constructed cycle ergometer, with a motor driving the pedals in the reverse direction |
Outcome measure (s) | Symptom-limited VO2, peak workload, isometric strength of leg extensor and ankle plantar flexors, distance covered during the 6-min walk test, and time to perform the 200-m fast walk test |
Duration | 5 weeks, 3 times/week |
Author (s)/year/type | Dor-Haim et al. [10]/2018/RCT Grade quality of evidence in a score out of 10, is 6 |
Aim | To compare the effectiveness of continuous AT (CAT) to super-circuit training (SCT), (SCT = combined RT and AT in interval) |
Participants’ characteristics | 29 men post-MI participants aged from 47–69 years, ejection fraction < 45%), stable and were able to attend regularly supervised exercise program, New York Heart Association Classification I-III |
Intervention/comparison group | CAT patients (n = 15) exercised at 60%-70% of their heart rate reserve and SCT patients (n = 14) exercised at 75–85% of their heart rate reserve. Each CAT session lasts for 45 min. Each SCT set included one RT set, 3 min of aerobic interval, and a resting period. This sequence was repeated eight times (8 sets). Exercise intensity was determined using the heart rate reserved method (i.e., maximal heart rate—resting heart rate) The patient's maximal heart rate was established via a baseline graded exercise tolerance test. The RT was composed of 8 different exercises, namely, horizontal rowing, chest press, leg press, shoulder press, leg extension, lateral pull-down, leg flexion and assisted squat. Each exercise consisted of one set of 15 repetitions. In the first two weeks of the program, the training intensity was light (30% of 1RM) and progressively increased to 50% of 1RM |
Outcome measure (s) | Cardiac function (LVEF, and aerobic functional capacity Aerobic fitness), Handgrip strength, and HRQOL (Medical Outcomes Study Short-Form Health Survey (SF-12). To evaluate the feasibility and safety of the SCT, data regarding the program's major and minor adverse events (e.g., hospitalization, syncope, arrhythmia, muscle ache) were recorded. In addition, information regarding reasons for attrition from the program was evaluated |
Duration | 12-weeks, 2 times/week |
Author (s)/year/type | Guiraud et al. [40]/2017/RCT Grade quality of evidence in a score out of 10, is 6 |
Aim | To compare 2 different modes of RT, an isometric mode with the Huber Motion Lab (HML) and traditional strength training (TST) dynamic muscle contraction, in CAD patients undergoing a CR program |
Participants’ characteristics | HML group (n = 25) and TST group (n = 25). Out of the 50 patients, 94% were men. Inclusion criteria: patients with ≥ 70% arterial diameter narrowing of at least one major coronary artery and/or documented previous MI. Exclusion criteria: patient with the recent acute coronary syndrome (≤ 1 month), significant resting electrocardiography abnormality, severe arrhythmia, history of congestive heart failure, uncontrolled hypertension, bypass surgery ≤ 3 months, percutaneous coronary intervention ≤ 1 month, LVEF ≤ 45%, pacemaker installation, modification of medication < 2 weeks, and musculoskeletal conditions making exercise on a cycle ergometer difficult or contraindicated |
Intervention/comparison group | The HML is a motorized rotating platform that allows patients to perform exercises that simultaneously involve balance, coordination, and strength training. HML sessions (isometric): 6 exercise blocks in different postures. Each block consisted of 8 contractions of 6 s alternating with 10 s of passive recovery, repeated twice. The total duration of the session, which included a 3-min warm-up, 10 min of maximum voluntary contraction (MVC) assessment, 27 min of exercise, and 5-min recovery, was 45 min. The intensity of isometric contraction was set at 70% of the MVC. Because the MVC was calculated at each session, the exercise intensity was automatically adapted to enable progression. TST sessions (dynamic) involved circuit training including 6 different machines: leg press, chest press, vertical traction (shoulder press), low row (working back), pectoral (butterfly), and leg extension. Movements allowed for dynamically working for the same muscle groups as with the HML. The intensity was set at 60% of MVC. At each position, patients were asked to repeat 3 series of 12 repetitions. With TST, the MVC was calculated by using the one-repetition maximum test (1-RM) on each machine at the beginning of each week during the program |
Outcome measure (s) | Cardiopulmonary exercise test (The peak power output (PPO), maximal HR, maximal SBP, maximal DBP), maximal upper and lower limbs isometric voluntary contraction, endothelial function (Reactive hyperemia index (RHI) and Anthropometric variables (BMI, waist circumference), body composition (bioelectrical impedance), HRQOL (French version of the Medical Outcomes Study Short Form 36 (SF-36) and sleep quality (The Pittsburgh Sleep Quality Index (PSQI) |
Duration | 4 weeks, 4 times/week |
Author (s)/year/type | Caruso [38]/2015/RCT Grade quality of evidence in score out of 10, is 6 |
Aim | To investigate the effects of high repetition/low load RT (HR/LL-RT) program on heart rate variability (HRV) and muscular strength and endurance in CAD patients |
Participants’ characteristics | Twenty male patients with CAD were randomized to control the usual AT care group (UCG) (61 ± 4.4 years) or CT (RTG) with RT (HR/LL-RT) and AT (61.3 ± 5.2 years). Inclusion criteria consisted of 1) an established clinical diagnosis of CAD for at least one year; 2) New York Heart Association (NYHA) classification I-II; 3) medical management for at least one year according to the American Heart Association/American College of Cardiology recommendations; and 4) participation in a CR program for at least 1 year, exclusively comprised of AT. Exclusion criteria consisted of 1) the presence of uncontrolled cardiac arrhythmias; 2) unstable angina pectoris, uncontrolled hypertension, or pulmonary and renal comorbidities; 3) conditions limiting participation in exercise training (i.e., orthopedic limitations and musculoskeletal disorder); and 4) abnormal hemodynamic responses during a previous incremental exercise testing |
Intervention/comparison group | The UCG program consisted of 1 h of AT, divided into 10 min of warm-up (stretching of upper and lower limbs), 20-30 min of treadmill or cycle ergometer training at an intensity of 70% of maximal HR obtained by exercise testing, cool-down (low-intensity dynamic exercises and stretching upper and lower limbs) and a relaxation phase (10 min). The AT program was performed 2 times per week and continued in all patients in both groups (UCG and RTG). Formal clinic evaluations by a cardiologist occurred every 6 months and exercise testing on a cycle ergometer was performed at 3-month intervals to adjust the intensity of the AT program. Patients that were allocated to the RTG were instructed to continue the CR program and in parallel perform the RT protocol (2 times/week for 8 weeks on days the CR program was not performed). Each session lasted 1 h and consisted of an arm-up, HR/LL-RT on a leg press, and a cool-down period. The warm-up and cool-down session consisted of lower limb stretching. Subjects underwent 3 sets over 2 min at a movement rhythm of 10 repetitions per minute, maintaining respiratory cadence (as the volunteer had been oriented during the 1-RM test). Each repetition was performed in 5 s (2 s of extension and 3 s of knee and hip flexion), with the rhythm controlled by verbal commands. Each set was separated by 5 min rest intervals. The intensity of exercise training was 30% of 1-RM, a resistance approximating the lactate threshold (LT) in a previous investigation. RTG received HR/LL-RT program of 45 degrees leg press 3 sets of 20 repetitions. The initial load was set on 30% of 1-RM |
Outcome measure (s) | Resting HRV Muscle strength (1 repetition maximum (1-RM) exercise test on leg press) Muscle endurance |
Duration | 8 weeks, 2 times/week |
Author (s)/year/type | Berent et al. [34]/2011/RCT Grade quality of evidence in a score out of 10, is 6 |
Aim | To compare the effectiveness of 2 different volumes of RT combined with AT in residential CR |
Participants’ characteristics | Patients (N = 295) (71 women, 224 men) with a mean age of 62.7 years. Included in the study were patients after a cardiovascular event with and without percutaneous coronary intervention and stent implantation or after heart surgery. Exclusion criteria were a pericardial effusion with a hemodynamic effect, pleural effusions responsible for dyspnea, acute infectious diseases, wound infections after surgery, and unstable angina |
Intervention/comparison group | Group I (134 patients): 2 sets X 12 repetitions (REPS) and Group II (161 patients): 3 sets X 15 REPS per session, 2 times per week; each RT session consisting of 10 different resistance exercises (back extension, back flexion, reversed chest butterfly, chest butterfly, leg press, rowing machine, leg extension, sitting leg curl, pull down, and dips). In addition, patients also completed continuous moderate intensity AT composed of cycle ergometry 6 times per week for 17 ± 4 min (mean ± SD) and walking 5 times per week for 45 min. The intensity of the RT was individualized for each patient. Patients performed RT at the ratings of perceived exertion (RPE) between 4 and 6 on a modified Borg scale of 1 through 7 (which was considered moderate intensity), and the desired RPE was determined when patients were lifting weights between 13 and 15 REPS of a given RT exercise. Stress perception for RT was maintained at an RPE of 4–6 for each training session followed by an increase in weight/load as patients improved in RT during residency. Avoiding determination of 1RM, the load-repetition relationship for RT was approximated and resulted in 50% to 60% of the 1RM |
Outcome measure (s) | Exercise capacity (VO2max), HR, SBP, DBP, muscle strength, blood biochemistries (lipids), body weight and body mass index (BMI) |
Duration | About 4 weeks (26 ± 4 (mean ± SD) days) the RT is applied 2 times/week |
Author (s)/year/type | Marzolini et al. [52]/2015/RCT Grade quality of evidence in a score out of 10, is 4 |
Aim | To compare the effects of AT combined with RT (1 versus 3 sets) versus AT alone on HRQOL and psychosocial outcomes |
Participants’ characteristics | patients with CAD participating in Outpatient Cardiac Rehabilitation Program. Fifty-three patients (mean ± SD age 60.6 ± 10.6 years) completed training. Patients have ≥ 50% block in at least one major coronary artery. They were post-percutaneous procedures or CABG |
Intervention/comparison group | All patients received AT (5 days/week) for the first 5 weeks then they were divided into three groups during the rest of the 24 weeks of the training duration (total 29 weeks). Group (1) (n = 16) continued to receive the AT alone (5 days/week), Group (2) (n = 19) received AT (3 days/week) + RT (one set, 2 days/week), Group (3) (n = 18) received AT (3 days/week) + RT (3 sets, 2 days/week). The AT included 30 min of walking and/or jogging (1.6 km and 60% VO2 peak.). The prescription of AT was progressed every 2 weeks with a maximum of 60 min, 6.4 km, 80% VO2 peak. The RT started with 60% of 1RM and progressed to 70–75% 1RM and the repetition progressed from 10 to 15 repetitions. Upper body exercise included 5 exercises + 2 exercises to the trunk. The lower body exercises included 3 exercises |
Outcome measure (s) | HRQOL and psychosocial parameters were assessed before and after 29 weeks of training by questionnaire (SF-36 and depression score). self-efficacy of lower and upper body physical activity, depression, and physical component of HRQOL |
Duration | 29 weeks, 2 times/week for RT and 5 times/week for CT |
Author (s)/year/type | Currie et al. [33]/2015/RCT Grade quality of evidence in a score out of 10, is 4 |
Aim | 1. To compare between 2 protocols of AT; the low-volume high-intensity interval training (Low volume HIIT) and the moderate-intensity continuous training (MICT). 2. To determine the effect of combining RT to the above-mentioned 2 AT on cardiovascular risk profiles in patients with CAD |
Participants’ characteristics | Nineteen patients (2 females) with CAD recruited during phase II cardiac rehabilitation outpatient program. Inclusion criteria included a recent (< 3 months) CAD event, which was defined as the patient having at least one of the following: myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft; angiographically documented stenosis ≥ 50% in at least one major coronary artery; positive exercise stress test determined by symptoms of chest discomfort accompanied by electrocardiographic (ECG) changes of > 1 mm horizontal or down sloping ST-segment depression, or a positive nuclear scan |
Intervention/comparison group | Group I: moderate-intensity continuous endurance (MICT) (n = 10) Group II: low volume high-intensity interval (HIIT) (n = 9) The first 3-months involved exclusive MICT or low-volume HIIT, after which progressive RT was added to both groups for the remaining 3-months. Each session involved a 10-min standardized warm-up and cool-down consisting of light AT and dynamic stretching. Both MICT and low-volume HIIT were performed on a cycle ergometer. The MICT protocol involved continuous cycling at 57% (range 51–65%) of their pretraining peak power output (PPOpre). Patients progressed from 30 min for month 1, to 40 min from month 2 to 50 min from month 3. The low-volume HIIT protocol Exercise progressions included increasing the intensity every month to continue to elicit heart rates associated with their initial PPOpre. Therefore, patients were training at 100% PPOpre for month 2 and 108% PPOpre for month 3. During the final 3 months, the HIIT group trained at 121% (range 100–152%) of PPOpre, while the MICT group trained at 78% (range 60–91%) of PPOpre. Following the first 3 months of MICT and HIIT, a standardized RT program was added to both groups after the MICT or HIIT bouts for the remaining 3 months. Patients performed 2 sets of 10–12 reps of various upper body and lower body RT. The amount of weight was determined using the Borg ratings of perceived exertion scale as enough weight to elicit a score of 11–15, or “somewhat hard”. The amount of weight was increased periodically over the 3 months to ensure patients continued to work at a score of 11–15. Possible exercises included leg press, leg extension, calf raises, biceps and triceps curls, chest press, seated row, and abdominal crunches |
Outcome measure (s) | Exercise capacity (VO2 peak), blood pressure and heart rate, lipid profiles and HRQOL assessments were performed at pretraining, 3 and 6-months training |
Duration | 24 weeks, 2 times/week |