Eccentric Muscle Training in Cardiac Rehabilitation

Experimental: Eccentric strength training + cardio

45 sessions experimental protocol

Outro: eccentric bike training

progressive following protocol, 10min

Outro: eccentric overload training

dynamic strength training + eccentric overload, progressive over time, 3sets*10reps (15-20min)

Outro: aerobic treadmill training

aerobic training, progressive over time, 10 min

Comparador Ativo: Traditional strength training + cardio

45 sessions traditional cardiac rehabilitation

Outro: aerobic treadmill training

aerobic training, progressive over time, 10 min

Outro: aerobic bike training

aerobic training, progressive following protocol, 10 min

Outro: traditional dynamic strength training

dynamic strength training, progression over time, 15-20 min

1Repetition Maximum (=RM) leg press (kg)

One repetition maximum on leg press device Technogym BioCircuit. The patient is positioned correctly on the leg press (back supported, feet on platform in standardized way so that repeated tests are in the same position).

The patiënt performes a maximal push, the load is automatically adjusted by the BioCircuit algorithm.

The system identifies the maximum successful single push as the 1RM (kg).

1Repetition Maximum (=RM) Low Row (kg)

One repetition maximum on the low row device Technogym BioCircuit. The patient sits with chest supported, feet on the ground, and grips the handles with arms extended.

The patiënt performes a maximal pull, the load is automatically adjusted by the BioCircuit algorithm. The system identifies the maximum successful single lift as the 1RM (kg).

1Repetition Maximum (=RM) chest press (kg)

One repetition maximum on chest press device Technogym BioCircuit. The patient is positioned correctly on the chest press (back supported, feet on the ground in standardized way so that repeated tests are in the same position). The patiënt performes a maximal push, the load is automatically adjusted by the BioCircuit algorithm. The system identifies the maximum successful single push as the 1RM (kg).

1Repetition Maximum (=RM) vertical traction (kg)

One repetition maximum on vertical traction device Technogym BioCircuit. The patient is positioned correctly on the vertical traction (back supported, feet on the ground in standardized way so that repeated tests are in the same position).

The patiënt performes a maximal pull, the load is automatically adjusted by the BioCircuit algorithm.

The system identifies the maximum successful single push as the 1RM (kg).

Handgrip strength

The Jamar handgrip dynamometer is used to measure grip strength in a standardized way ( 90° flex elbow, forearm neutral, and wrist slightly extended).

3 trials per hand are performed, with 10seconds rest in between. The average value is recorded as grip strength.

Isometric Qceps peak torque (Nm)

The subject is seated in the Biodex System dynamometer and securely strapped (trunk, pelvis, thigh). The dynamometer axis is aligned with the knee joint axis (lateral femoral epicondyle).

The knee is fixed at 60° of flexion (0° = full extension). The lower leg is attached to the lever arm just above the ankle. The subject performs a maximal isometric knee extension (pushing against the immovable arm) for 3seconds.

3 tests are done with 10seconds rest in between. The highest torque value (Nm) recorded is taken as the quadriceps peak torque.

6mwt (m)

The 6-minute walk test (6MWT) assesses functional exercise capacity by measuring the distance walked in 6 minutes.

It is performed on the same flat, straight corridor (50 meter) with marked turnaround points.

The participant is instructed to walk as fast as possible at a self-paced speed.

Standardized encouragement is given every minute. A timer is started at the beginning and stopped at 6 minutes. The total distance walked is measured in meters.

Time up and go (s)

The participant starts seated in a standard chair (back against the chair, no armrests) On the command "go," the participant stands up, walks 3 meters, turns around, walks back, and sits down again.

Timing starts on "go" and stops when the participant is seated again with the back against the chair). The test is performed 3 times (with 20seconds rest in between).

The outcome is the mean time taken to complete the 3 tasks (seconds).

VO2 peak (ml/kg/min)

VO₂peak is measured during a cardiopulmonary exercise test (CPET) on a cycle ergometer. The test is performed on a Lode Corival ergometer with breath-by-breath gas analysis via a Vyaire Medical system.

After calibration of flow and gas analyzers, the subject is fitted with a mask and monitoring devices (ECG, BP). A short resting phase and unloaded cycling (warm-up) are performed. Workload then increases continuously using an individualized ramp protocol (e.g. 5-20 Watt/min - so small increase every 3-12 seconds). The same protocol is used in the pre and post test.

The participant cycles at a constant cadence(≈60-70 revolutions/min) until volitional exhaustion. Expired gases are analyzed to determine oxygen uptake (VO₂) and carbon dioxide production (VCO₂). Strong verbal encouragement is given to reach maximal effort. VO₂peak is defined as the mean VO₂ value averaged over the final 30 seconds of exercise.

Test termination follows symptom limitation or standard clinical safety criteria.

maximal load (Watt)

Wattmax is determined during a CPET performed on a Lode Corival ergometer with monitoring via a Vyaire Medical system.

After calibration of flow and gas analyzers, the subject is fitted with a mask and monitoring devices (ECG, BP). A short resting phase and unloaded cycling (warm-up) are performed. Workload then increases continuously using an individualized ramp protocol (e.g. 5-20 Watt/min - so small increase every 3-12 seconds). The same protocol is used in the pre and post test. The participant cycles at a constant cadence (≈60-70 revolutions/min) until volitional exhaustion.

Wattmax is defined as the highest workload (in watts) achieved in the final stage.

Strong encouragement is provided to achieve maximal effort.

VO2/W slope (ml/min/W)

VO2/W slope is measured during a cardiopulmonary exercise test (CPET) on a cycle ergometer. The test is performed on a Lode Corival ergometer with breath-by-breath gas analysis via a Vyaire Medical system. After calibration of flow and gas analyzers, the subject is fitted with a mask and monitoring devices (ECG, BP). A short resting phase and unloaded cycling (warm-up) are performed. Workload then increases continuously using an individualized ramp protocol (e.g. 5-20 Watt/min - so small increase every 3-12 seconds). The same protocol is used in the pre and post test. The participant cycles at a constant cadence (≈60-70 revolutions/min) until volitional exhaustion.

The relationship between VO₂ (y-axis) and work rate (x-axis) is plotted. A linear regression is applied. The slope of this line represents the VO₂/W slope (mL/min/W).

VE/VCO2 slope

The VE/VCO₂ slope is measured during CPET on a Lode Corival ergometer with breath-by-breath analysis via Vyaire Medical.

After calibration of flow and gas analyzers, the subject is fitted with a mask and monitoring devices (ECG, BP). A short resting phase and unloaded cycling (warm-up) are performed. Workload then increases continuously using an individualized ramp protocol (e.g. 5-20 Watt/min - so small increase every 3-12 seconds). The same protocol is used in the pre and post test. The participant cycles at a constant cadence (≈60-70 revolutions/min) until volitional exhaustion.

VE is plotted against VCO₂ over the course of exercise. A linear regression is applied from the start of exercise up to the ventilatory compensation point.

The slope of this relationship represents the VE/VCO₂ slope.