4.8.3. Recommendations

Equipment for resistance training typically includes:


An initial intensity of 30–40% of 1-RM for upper body and 50–60% of 1-RM for the lower body is recommended. The general recommendations for resistance training according to the American College of Sports Medicine (modified) are given in Table 35 [12].


**Table 35.** ACSM resistance training recommendations.

Abbreviations: ACSM—American College of Sports Medicine; 1-RM—one repetition maximum. Source: Adapted from [12].

The AACVPR and ACSM recommendations for the commencement of resistance training and acceptable load are summarized in Table 36 [1,12].


**Table 36.** Commencement of resistance training and acceptable load.

Abbreviations: AACVPR—American Association of Cardiovascular and Pulmonary Rehabilitation; ACSM—American College of Sports Medicine; CABG—coronary artery bypass graft surgery; MI—myocardial infarction; PPM—permanent cardiac pacemaker. Source: Adapted from [1,12].

Resistance training can be implemented a few weeks after myocardial infarction (after at least 1 week of well-tolerated aerobic training); however, it should be postponed following cardiac surgery until full sternum stability—i.e., for 3 months. In the case of individuals with a very low functional capacity or muscular atrophy, resistance training should commence simultaneously or before the aerobic component to increase muscle power. Resistance training can be performed as an independent session or may be used as part of warm-up or cool-down phases. Sessions should be performed 2–3 times a week with at least 48 h separating training for the same muscle groups [80].

Considering the findings of recent studies, high-intensity dynamic strength training is recommended, as it leads to greater muscle strength improvement than low-intensity exercise, and, if executed properly, has been demonstrated as safe [81]. It has been postulated that dynamic high-intensity resistance training elicits enhanced myofibrillar protein synthesis, subsequently leading to greater gains in muscle mass compared to dynamic low-intensity training [82,83].

### 4.8.4. Strength Testing

Strength testing prior to the commencement of resistance training enables appropriate load assessment. Typical approaches to determining appropriate resistance training intensity include [8]:


60% of 1-RM = 17 repetitions possible; 70% of 1-RM = 12 repetitions possible; 80% of 1-RM = 8 repetitions possible; 90% of 1-RM = 5 repetitions possible; 100% of 1-RM = 1 repetition possible.

Based on recent studies, for a precise 1-RM estimation, the use of no more than 10 repetitions has been suggested during strength testing [84]. In addition, the rating on the perceived exertion scale can be a valuable adjunct to control the intensity of resistance training [85].

To facilitate load estimation, dedicated equations for 1-RM estimation from multiple RM tests have been proposed [86,87]—e.g., 1-RM = (1 + 0.0333 × repetitions) × applied weight.

Typically, 8–12 repetitions improve muscle strength, whereas 15–20 repetitions improve endurance.
