February 3, 2025, 4:30 pm | Read time: 6 minutes

For heart patients, regular exercise can be an important factor in improving health for heart patients. But which type of exercise offers the greatest benefit? A study by the University of Nottingham investigated this question. It investigated whether combined strength and endurance training offers an advantage over pure endurance training in terms of physical fitness and body composition in patients with coronary heart disease (CHD). Recommendations for the treatment and support of patients can be derived from the results.

What Exactly Was Investigated?

In the systematic review and meta-analysis published in the British Journal of Sports Medicine, 23 randomized clinical trials with a total of 916 participants were evaluated. Patients with CHD were randomly divided into two groups. One group performed combined strength and endurance training, and the other undertook exclusively endurance training. This approach ensures that the results are not influenced by unconscious bias due to the random group allocation.

The aim was to compare the effect of the two training approaches with regard to three key aspects:

• Cardiorespiratory fitness (CRF): this describes how well the heart, lungs, and muscles work together to supply the body with oxygen during exercise. A high CRF is an important indicator for lower mortality rates.
• Body composition: The proportion of muscle mass, fat, and water in the body.
• Cardiometabolic markers: Values such as cholesterol and blood sugar that indicate the risk of heart and metabolic diseases.

The researchers wanted to investigate whether adding strength training could further enhance the positive effects of endurance training without reducing the benefits of endurance training.

Study Design and Methods

The studies were selected and evaluated on the basis of the so-called PRISMA guidelines, an international standard for high-quality scientific analyses.

The researchers also ensured that the included studies had a duration of at least four weeks. This a period of time that is necessary for initial physiological adaptations.

The endurance training consisted of activities such as walking, cycling, or running. Strength training included exercises with free weights, machines, or self-weight. The main objectives of the respective studies were fitness, body composition, and laboratory values such as cholesterol. All data was systematically analyzed and compared with each other.

Training for Heart Patients – the Results of the Analysis

The study showed clear advantages of combined training:

1. In Fitness

Cardiorespiratory fitness improved more in the group that trained both strength and endurance. However, it was also shown that the combined training only significantly improved cardiorespiratory fitness if the volume of endurance training was fully maintained – in this case, the effect was 0.36 standard deviations higher than with endurance training alone. This means that the combination leads to a moderate improvement in fitness. However, if endurance training was reduced in favor of strength training, there was no additional advantage over the endurance-only group, which is particularly relevant for training planning.

2. Body Composition

The fat-free body mass of the patients increased by almost 800 grams, while the body fat percentage decreased by 2.2 percent. For a person weighing 70 kilograms, this corresponds to a fat loss of around 1.5 kilograms.

3. In HDL Cholesterol

HDL cholesterol, which is considered beneficial, increased significantly more when the combined training was carried out without reducing the endurance training. This effect indicates an additional benefit for heart health.

Cardiometabolic markers such as total cholesterol or blood glucose did not differ between the groups, as many participants already had well-controlled levels, limiting potential improvements. Furthermore, the combination of aerobic interval training (AIT) and strength training showed no additional benefits over AIT alone.

What is the Significance of the Results?

The results underline the clear recommendation to use strength training as a supplement to endurance training in rehabilitation programs – but without reducing endurance training. Higher cardiorespiratory fitness has been shown to reduce the risk of recurrent heart problems and is an important indicator of longer life expectancy.

In addition, the positive changes in body composition show that the combined training offers benefits beyond the cardiovascular system, for example, by building muscle and reducing body fat.

The increase in HDL cholesterol as a result of combined training is also interesting. This could also contribute to heart health.

When asked about the study by FITBOOK, Tasuku Terada said: “Our results underline the importance of training volume for improving cardiorespiratory fitness.” A combined program that integrates both endurance and strength training, therefore, leads to greater improvements in cardiorespiratory fitness.

“Replacing part of the endurance training with strength training does not affect the improvements in cardiorespiratory fitness, but also increases muscle strength,” adds Terada. To achieve further improvements in cardiorespiratory fitness, however, it is crucial to add strength training without reducing the volume of aerobic training.

Exercise for Heart Patients – What the Researchers Recommend

According to Terada, general recommendations for people without contraindications include at least 150 minutes per week of moderate aerobic exercise or 75 minutes per week of intense aerobic exercise, as well as strength training on at least two non-consecutive days per week. “Regular physical activity is crucial for maintaining and improving overall health,” emphasizes Terada.

Regarding the choice of weight training methods, the researcher says: “Strength training equipment, free weights, resistance bands, and bodyweight exercises are all effective.” The key is to find a form of training that is easily accessible and enjoyable in order to maintain training in the long term.

Terada continues: “It is recommended to start with low resistance and higher repetition numbers, ten to 15 repetitions, and to focus on the large muscle groups before gradually increasing the load. Exercises that involve multiple joints, such as the leg press and chest press, should be prioritized where possible.”

Classification of the Study and Possible Limitations

The study includes high-quality studies from various countries but also has limitations. For example, differences in methodology, training intensity, and duration make comparability difficult. Furthermore, in some of the studies examined, participants dropped out, partly due to side effects such as muscle and joint pain. In addition, not all relevant data was always recorded in full, which could influence the validity of the results.

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Conclusion on Training for Heart Patients

Combined strength and endurance training offers patients with coronary heart disease decisive benefits – particularly in terms of fitness, body composition, and increasing HDL cholesterol. The full benefit is achieved when strength training complements existing endurance training without reducing its volume.

These findings could offer new approaches for rehabilitation programs and help those affected to improve their health in the long term.