2023+AHA科学声明：伴或不伴心血管疾病个体的抗阻运动训练（英文更新版）.pdf

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1、CirculationCirculation.2023;148:e00e00.DOI:10.1161/CIR.0000000000001189 TBD TBD,2023 e1 2023 American Heart Association,Inc.Circulation is available at www.ahajournals.org/journal/circAHA SCIENTIFIC STATEMENTResistance Exercise Training in Individuals With and Without Cardiovascular Disease:2023 Upd

2、ate:A Scientific Statement From the American Heart AssociationAmanda E.Paluch,PhD,FAHA,Chair;William R.Boyer,PhD;Barry A.Franklin,PhD,FAHA;Deepika Laddu,PhD,FAHA;Felipe Lobelo,MD,PhD,FAHA;Duck-chul Lee,PhD;Mary M.McDermott,MD,FAHA;Damon L.Swift,PhD,FAHA;Allison R.Webel,RN,PhD;Abbi Lane,PhD,FAHA,Vice

3、 Chair;on behalf the American Heart Association Council on Lifestyle and Cardiometabolic Health;Council on Arteriosclerosis,Thrombosis and Vascular Biology;Council on Clinical Cardiology;Council on Cardiovascular and Stroke Nursing;Council on Epidemiology and Prevention;and Council on Peripheral Vas

4、cular DiseaseABSTRACT:Resistance training not only can improve or maintain muscle mass and strength,but also has favorable physiological and clinical effects on cardiovascular disease and risk factors.This scientific statement is an update of the previous(2007)American Heart Association scientific s

5、tatement regarding resistance training and cardiovascular disease.Since 2007,accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease.This scientific statement summarizes the benefits of

6、resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors.We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations.Because less than one-t

7、hird of US adults report participating in the recommended 2 days per week of resistance training activities,this scientific statement provides practical strategies for the promotion and prescription of resistance training.Key Words:AHA Scientific Statements cardiovascular diseases exercise resistanc

8、e training risk factors Resistance training(RT exercise that evokes muscular contraction against an external force)improves or maintains muscle mass and strength,and has beneficial physiological and clinical effects on cardiovascular disease(CVD)and CVD risk factors.1,2 Epidemiological evidence sugg

9、ests that RT is associated with a lower risk of all-cause mortality and CVD morbidity and mortality.2 Adults who participate in RT have 15%lower risk of all-cause mortality and 17%lower risk of CVD,compared with adults who report no RT.Approxi-mately 30 to 60 minutes per week of RT is associated wit

10、h the maximum risk reduction for all-cause mortality and incident CVD.2 Given the expanded evidence sup-porting the use of RT to combat CVD,we updated the previous American Heart Association(AHA)2007 sci-entific statement on the topic.3 This updated scientific statement synthesizes newer evidence re

11、garding the effect of RT on both traditional(eg,blood pressure,lip-ids)and nontraditional(eg,arterial stiffness,physical functioning,depression)CVD risk factors.One of the 8 components in AHA Lifes Essential 8 is a focus on physical activity and“moving more,”through both aerobic and muscle-strengthe

12、ning activities.4 The effects of RT in adults with and without CVD and the benefits associ-ated with combination(aerobic+resistance)training are discussed.Despite the well-documented benefits,only 28%of US adults report participating in 2 days per week of RT as recommended by the 2018 Federal Physic

13、al Activity Guidelines.5 This scientific statement is intended to provide a summary of cardiovascular-related benefits of RT tailored to clinicians and public health promotion.In addition to reviewing the benefits for performing RT,this scientific statement addresses the promotion,prescrip-tion,and

14、safety considerations for RT engagement.CLINICAL STATEMENTS AND GUIDELINESTBD TBD,2023 Circulation.2023;148:e00e00.DOI:10.1161/CIR.0000000000001189Paluch et al Resistance Exercise Training:2023 Updatee2HEALTH BENEFITS OF RTTraditional CVD Risk FactorsResistance training can improve traditional CVD r

15、isk fac-tors,including blood pressure(BP),glycemia,lipids,and body composition.Included evidence is based largely on randomized controlled trials of medium length(26 months);few data were available for trials 6 months.Most trials implemented programs of moderate-to high-intensity(40%80%of maximum ef

16、fort)RT on 2 to 3 days per week.RT and Resting BPRT can reduce resting BP in healthy adults,68 in those with prehypertension,hypertension,and elevated cardiometa-bolic risk.6,7,9 Several proposed mechanisms responsible for these benefits include improvements in endothelial func-tion,vasodilatory cap

17、acity,and vascular conductance.10 Among healthy young adults(40 years of age),RT can elicit small,but significant reductions in diastolic BP(1 mm Hg).6 For middle-aged and older healthy adults(40 years),RT results in larger reductions in systolic BP(4 mm Hg)and diastolic BP(2 mm Hg).7 Effects of RT

18、are more pronounced for both systolic and diastolic BP in those with prehypertension9(3 mm Hg systolic BP;3 mm Hg diastolic BP)and hypertension8(6 mm Hg systolic BP;5 mm Hg diastolic BP)compared with normotensive in-dividuals.The listed evidence suggests that the decreases in resting systolic BP are

19、 similar when comparing RT with antihypertensive medications.6RT and GlycemiaRT is associated with improvements in glycemia and in-sulin resistance across varied populations.7,1113 Several proposed beneficial mechanisms of RT include improved insulin sensitivity,increased GLUT4 translocation in skel

20、-etal muscle,and increased energy expenditure both dur-ing and after exercise.14 In observational studies,regular participation in RT is associated with a 17%lower inci-dence of diabetes compared with no participation in RT.2 The dose-response association appears nonlinear with a progressively lower

21、 risk of diabetes associated with par-ticipation in up to 60 minutes per week of RT,followed by a continued,more gradual decrease beyond this thresh-old duration.2RT interventions may reduce fasting glucose by 2 to 5 mg/dL among older adults,7 and among those with prediabetes12 and type 2 diabetes,a

22、s well,13,15 but not in young and healthy participants.7 Among older patients with type 2 diabetes,RT was associated with a 0.34%decline in hemoglobin A1c.13 Patients with more recent documented type 2 diabetes(6 years)and those with higher hemoglobin A1c at baseline(7.5%)demon-strated greater decre

23、ases in hemoglobin A1c after RT.15RT and Lipid ProfilesThere is a favorable,although modest,effect of RT on to-tal cholesterol,triglycerides,and high-density lipoprotein cholesterol.7,16 Resistance training interventions result in improvements in high-density lipoprotein cholesterol(+2 to+12 mg/dL),

24、total cholesterol(8 mg/dL),and triglyc-erides(7 to 13 mg/dL).7,16 The effect of RT on lip-ids and lipoproteins may be less pronounced in younger adults(40 years of age),corresponding to significant,although small,improvements in high-density lipoprotein cholesterol only(+2 mg/dL).7 Evidence for an e

25、ffect on low-density lipoprotein cholesterol is less consistent.A meta-analysis of 46 studies,including varied populations with and without elevated cardiometabolic risk,report-ed a significant decrease of approximately 10 mg/dL in low-density lipoprotein cholesterol.16 In contrast,an-other meta-ana

26、lysis found no significant reductions in low-density lipoprotein cholesterol in older adults with-out elevated cardiometabolic risk,whereas older adults with elevated cardiometabolic risk showed significant decreases in low-density lipoprotein cholesterol(13.4 mg/dL)after RT.7RT,Body Composition,and

27、 WeightRT appears to have a beneficial effect on lean body mass and fat mass.17,18 Among adults who are overweight or obese,RT alone is associated with increased lean body mass(0.8 kg),decreased body fat percentage(1.6%),and decreased whole-body fat mass(1.0 kg)com-pared with nontraining controls.17

28、 RT alone is unlikely to produce clinically significant weight loss.19 RT improves body composition by reducing body fat stores,increas-ing or maintaining muscle mass,and increasing resting metabolic rate;it may attenuate weight gain over time.20In summary,more recent data suggest that RT has signif

29、icant and favorable effects on traditional CVD risk factors,including resting BP,glycemia,lipids and lipopro-teins,and body composition.Benefits tend to be greater in older adults and those with elevated cardiometabolic risk factors.RT and Nontraditional CVD Risk FactorsAccumulating research since 2

30、007 has identified po-tential mechanisms,beyond the favorable effect on conventional CVD risk factors by which RT may re-duce CVD risk(Table 1).Resistance training appears to confer small to moderate beneficial increases in cardiorespiratory fitness through mechanisms such as increased leg strength,

31、improvements in oxidative en-zymes,and increased type II muscle fibers.21 Although RT often has modest benefits for cardiorespiratory fit-ness,this can still be clinically meaningful given the well-established benefits of even moderate levels of cardiorespiratory fitness for lower risk of cardiovasc

32、ular CLINICAL STATEMENTS AND GUIDELINESCirculation.2023;148:e00e00.DOI:10.1161/CIR.0000000000001189 TBD TBD,2023Paluch et al Resistance Exercise Training:2023 Updatee3events and mortality in adults with and without car-diovascular disease.22 Higher volumes of RT are most beneficial to elicit changes

33、 in fitness.21 RT appears to favorably influence endothelial function,7,23 whereas the effects of RT on arterial stiffness and inflammatory makers are less consistent,ranging from null to benefi-cial associations.7,16,24,25 Limited evidence from studies with small sample sizes suggests there are ben

34、eficial effects of RT on fibrinolysis.26 A 2022 AHA presidential advisory statement introduced the Essential 8,adding sleep health as a new component and emphasizing the foundational factor of psychological health and well-be-ing for preserving and optimizing cardiovascular health.4 Recent evidence

35、suggests that RT is associated with enhanced sleep quality,27 and reduced symptoms of depression and anxiety and improved quality of life,as well.2830Resistance Versus Aerobic Versus Combined Training and CVD Risk FactorsA common yet understudied question is“What type of exercise is most effective f

36、or preventing CVD?”Several large observational studies suggest that,although no statistically significant differences were found between RT versus aerobic training(AT)alone,combining RT and AT(combination training CT)resulted in slightly larger reductions in some CVD risk factors,including obesity,3

37、1 diabetes,32 and hypercholesterolemia.33 CT appears to have stronger associations than either AT or RT alone with all-cause and CVD mortality.2,34 Compared with adults reporting no activity,individuals participating in CT have a 40%to 46%lower risk of all-cause and CVD mortality.2 In contrast,RT or

38、 AT alone is associated with an 18%to 29%lower risk of all-cause and CVD mortal-ity compared with no activity.2Several meta-analyses,based primarily on interven-tions ranging 2 to 6 months,summarized the compara-tive effectiveness of RT,AT,and CT on CVD risk factors(Table 2).Overall,despite variatio

39、ns in study design and populations,RT,AT,and CT appear to similarly improve BP and lipids.3537 CT appears to be more effective for improving body composition and glycemic control especially in patients with type 2 diabetes.12,19,3739 RT is potentially a viable alternative to AT and may provide indep

40、endent and additive benefits to AT for improving CVD risk factors.However,additional well-designed large randomized controlled trials with long-term(6 months)interventions directly comparing RT,AT,and CT are needed.Individuals who do not meet the aerobic physical activity guidelines are less likely

41、to participate in RT than those who are aerobically active.For example,only 3.6%of adults who report no aerobic activity do RT,compared with 43.5%of adults who are aerobically active and participate in RT.5 Physical inactivity is an established CVD risk factor.RT may be a viable strategy to support

42、cardiovascular health among those who are otherwise Table 1.Associations of Resistance Training With Nontraditional Cardiovascular Risk FactorsNontraditional risk factor Association Summary Cardiorespiratory fitness or Small or moderate improvements in fitness in adults with and without CVD(+1 to 3

43、mLkg1min1 in Vo2max).6,17 For peo-ple with coronary heart disease,similar improvements in Vo2max shown with RT(17%)as with aerobic training(21%)18Arterial stiffness,or Low-intensity to moderate-intensity RT favorably associated with lower central(0.71.4 m/s)and peripheral(1.31.07 m/s)PWV.20Effects o

44、f high-intensity RT are inconsistent,identifying studies with positive and negative associations with PWV.20Inflammation(CRP)or RT lowers CRP by-0.26 to-0.37 mg/L in adults overall.6,13RT lowers CRP in adults with elevated cardiometabolic risk by-2.47 mg/L.6Among 3 studies of adults with overweight

45、or obesity,associations for CRP coincided with fat mass reduction.21Fibrinolysis and coagulation fibrinolysis coagulationHigher volume and intensity RT associated with a greater fibrinolytic response and platelet activity,although on the basis of limited evidence in only apparently healthy young adu

46、lts.22Among patients with coronary artery disease,a single RT session was associated with improvements in the fibrinolytic response without elevating potential thrombotic markers.22Endothelial function Improvements of 2%3%(flow-mediated dilation)in adults with and without cardiometabolic conditions.

47、6,23Depression and anxiety Moderate-effect sizes in reduction in depressive symptoms(ES=0.66).24Small-to-moderate effect in reductions in anxiety(ES=0.33).25Quality of life Positive effect on mental healthrelated QoL measures,including total Mental Component(ES=0.54),Mental health(ES=0.64),and Vital

48、ity(ES=0.39).26Positive effect on physical healthrelated QoL measures,including total Physical Component(ES=0.50),Bodily pain(ES=0.81),General health(ES=0.57),and Physical functioning(ES=0.40).26Sleep sleep quality Moderate-effect sizes in better sleep outcomes,with the strongest beneficial associat

49、ions for sleep quality.Associations are less consistent for sleep duration.27CRP indicates C-reactive protein;CVD,cardiovascular disease;ES,effect size;PWV,pulse wave velocity;QoL,quality of life;and RT,resistance training.represents direct association;represents inverse association;represents no as

50、sociation.CLINICAL STATEMENTS AND GUIDELINESTBD TBD,2023 Circulation.2023;148:e00e00.DOI:10.1161/CIR.0000000000001189Paluch et al Resistance Exercise Training:2023 Updatee4aerobically inactive.As demonstrated in this scientific statement on RTs independent cardiovascular benefits,RT programs targete