Resistance training for patients with sarcopenia and coronary artery disease: it’s what they want!

This invited commentary refers to ‘Resistance-based exercise intervention for patients with coronary artery disease and sarcopenia: a pilot randomized controlled trial’ by PWC Li et al., https://doi.org/10.1093/eurjcn/zvaf041. The physiological benefits and protective effects of resistance training for health among sarcopenic adults are well-known. Li et al.1 conducted a pilot randomized trial for individuals with comorbid sarcopenia and coronary artery disease (CAD) to determine feasibility and examine preliminary effects within this population. The intervention consisted of 2 × 60 min sessions per week, at 30–69% of maximal intensity resistance training for 12 weeks. The first two weeks of intervention were supervised in a gym, and in Weeks 3 and 4, participants completed video-monitored home workouts with resistance bands. Supervision gradually decreased from Weeks 5–12 until participants self-conducted unsupervised sessions. Assessments of cardiovascular health, body composition, and functional performance were completed at baseline, immediately following the 12-week intervention, and 3 months following the intervention. No serious adverse events occurred, and attendance rate was high (94%). Compared to a control group, the intervention improved physical performance and handgrip strength immediately post-intervention, but these improvements did not remain at 3-month follow-up. This study demonstrates the potential applications of resistance training for patients with cardiovascular disease and sarcopenia. As recently stated by the American Heart Association, resistance training for individuals with cardiovascular disease is generally safe.2 Resistance training has long been perceived as potentially harmful to cardiovascular health and maybe dangerous for people with CAD. However, this dogma has increasingly been challenged in the last decade, notably with a recent systematic review highlighting the safety of this type of exercise in the context of CAD.3 The study by Li et al.1 makes a substantial contribution to the scientific literature by conducting a successful resistance training intervention in a highly relevant population, individuals with both CAD and sarcopenia. Older adults often report challenges related to the accessibility of specialized equipment and the lack of knowledge regarding resistance training practice.4 These barriers were taken into consideration by designing an intervention that gradually evolved from a centre-based supervised context to a semi-supervised context via videoconference, and then to a non-supervised home-based context. The authors observed an improvement in the short physical performance battery and increase in grip strength, indicating an impact on physical function for this type of prescription scheme. Unfortunately, improvements were not sustained at the 3-month follow-up. This finding, often observed among older adults, underscores the need for research to identify strategies that promote long-term adherence to resistance training.5 It is unclear whether the adaptations seen immediately following the intervention were attributed to muscle mass increase or total body mass decrease.6 These anthropometric factors and potential improvements in cardiometabolic health outcomes (heart rate variability, blood pressure regulation, etc.) are of interest and would shine important light on the impact of resistance training in this population. This article provides a critical step forward into the investigation of the benefits of resistance training for individuals with sarcopenia and CAD and provides a foundation for future studies to optimize training in this population. Exercise training studies that target clinical populations are particularly challenging due to the barriers experienced by these vulnerable populations and often inexperience with structured training.7 An appreciated point of the feasibility trial presented by Li et al.1 is the timely collection of participants, with recruitment and follow-up for the trial completed in one year, with the primary reason for exclusion following eligibility being non-sarcopenic, with lack of interest representing <5% of cases. Of the n = 21 randomized into the intervention group, there were no major adverse events or dropouts, with exercise adherence of 94%. This level of uptake and adherence to the intervention is particularly impressive in the context of the participants of interest. Patients with CAD and sarcopenia likely have the least experience with resistance training but are those who need it the most. Implementation frameworks have included eight distinct aspects to evaluating the quality and extent of an implemented programme, including: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. The feasibility study of Li et al.1 touches on some of these aspects, with future considerations for fidelity into a standard clinical practice setting, cost of running a programme like this (including total cost and cost-savings), and sustainability of progressive resistance training models in care. Possibly, options to maintain gym-based exercise for those interested or periodic check-ins with those who elect for home-based exercise may be a useful way in promoting health behaviour change that lasts beyond the end of the study intervention. Clearly, the interventional model implemented by Li et al.1 is attractive to this clinical population characterized by unique cardiovascular and muscle challenges. Following the feasibility trial, an effectiveness trial that builds on this positive observation but addresses the concerns over sustainability and effectiveness beyond the end of the programme is warranted to build from these promising observations. The study by Li et al.1 makes an important contribution to the field and is likely to stimulate future practice and research aimed at testing resistance training among sarcopenic patients with CAD. Their study clearly conveys to clinicians and researchers the strong interest that these patients have in participating in resistance training supporting this model as a useful strategy for improving muscle function in those who need it, and likely benefit the most. Rather than shying away from prescribing resistance training to populations characterized by cardiovascular and musculoskeletal conditions, the trial clearly shows that resistance training is what these patients want! Sophie Rayner (Conceptualization [equal], Writing—original draft [equal], Writing—review & editing [equal]), Renaud Tremblay (Conceptualization [equal], Writing—original draft [equal], Writing—review & editing [equal]), and Myles W. O’Brien (Conceptualization [equal], Writing—original draft [equal], Writing—review & editing [equal]) Not applicable. No primary data related to this commentary.

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