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Modalities of Exercise Training in Cardiac Rehabilitation

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Textbook of Sports and Exercise Cardiology

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Abstract

In order to be able to prescribe exercise in cardiac rehabilitation, a basic understanding of the training principles is mandatory. After discussing the general concepts of exercise prescription (FITT principles), a more detailed elaboration on the exercise modes in strength training (e.g. volume, type and intensity of contraction and difference between strength and endurance training) is provided. Next, exercise modes in aerobic (endurance) training in continuous and interval exercise training is described in greater detail, including the concepts of exercise intensity, training volume and mode of exercise training. In final, some considerations on how to maximise adherence to exercise training interventions, or increase the attractiveness of exercise training, are made.

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Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, Research group Rehabilitation for internal disorders, University of Leuven, Leuven, Belgium

    Luc Vanhees

  2. Heart Centre Hasselt, Jessa Hospital, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium

    Dominique Hansen

Authors
  1. Luc Vanhees
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  2. Dominique Hansen
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Corresponding author

Correspondence to Luc Vanhees .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    What are the 5 major components of health-related fitness?

  2. 2.

    How should we classify the different characteristics of exercise?

  3. 3.

    How can the intensity of aerobic exercise be individually determined?

  4. 4.

    In what effects are endurance and strength training different from each other?

1.2 Answers

  1. 1.

    Major components of health related fitness are (1) a morphological component (body mass relative to height, body composition, subcutaneous fat distribution, abdominal visceral fat, bone density and flexibility); (2) a muscular component (power or explosive strength, isometric strength, muscular endurance); (3) a motor component (agility, balance, coordination, speed of movement); (4) a cardiorespiratory component (endurance or submaximal exercise capacity, maximal aerobic power, heart function, lung function, blood pressure); and (5) a metabolic component (glucose tolerance, insulin sensitivity, lipid and lipoprotein metabolism, substrate oxidation characteristics).

  2. 2.

    The FITT++ principles are Frequency, Intensity, Type, Time (or duration) and Mode(+) and Attractiveness(+) of exercise.

  3. 3.

    After performing a maximal exercise test (until exhaustion or until symptoms), maximal heart rate, maximal load or capacity and ventilatory or lactic thresholds can be used to determine the individual intensity of aerobic exercise.

  4. 4.

    As a result of endurance exercise training, skeletal muscle mitochondrial biogenesis is activated after phosphorylation of 5′ adenosine monophosphate-activated protein kinase (AMPK), which in effect will lead to enhanced muscle respiration capacity to resynthesize ATP. In addition, muscle fibre type shifts may be induced (in favour of type 1 muscle fibre) next to enhanced capillarisation. From these molecular changes, improvements in endurance capacity and skeletal muscle fat oxidation capacity are the key adaptations. Finally, in the heart hypertrophy of the left ventricle, together with increments in left-ventricular cavity, can be induced by long-term exposure to endurance training.

    Strength training, on the other hand, induces completely different molecular and clinical adaptations. As result of strength training, skeletal muscle ribosomal biogenesis is induced after activation of mammalian target of rapamycin (mTOR), which in effect will lead to muscle hypertrophy to be able to generate greater muscle tension/strength. In addition, muscle fibre type shifts may be induced (in favour of type 2b muscle fibre). From these molecular changes, improvements in muscle strength and mass are the key adaptations. Moreover, in the heart more pronounced hypertrophy of the left ventricle, but without increments in left-ventricular cavity, can be induced by long-term exposure to strength training.

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Vanhees, L., Hansen, D. (2020). Modalities of Exercise Training in Cardiac Rehabilitation. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_42

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_42

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