Combined resistance and aerobic training is more effective than aerobic training alone in people with coronary artery disease

Abstract

To review the evidence as to whether combined aerobic and resistance training is as effective as aerobic training at improving body composition, fitness, strength and quality of life in people with coronary artery disease. Cochrane Controlled Trials Register, Embase, Medline, PreMedline, SportDiscus and CINAHL, searched up to October 2009. This search was supplemented by citation tracking. Randomised controlled trials involving people with coronary artery disease (including people who had undergone coronary artery surgery or percutaneous intervention) in which aerobic training was compared to combined aerobic and resistance training. Outcome measures were measures of cardiovascular fitness, body composition measured by dual energy X-ray absorptiometry, muscular strength, healthrelated quality of life and self efficacy. Trials involving only patients with heart failure were excluded. Two reviewers determined eligibility and one reviewer extracted data. Methodological quality was assessed using the PEDro scale and the Jadad scale. Of 271 studies initially identified by the search, 12 studies with a total of 504 patients met the selection criteria and were included in the review. Study quality ranged from 4 to 8 out of 10 on the PEDro scale, and 2 to 3 out of 5 on the Jadad scale. Based on the quantitative pooling of the available data from these trials, the combined training induced significantly greater improvements than aerobic training on most outcomes. Peak exercise capacity was better by a standardised mean difference of 0.88 (95% CI 0.45 to 1.31), fat free mass improved by 0.9kg more (95% CI 0.4 to 1.4) and percent body fat improved by 2% more (95% CI 1 to 4). Trunk fat and upper and lower limb strength were also significantly better after combined training than after aerobic training. Data for quality of life and self efficacy could not be pooled quantitatively, but all the studies that measured these outcomes reported improvements either in both groups or in the combined training group only. The adverse events noted were typically mild cardiovascular changes or musculoskeletal pain. In subgroup analyses, the study duration and the intensity of the resistance were not associated with an altered treatment effect. Combined aerobic and resistance training is more effective than aerobic training in improving body composition, strength and cardiovascular fitness, probably improving quality of life and self efficacy as well.