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  • Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta-analysis of randomised clinical trials

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Systematic review
Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta-analysis of randomised clinical trials
  1. Tasuku Terada1,2,
  2. Robert Pap3,
  3. Abby Thomas4,
  4. Roger Wei5,
  5. Takumi Noda6,7,
  6. Sarah Visintini8,
  7. Jennifer L Reed2,9,10
  1. 1Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham, UK
  2. 2Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
  3. 3University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
  4. 4Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
  5. 5Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  6. 6Graduate School of Medical Sciences, Department of Rehabilitation Sciences, Kitasato University, Sagamihara, Japan
  7. 7Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
  8. 8Berkman Library, University of Ottawa Heart Institute, Ottawa, ON, Canada
  9. 9School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  10. 10School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
  1. Correspondence to Dr Tasuku Terada; tasuku.terada{at}nottingham.ac.uk

Abstract

Objective To compare the effects of aerobic training combined with muscle strength training (hereafter referred to as combined training) to aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease (CAD).

Design Systematic review with meta-analysis.

Data sources MEDLINE, Embase, CINAHL, SPORTDiscus, Scopus, trial registries and grey literature sources were searched in February 2024.

Eligibility criteria Randomised clinical trials comparing the effects of ≥4 weeks of combined training and aerobic training alone on at least one of the following outcomes: cardiorespiratory fitness (CRF), anthropometric and haemodynamic measures and cardiometabolic blood biomarkers in patients with CAD.

Results Of 13 246 studies screened, 23 were included (N=916). Combined training was more effective in increasing CRF (standard mean difference (SMD) 0.26, 95% CI 0.02 to 0.49, p=0.03) and lean body mass (mean difference (MD) 0.78 kg, 95% CI 0.39 kg to 1.17 kg, p<0.001), and reducing per cent body fat (MD −2.2%, 95% CI −3.5% to −0.9%, p=0.001) compared with aerobic training alone. There were no differences in the cardiometabolic biomarkers between the groups. Our subgroup analyses showed that combined training increases CRF more than aerobic training alone when muscle strength training was added to aerobic training without compromising aerobic training volume (SMD 0.36, 95% CI 0.05 to 0.68, p=0.02).

Conclusion Combined training had greater effects on CRF and body composition than aerobic training alone in patients with CAD. To promote an increase in CRF in patients with CAD, muscle strength training should be added to aerobic training without reducing aerobic exercise volume.

  • Training
  • Muscle

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bjsports-2024-108530

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @TasukuTerada

    • Contributors TT is the guarantor. TT drafted the manuscript. TT and SV contributed to the development of the selection and data extraction criteria. SV developed the search strategy. TT, AT, RW, RP and TN screened studies for inclusion. TT, AT, RW, RP and TN extracted information on adherence and adverse events. TT and PR completed the risk of bias assessments. RP and JR critically reviewed the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.