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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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)
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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.
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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.
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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.