Aerobic training in patients with coronary artery disease is most effective in those most sedentary at baseline. No additional benefits are found in this patient population with the addition of high-load or low-load resistance training to aerobic training. These are among the study findings published in the International Journal of Cardiology.

Researchers in Slovenia sought to evaluate the effect of high-load and low-load resistance training combined with aerobic training on physical activity and sedentary behavior among patients with coronary artery disease vs the effect of aerobic training alone.

They conducted a randomized controlled trial ( Identifier: NCT04638764) that included 79 patients (18-85 years of age) with stable preserved left ventricular ejection fraction (53%). Patients were randomly assigned into high-load resistance training combined with aerobic training, low-load resistance training combined with aerobic training, or aerobic training alone. Researchers used triaxial accelerometer measurements at baseline (7-10 days before study enrollment) and post-training for 8 days to determine physical activity and sedentary behavior.

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Patients (61±8 years of age) experienced 3 training sessions per week for 12 weeks with 2 to 3 days rest between sessions. All patients also received a physical activity brochure and an hour of in-group physical activity counselling emphasizing ways to decrease sedentary behavior and increase leisure physical activity. In total, 57 patients completed the study protocol, with primary loss due to COVID-19 lockdown restrictions. The researchers noted that 95% of patients overall were physically active, surpassing the daily moderate to vigorous intensity physical activity recommendation for patients enrolled in cardiac rehabilitation. There were no clinically relevant between-group differences.

The researchers found that post-training physical activity and sedentary behavior showed no difference between the training formats. The majority of waking hours were spent sedentary (8 hours, 62%), unchanged before and after training intervention. Baseline stratification by sedentary behavior revealed very sedentary patients improved sedentary behavior (-52 min/d; P =.001) and they improved light intensity physical activity (+27 min/d; P =.009) after training. Compared with very active patients, improvement in physical activity was greater in very sedentary patients (sedentary behavior improvement +27%; P =.002; light intensity physical activity +24%; P =.004), and it was greater in sedentary patients (sedentary behavior improvement +24%, P =.009).

Study limitations include the underpowered sample size and that results were influenced by high moderate-to-vigorous physical activity thresholds. Also, unaccounted for levels of movement restrictions during COVID-19 lockdowns impacted physical activity and sedentary behavior.

“Post-training improvement in PA [physical activity] and SB [sedentary behavior] was determined by baseline SB, while the addition of low-load or high-load resistance training provided no further benefits in coronary artery disease patients,” the researchers wrote. “The combination of aerobic training and resistance training improves sedentary behavior and light physical activity in very sedentary patients with coronary artery disease.”


Kambic T, Šarabon N, Hadžić V, Lainscak M. Physical activity and sedentary behaviour following combined aerobic and resistance training in coronary artery disease patients: A randomized controlled trial. Int J Cardiol. Published online October 28, 2022. doi:10.1016/j.ijcard.2022.10.157

This article originally appeared on The Cardiology Advisor