4.8.5. Strength Training

Prior to the commencement of strength training, preliminary instruction should be given regarding the appropriate weight loads, adequate lifting technique, range of motion for each exercise, and appropriate breathing pattern. Progression should be achieved by increasing the number of repetitions and training intensity and shortening the rest period.

A resistance training circuit should include [12,83]:


Patients with cardiovascular diseases should complete such training in 15–20 min. Exercise with a hand raised above shoulder level is not recommended for a patients recently after cardiac surgery (for a three months) and for an individuals with heart failure. Typical resistance training for major muscle groups is demonstrated below (Figures 7–13).

**Figure 7.** Chest press. Source: Photos by authors.

 

**Figure 8.** Shoulder press. Source: Photos by authors.

6 9999 6 9999 **Figure 9.** Triceps extension (**A**); triceps extension with Thera-band (**B**). Source: Photos by authors.

(B)

10 10 **Figure 10.** Biceps curl (**A**); biceps curl with Thera-band (**B**). Source: Photos by authors.

(B)

7

**Figure 11.** Pull-down (upper back). Source: Photos by authors.

11 

12 **Figure 12.** *Cont*.

9

(B)

(A)

12 **Figure 12.** Quadriceps extension (**A**); quadriceps extension with Thera-band (**B**). Source: Photos by authors.

**Figure 13.** Calf raise. Source: Photos by authors.

13 

General rules for resistance training performance include [88]:


It is crucial to train opposite muscle groups, e.g., through low back extension and abdominal crunches, or leg presses and leg curls, to exercise quadriceps and hamstring muscles. Such an approach minimizes the risk of injuries due to muscle imbalance.

Holding one's breath during muscle contraction induces a Valsalva maneuver—i.e., a sudden rise in venous return, thus leading to an uncontrolled increase in blood pressure.

### 4.8.6. Training Progression Utilizing OMNI Scale

During the early stage of resistance training, emphasis is placed on practicing good technique to reduce the risk of injuries. Initial load should be set at a level where it is possible to achieve the number of repetitions prescribed without straining—e.g., <40% of one repetition maximum. The same recommendation applies to patients with frailty [89]. Training progression can be achieved by increasing the load, repetitions, or number of sets, or by reducing the amount of rest between sets. In practice, an increase in repetitions is recommended before an increase in weight. Once the upper range of expected repetition is achieved, load may be increased by 5% [88].

The OMNI-RES scale was developed to facilitate strength training progression and can be utilized to track the perceived intensity during strength training [89,90]. The OMNI-RES scale includes visual, numerical, and verbal perceptual exercise intensity descriptors from "extremely easy" (0 points) through to "easy" (2 points), "somewhat hard" (6 points), "hard" (8 points), and "extremely hard" (i.e., 10 points). Gearhart et al. demonstrated the effectiveness of the use of this scale in the elderly for tracking the strength changes from a resistance exercise program using RPE from the OMNI-RES [91,92]. The OMNI-RES scale can also be a useful tool for a resistance training beginner, as it provides a simple and subjective intensity guide. There is a need, however, for a periodic evaluation to accurately adjust the program intensity. In view of this, the <10 RM test can be used once every few weeks. Moreover, a growing body of evidence supports the idea of a shift into functional strength training during phase III of cardiac rehabilitation and focusing on the muscle groups needed for the activities of daily living [25].
