Are there benefits to wearing a weighted vest with coronary Microvascular Disease (MVD)?

Weighted Vests Are Not Recommended for Patients with Coronary Microvascular Disease

Wearing a weighted vest with coronary microvascular disease (MVD) is not advisable and should be avoided. There is no evidence supporting the use of weighted vests in this population, and such resistance training carries significant cardiovascular risks that outweigh any potential benefits.

Why Weighted Vests Are Contraindicated in MVD

Physiological Concerns Specific to MVD

• Coronary microvascular dysfunction involves impaired regulation of coronary blood flow in response to myocardial oxygen demand, creating a perfusion mismatch that causes myocardial ischemia 1, 2
• Weighted vests increase cardiac workload through both the added external load and the Valsalva maneuvers typically associated with resistance exercise, which can precipitate ischemia in patients with already compromised microvascular perfusion 3
• Patients with CMD face an increased risk of Major Adverse Cardiovascular Events (MACEs), including death, making activities that substantially increase myocardial oxygen demand particularly hazardous 1

Guideline-Based Exercise Restrictions

• Resistance training with weighted vests involves straining and Valsalva-like maneuvers that should be avoided in patients with coronary disease 3
• The American Heart Association recommends that intense exercise should not be explicitly advocated in patients with cardiovascular disease, and activity recommendations must be made in concert with the responsible cardiologist 4
• For patients with coronary disease, aerobic physical activity of at least 150–300 minutes per week of moderate intensity or 75–150 minutes per week of vigorous intensity is recommended—not resistance training with added weight 3

What Exercise IS Recommended for MVD Patients

Safe Exercise Parameters

• Moderate-intensity aerobic exercise (30 minutes at least five times per week) is the cornerstone of exercise therapy for coronary disease patients 3
• Exercise capacity should be assessed before prescribing any exercise program, ideally through graded exercise testing to identify the ischemic threshold 3
• Patients should be able to exercise at 5 METs without angina, excessive dyspnea, ischemic ST-segment changes, or arrhythmia before engaging in more demanding physical activities 3

Structured Exercise Approach

• A multidisciplinary exercise-based cardiac rehabilitation program is recommended to improve cardiovascular risk profile and reduce cardiovascular mortality 3
• Exercise training improves endothelial function, reduces progression of coronary lesions, decreases thrombogenic risk, and enhances collateralization—all beneficial for MVD patients 3
• Walking, cycling, and other forms of rhythmic aerobic activity without added resistance are appropriate 3

Critical Pitfalls to Avoid

• Do not assume that because there is no obstructive epicardial disease on angiography, the patient can engage in unrestricted physical activity—CMD carries significant cardiovascular risk despite non-obstructed epicardial arteries 5
• Avoid high-intensity resistance training, weighted vests, or exercises involving significant Valsalva maneuvers, as these dramatically increase myocardial oxygen demand in patients with impaired coronary flow reserve 3
• Never delay proper risk stratification with exercise testing before prescribing exercise—patients with CMD require functional assessment to determine safe exercise intensity 3
• Do not focus solely on exercise prescription without addressing other cardiovascular risk factors including hypertension, dyslipidemia, diabetes, and smoking cessation, which are critical in CMD management 6, 7

Alternative Beneficial Interventions for MVD

• Mediterranean diet and DASH dietary patterns have proven cardiovascular mortality reduction and should be prioritized 6
• Weight reduction of 5-10% of initial body weight improves multiple cardiovascular risk factors 6
• Endotype-specific pharmacological therapies targeting the underlying mechanisms of CMD (endothelial dysfunction, inflammation) are the mainstay of treatment 1, 8
• Complete tobacco cessation is non-negotiable 6