**1.6 Non-communicable disease intervention research unit (NCDIRU) resistance training guidelines for the prevention and management of CVD**

Although RT is increasingly recommended as an integral component of an overall CVD prevention and management programme, many global guidelines impose specific RT programme design recommendations for each CVD risk, type of disease, even at each severity level, or fail to provide specific criteria for training progression [79]. Further, a significant barrier to increased implementation of RT as a clinical therapy is the complex, difficult-to-follow regimes compulsively focusing on design variables such as load, intensity and volume. As such, a more feasible and easier-to-adhere-to paradigm for RT should be explored and adopted as a prescription for public health [80, 81].

In this regard, for apparently healthy individuals or those at low-risk, the Non-Communicable Disease Intervention Research Unit (NCDIRU) recommends utilising 8–10 different RT exercises that train the major muscle groups, with multiple sets (i.e. 3–4 sets) of 8–12 repetitions, with minimal rest intervals (i.e. 30–60 seconds) for most days of a week.

In turn, the NCDIRU recommends that individuals with high-risk should utilise 8–10 different RT exercises that train the major muscle groups using multiple sets (i.e. 3 sets) of 10–12 repetitions, with moderate-long rest intervals (i.e. 60–90 seconds) for 3 days weekly. These high-risk individuals should also have increased patient monitoring and programme supervision when compared to low-risk patients.

Despite much overlap and impracticality, many international organisations have guidelines or position statements for each CVD. However, in an effort to develop a practical and easy-to-follow RT regime that will increase adherence and outcomes, the NCDIRU recommends the following for those patients with existing CVD to delay progression or assist in the management of CVDs: an RT prescription of 8–10 different exercises that train the major muscle groups using 1–2 sets of 10–15 repetitions, twice weekly. In this existing CVD group, exercise sessions should begin at a lower intensity level of 12–15 repetitions and progress more slowly than programmes designed for low-risk patients, allowing time for adaptation. These patients should also have the most patient monitoring and programme supervision. Further, variable resistance machines with selectorised weight stacks should be utilised. In this regard, variable resistance machines with selectorised weight stacks; (1) allow the initial weight applied to be at a low level and increased in small increments; (2) the equipment is usually designed to protect the lower back, thus reducing the risk of injury; (3) many machines are designed to avoid handgripping which reduces the risk of exercise-induced hypertension; (4) the machines are usually designed to allow the resistance to be applied evenly through the patients'

full range of motion (ROM); (5) many types of equipment can be double pinned to allow the individual to exercise through their pain-free ROM and 6) many machines do not require the individual to balance or control the weight, as do dumbbells and barbells, which may reduce the likelihood of injury [82].
