**3.1 Moving beyond cardio and cardiorespiratory fitness: the value of resistance training in cardiovascular disease prevention and management**

Many health organisations, such as the American Heart Association (AHA), provide exercise guidelines and recommendations for CVD, which tend to focus on aerobic exercise prescription [14]. While the health benefits of aerobic exercise are well established there is sufficient evidence from experimental studies, reviews and meta-analyses to justify the inclusion of RT, either alone, or at least in equal combination to aerobic training, not only in apparently healthy populations [15] but also for the attenuating of several risk factors of CVD [16] and in comprehensive cardiovascular therapy programmes [17]. Recently, in fact, a low volume, single-set RT exercise programme has proven sufficient to reduce CVD risk in untrained older women [18].

#### *Moving beyond Cardio: The Value of Resistance Exercise Training for Cardiovascular Disease DOI: http://dx.doi.org/10.5772/intechopen.104909*

Further, evidence is mounting that RT plays a significant role in morbidity. This is because muscular fitness (a general term that describes the general health, endurance, power and strength of muscles) is increasingly being correlated to many types of mortality, including cardiovascular mortality [19]. As with cardiorespiratory fitness, muscular fitness may also be directly related to the integrated function of numerous physiological systems, including the cardiorespiratory and musculoskeletal systems, and could be utilised to provide a reflection of wholebody health and function. Research on the relationship between morbidity and muscular strength, and specifically handgrip strength [20, 21], quadriceps testing [21, 22] and bench press testing [22] suggest that muscular strength should be viewed as an independent CVD risk factor [23]. This is because these proxies of overall strength have been proven to have significant inverse relationships with all-cause mortality, even after controlling for other risk factors, including level of cardiorespiratory fitness [19, 24]. With regards to muscular endurance, research has shown an inverse association between the number of sit-ups in one minute and mortality [25]. Research has also demonstrated that death rates of 30 per 10,000 in individuals with low muscular fitness, compared with just 12 per 10,000 in individuals with high muscular fitness [26]. As with cardiorespiratory fitness, there may be many health benefits directly and indirectly associated with muscular fitness, for example, high levels of muscular fitness may indirectly improve cardiovascular health profiles, through its beneficial effects on hypertension [27], dyslipemia [8], body composition [28, 29], diet [30], aerobic performance [31] and functional capacity [19]. Given the prognostic power of muscular fitness (and specifically muscular endurance and muscular strength) as a predictor of all-cause mortality, muscular fitness assessments should be highly considered to improve the efficacy of individualised CVD patient risk assessment and resultant clinical decisions.

#### **3.2 The rise of home-based exercise training**

Many governments adopted hardened nationwide quarantine or implemented forms of lockdowns in attempts to reduce the spread of COVID-19. Lockdowns present a major problem in terms of physical activity. Lockdowns promote inactivity through direct personal restrictions, shutting down gymnasiums and fitness centers, and through suspension or cessation of many outdoor activities [32, 33]. These COVID-19 restriction attempts rapidly accelerated the uptake of home-based exercise training [34], a trend which has been building, albeit slowly, for decades [35]. As gymnasiums and fitness centers closed due to COVID-19 restrictions, individuals and health professionals were forced to exercise differently using limited equipment in limited space. While COVID-19 restrictions are being lifted worldwide, and even as gymnasiums and fitness centers begin to open, home-based exercise training may become a new mainstay, whether due to their ease of use, or even due to economic downturns. Already, the American College of Sports Medicine (ACSM) ranks home exercise gymnasiums, strength training with free weights and body weight training at 2, 4 and 8, respectively in their Worldwide Survey of Fitness Trends for 2022 [34]. Notwithstanding the COVID-19 crisis, many individuals chose to and will continue to choose home-based exercise training as it is more convenient and flexible. Importantly, home-based exercise training can be as effective as facility-based exercise training, in clinically stable low- to moderate-risk patients with CVD [36].
