Can Lifting Weights Save Your Heart? The Best Exercise for a Healthy Heart Revealed!

Exercise Training for Heart Failure: Finding the Perfect Balance Between Endurance and Resistance Training

Heart failure affects approximately 6.7 million Americans, with at least half having preserved ejection fraction (**HFpEF**). While cardiovascular exercise has long been the recommended approach for heart health, emerging research suggests that a combined approach of endurance and resistance training may offer significant benefits for patients with heart failure. This article explores the latest scientific findings on exercise interventions for heart failure patients and provides practical guidance for implementing an effective exercise routine.

The Ex-DHF trial, one of the largest studies on this topic, demonstrated that patients following a structured 12-month exercise program improved their peak oxygen consumption (VO₂) by 1.3 ml/kg/min and experienced better New York Heart Association (NYHA) functional class scores. This underscores the importance of tailoring exercise prescriptions progressively — starting with moderate-intensity aerobic workouts and gradually integrating resistance training.

Resistance training alone has been shown to lower blood pressure, improve blood sugar control, and enhance body composition — factors that collectively reduce cardiovascular disease risk. However, finding the optimal dose is crucial, as excessive resistance exercise may lead to arterial stiffness and chronic inflammation.

A balanced regimen of 2-3 sessions per week combining aerobic and resistance training for 30-60 minutes appears to maximize benefits while minimizing risks. Long-term adherence remains a challenge, but strategies like remote monitoring and psychological support can help patients maintain consistency and improve outcomes.

Understanding Heart Failure with Preserved Ejection Fraction (HFpEF)

Heart failure with preserved ejection fraction (HFpEF) represents about half of all heart failure cases and carries a prognosis similar to heart failure with reduced ejection fraction (HFrEF). However, treatment options for HFpEF remain limited compared to HFrEF.

A hallmark clinical feature of HFpEF is reduced exercise tolerance, measured as decreased peak oxygen consumption (VO₂) during cardiopulmonary exercise testing. This reduction stems from impaired cardiac, vascular, and skeletal muscle function. Exercise training has emerged as an effective therapy to improve peak VO₂ in clinically stable HFpEF patients.

The Exercise Training in Diastolic Heart Failure

Recent research has significantly advanced our understanding of exercise's role in HFpEF management. One of the largest randomized controlled trials in this area evaluated the effects of a 12-month combined endurance and resistance exercise program on HFpEF patients.

The study included 322 clinically stable patients with HFpEF (mean age 70 years, 60% female) who were randomized to either exercise training (ET) or usual care (UC). The exercise program consisted of thrice-weekly sessions combining endurance and resistance training.

Key Findings from the Exercise Trial:

While the primary endpoint (a modified Packer score including mortality, hospitalizations, and clinical measures) did not show a significant overall improvement with ET, secondary analysis revealed important benefits.

• Patients in the exercise group showed significantly improved peak VO₂, with a clinically meaningful increase of 1.3 ml/kg/min at 12 months.

• New York Heart Association (NYHA) functional class improved significantly in the exercise group.

• The progressive nature of the exercise prescription (increasing duration and intensity over time) proved important for long-term benefits

  .

The Cardiovascular Benefits of Resistance Training

While much attention has focused on endurance training for heart health, recent scientific evidence strongly suggests that resistance training might be equally crucial for cardiovascular health. The American Heart Association has highlighted the importance of weight training for heart health in its latest guidelines.

• Reduced Mortality and Disease Risk:

  • 15% lower risk of all-cause mortality

  • 17% lower risk of cardiovascular disease

  • Significant improvements in multiple heart health markers

• Blood Pressure Management:

  • 4 mm Hg reduction in systolic blood pressure

  • 2 mm Hg reduction in diastolic blood pressure

  • Greater reductions in individuals with pre-existing hypertension

• Blood Sugar Control:

  • 2-5 mg/dL reduction in fasting glucose

  • 0.34% decline in hemoglobin A1c in type 2 diabetes patients

  • 17% lower incidence of diabetes compared to non-participants

• Improved Lipid Profile:

  • HDL cholesterol increase of 2-12 mg/dL

  • Total cholesterol reduction of 8 mg/dL

  • Triglycerides reduction of 7-13 mg/dL

• Body Composition Enhancement:

  • 0.8 kg increase in lean body mass

  • 1.6% decrease in body fat percentage

  • 1.0 kg reduction in whole-body fat mass

Finding the Sweet Spot: How Much Exercise Is Optimal?

Current research suggests there's a "sweet spot" for exercise duration and intensity that maximizes cardiovascular benefits while minimizing risks.

The Optimal Duration:

• 30-60 minutes of resistance training per week shows maximum risk reduction

• Benefits may plateau or slightly decrease beyond this range

• 2-3 sessions per week appear optimal for most people

The J-Shaped Curve Phenomenon:

Recent studies have identified a J-shaped relationship between training volume and cardiovascular benefits:

• Initial benefits increase with training volume

• Peak benefits occur around 40-60 minutes weekly

• Excessive training might lead to diminishing returns

Potential Downsides of Excessive Resistance Training:

While the exact mechanisms are still under investigation, exceeding the optimal dose of resistance exercise might have negative consequences:

• Increased Arterial Stiffness: Intense resistance training could potentially stiffen arteries, increasing cardiovascular risk.

• Chronic Inflammation: Excessive weightlifting might lead to chronic low-grade inflammation, contributing to heart disease.

The Progressive Approach to Exercise Training

The Ex-DHF trial highlighted the importance of progressive exercise prescription for long-term benefits. The protocol initially prescribed three 30-minute sessions per week at 50% peak VO₂, gradually increasing to 60-minute sessions at 70% peak VO₂ at 3 months, with resistance training added after the first month.

This progressive approach provided sufficient exercise stimulus in the long term and highlights the importance of combining different training modalities. Resistance training may be particularly important for preventing sarcopenia, a comorbidity associated with worse prognosis in heart failure patients.

Peripheral vs. Central Adaptations

Research suggests that improvements in peak VO₂ with exercise training in HFpEF patients are primarily driven by peripheral rather than central adaptations. Studies show that changes in peak VO₂ were primarily associated with increased peak exercise arterio-venous oxygen difference, while stroke volume and peak heart rate remained largely unchanged.

The main mechanisms responsible for improvement in peripheral oxygen extraction remain uncertain. However, previous studies indicate that exercise training may induce significant molecular changes in skeletal muscle, especially when performed at higher intensities.

Practical Implementation Guidelines

Getting Started Safely:

• Begin with proper form:

  • Focus on basic movements

  • Start with lighter weights

  • Gradually increase intensity

• Weekly schedule:

  • 2-3 sessions per week

  • Allow 48 hours between sessions

  • Combine with moderate aerobic activity

• Progressive Overload Principles:

  • Start with 40-50% of maximum effort

  • Gradually increase to 60-80% over time

  • Maintain proper form throughout progression

Special Considerations for Different Populations:

• Older Adults:

  • Focus on functional movements

  • Emphasize proper form over weight

  • Include balance training components

• People with Existing Heart Conditions:

  • Obtain medical clearance first

  • Start with supervised sessions

  • Monitor heart rate and blood pressure

• Beginners:

  • Master bodyweight exercises initially

  • Focus on fundamental movement patterns

  • Gradually introduce external resistance

Addressing Adherence Challenges

One significant challenge in exercise interventions is maintaining long-term adherence. The Ex-DHF trial reported relatively low adherence rates, a finding consistent with other long-term exercise studies in patients with heart conditions.

A strong association was found between adherence to the intervention and the effects of exercise training. This reinforces the need to evaluate ways to improve adherence, which could include:

• Psychological components to increase motivation

• Telemedical approaches for remote monitoring and support

• Faster reintegration into regular exercise after acute clinical events

Key Takeaways

• Combined endurance and resistance training provides significant cardiovascular benefits for heart failure patients when performed properly.

• The optimal "dose" appears to be 30-60 minutes per week of resistance training, combined with regular endurance exercise.

• Benefits include improved peak oxygen consumption, NYHA functional class, blood pressure, blood sugar, and cholesterol levels.

• A progressive approach to exercise intensity and duration is crucial for long-term benefits.

• Peripheral adaptations (improved oxygen extraction in muscles) rather than central adaptations (heart function) primarily drive improvements in exercise capacity.

• Adherence remains a significant challenge but is crucial for realizing the full benefits of exercise training.

Frequently Asked Questions

Q: Can resistance training replace cardio for heart health?

A: While resistance training offers significant cardiovascular benefits, it's best combined with aerobic exercise for optimal heart health. Both forms of exercise provide unique benefits that complement each other.

Q: How often should I do resistance training for heart health?

A: Current research suggests 2-3 sessions per week, totaling 30-60 minutes, provides optimal cardiovascular benefits while allowing adequate recovery time.

Q: Is resistance training safe for people with heart failure?

A: Yes, when done properly under medical supervision, resistance training can be safe and beneficial for clinically stable heart failure patients. Always obtain medical clearance before starting any exercise program.

Q: What's the minimum amount of resistance training needed for heart benefits?

A: Studies indicate that even 30 minutes per week of resistance training can provide significant cardiovascular benefits. Consistency is more important than duration.

Q: Does age or disease severity affect the benefits of exercise training?

A: Subgroup analyses show that age and disease severity do not significantly influence treatment effects in clinically stable heart failure patients. However, very sick, recently hospitalized patients may require more tailored interventions.

Take Action for Your Heart Health

Ready to strengthen your heart through a balanced exercise approach? Here's how to get started:

• Schedule a Check-up: Consult your healthcare provider to ensure you're ready for a combined exercise program.

• Find Professional Guidance: Consider working with a certified personal trainer with experience in cardiac rehabilitation to learn proper form and technique.

• Start Your Journey: Begin with 2-3 weekly sessions, focusing on both endurance and resistance exercises with proper form.

• Track Your Progress: Keep a workout log to monitor your improvements and maintain motivation.

• Build Consistency: Remember that consistency over time is more important than intensity, especially when starting out.

Remember, every rep counts toward a healthier heart. Start your balanced exercise journey today and take control of your cardiovascular health!

Related Articles

CardioRACE Study: Unveiling the Winning Exercise Strategy Against Heart Disease in Overweight Adults

Strength Training: Can Lifting Weights Reverse Your Biological Age?

Journal References

Edelmann, F., Wachter, R., Duvinage, A., Mueller, S., Schwarz, S., Christle, J. W., Seyfarth, M., Knapp, M., Dörr, M., Nolte, K., Düngen, H., Esefeld, K., Hagendorff, A., Haykowsky, M. J., Hasenfuss, G., Holzendorf, V., Prettin, C., Mende, M., Pieske, B., . . . Halle, M. (2024). Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: A randomized controlled trial. Nature Medicine, 31(1), 306-314. https://doi.org/10.1038/s41591-024-03342-7

Cardio plus strength training lowers cardiovascular disease risk profile in overweight or obese individuals | NHLBI, NIH. (2024b, January 31). NHLBI, NIH. https://www.nhlbi.nih.gov/news/2024/cardio-plus-strength-training-lowers-cardiovascular-disease-risk-profile-overweight-or#:~:text=New%20NHLBI-funded%20research%20finds%20that%20in%20adults%20with,cardio%20alone%2C%20can%20improve%20cardiovascular%20disease%20%28CVD%29%20risk.

Lee, D. C., & Lee, I. M. (2023). Optimum Dose of Resistance Exercise for Cardiovascular Health and Longevity: Is More Better?. Current cardiology reports, 25(11), 1573–1580. https://doi.org/10.1007/s11886-023-01976-6

Paluch, A. E., Boyer, W. R., Franklin, B. A., Laddu, D., Lobelo, F., Lee, D., McDermott, M. M., Swift, D. L., Webel, A. R., & Lane, A. (2023). Resistance exercise training in individuals with and without cardiovascular disease: 2023 Update: A scientific statement from the American Heart Association. Circulation, 149(3). https://doi.org/10.1161/cir.0000000000001189

Edelmann, F., Bobenko, A., Gelbrich, G., Hasenfuss, G., Herrmann-Lingen, C., Duvinage, A., Schwarz, S., Mende, M., Prettin, C., Trippel, T., Lindhorst, R., Morris, D., Pieske-Kraigher, E., Nolte, K., Düngen, H. D., Wachter, R., Halle, M., & Pieske, B. (2017). Exercise training in Diastolic Heart Failure (Ex-DHF): rationale and design of a multicentre, prospective, randomized, controlled, parallel group trial. European journal of heart failure, 19(8), 1067–1074. https://doi.org/10.1002/ejhf.862

Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop.