BELLARMINE UNIVERSITY, LOUISVILLE, KY

Eccentric Training and CAD

Michael Beavin, Jason Copelin, Madelaine Nolan,

and Kaitlyn Stahl

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Eccentric Training: Is it safe and effective in

patients with CAD?

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Why is it relevant?

• Strength training previously contraindicated in CAD (Steiner, 2004)

• Safety and Efficiency?• Lack of research on eccentric

training in persons with CAD– Not commonly implemented in practice

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Background

• 1 in every 4 deaths is attributed to CAD (CDC, accessed November 19, 2013)

• Physical activity can delay progression of CAD

(Steiner, 2004)

• Aerobic exercise and concentric training has been the foundation for treatment of cardiac patients Steiner, 2004)

• Eccentric training in cardiac patients has not been studied as a method of therapeutic exercise

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Study Designs

• 2 Randomized Controlled Trials (Meyer,

2008) (Steiner, 2004)

• 1 Quasi-Experimental Study (Gremeaux, 2010)

• 1 Systematic Review (Roig, 2008)

• 1 Meta-analysis (Roig, 2009)

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Subjects

• Meyer, 2008: n=13, males age 40-66 • Roig, 2008: 9 Studies (3 CAD), n= 12-

20, ages 40-66• Gremeaux, 2010: n=14, males age 40-

65• Steiner, 2004: n=13, males age 42-66• Roig, 2009: 20 studies, n=10-70, ages

21-33

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Methods/Interventions

Meyer, 2008 and Steiner, 2004: •Eccentric Bike Ergometer

– 3x weekly for 30mins. Intensity set at 60% VO2max or 85% max HR.

– Identical increase in workload across groups until week 5, kept constant for last 3 weeks.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Methods/Interventions cont.

• Roig, 2008: Interventions in the 3 CAD studies used Eccentric Cycling for treatment group

• Gremeaux, 2010: Eccentric Cycling 3x weekly for 15 sessions.

• Roig, 2009: Studies selected compared eccentric and concentric training

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Results

Roig, 2009•Eccentric is more effective in promoting muscle mass than concentric•Increased strength

http://www.telegraph.co.uk/

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Results cont.

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Results cont.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Conclusions

Meyer, 2008:•Uncoupling of skeletal muscle load and cardiovascular stress during eccentric training•Hemodynamically safe in CADRoig, 2008: •Strength gains at a reduced metabolic level

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Conclusions cont.

Gremeaux, 2010: •As efficient as concentric•Less oxygen demand and workload on the heartSteiner, 2004: •Increased muscular strength and function Roig, 2009: •Eccentric training is effective for increasing strength

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Limitations

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Future Research

• Longitudinal studies• Implement eccentric training at

higher workload • Safety in patients with advanced

cardiac disease• Creation of standardized protocols

based on patient characteristics• Effects on gait cycle and ambulation

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Implications

For low-risk middle aged male patients with mild CAD, eccentric training can be recommended as a safe, feasible, and well tolerated approach to strength training.

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Questions?

http://www.riskmanagement365.com/tag/cardiac-rehab/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References

• 1. Gremeaux V. Does eccentric endurance training improve walking capacity in patients with coronary artery disease? A randomized controlled pilot study. Clinical Rehabilitation [serial online]. July 2010;24(7):590-599. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. Accessed September 21, 2013.

• 2. Meyer K, Steiner R, Hoppeler H, et al. Eccentric exercise in coronary patients: central hemodynamic and metabolic responses. Medicine & Science In Sports & Exercise [serial online]. July 2003;35(7):1076-1082. Available from: CINAHL, Ipswich, MA. Accessed September 21, 2013.Roig M, Shadgan B, Reid W.

• 3. Roig M, Shadgan B, Reid W.D.. Eccentric Exercise in Patients with Chronic Health Conditions: A Systematic Review. Physiotherapy Canada. 2008; 60: 146-160

• 4. Roig M, O'brien K, Kirk G, et al. The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. Br J Sports Med. 2009;43(8):556-68.

• 5. Steiner R., Meyer K., Lippuner K., Schmid J.-P., Saner H., Hoppeler H. Eccentric endurance training in subjects with coronary artery disease: a novel exercise paradigm in cardiac rehabilitation? Eur J Appl Physiol. 2004;(91):572–578.