**4.6 Exclusion criteria and further recommendations**

As discussed previously, appropriately designed PRT is safe, and well tolerated by males and females of all ages and most conditions, including RA (ACSM, 1998). In the recommendations made by the AHA regarding resistance training for patients with and without CVD (Pollock et al., 2000), the contraindications to PRT are: unstable angina, uncontrolled hypertension (≥160/100 mm Hg), recent and untreated episodes of congestive heart failure, uncontrolled dysrhythmias, severe stenotic or regurgitant valvular disease, and hypertrophic cardiomyopathy. Additionally, for low to moderate risk cardiac patients wanting to participate in PRT programs, they suggest preliminary aerobic exercise training for 2-4 weeks (Pollock et al., 2000). Overall, however, they concluded that "resistance training exercise is strongly recommended for implementation in primary and secondary cardiovascular disease-prevention programs" and "…is particularly beneficial for improving the function of most cardiac, frail, and elderly patients"( Pollock et al., 2000). In part, this is because increased strength reduces the myocardial demands (i.e. heart rate and BP) when patients perform ADL's because the task requires a lower percentage of functional capacity (McCartney et al., 1993).

Caution must be taken when prescribing PRT to severely osteoporotic patients, with highintensity exercise to be avoided (ACSM, 2010a). In the case of these patients, specialist advice with regard to exercise should be sought.

Despite the apparently beneficial consequences of training during acute flares shown by Van den Ende et al. (2000), we discourage training during flares. Similarly, as healthy individuals should be advised, we also discourage training during illness (e.g. colds, influenza etc), and tell patients to only resume training when health is restored. Upon resumption of training, loads should be adjusted to account for loss of strength due to detraining. Under these circumstances, pre-illness strength levels are usually rapidly regained. To underline the safety of and tolerance to PRT for RA patients, in our high intensity PRT intervention studies (Lemmey et al., 2009; Marcora et al., 2005a), mean compliance to training sessions (i.e. sessions attended as a % of those scheduled) was around 80%. Thus, even when advised to avoid training when unwell, patients training compliance was similar to that expected of healthy individuals.
