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Abstract: Training to Momentary Muscular Failure Improves Cardiovascular Fitness in Humans: A Review of Acute Physiological Responses and Chronic Physiological Adaptations. JEPonline 2012;15(3):53- 80. Research demonstrates resistance training produces significant improvement in cardiovascular fitness (VO2 max, economy of movement). To date no review article has considered the underlying physiological mechanisms that might support such improvements. This article is a comprehensive, systematic narrative review of the literature surrounding the area of resistance training, cardiovascular fitness and the acute responses and chronic adaptations it produces. The primary concern with existing research is the lack of clarity and inappropriate quantification of resistance training intensity. Thus, an important consideration of this review is the effect of intensity. The acute metabolic and molecular responses to resistance training to momentary muscular failure do not differ from that of traditional endurance training. Myocardial function appears to be maintained, perhaps enhanced, in acute response to high intensity resistance training, and contraction intensity appears to mediate the acute vascular response to resistance training. The results of chronic physiological adaptations demonstrate that resistance training to momentary muscular failure produces a number of physiological adaptations, which may facilitate the observed improvements in cardiovascular fitness. The adaptations may include an increase in mitochondrial enzymes, mitochondrial proliferation, phenotypic conversion from type IIx towards type IIa muscle fibers, and vascular remodeling (including capillarization). Resistance training to momentary muscular failure causes sufficient acute stimuli to produce chronic physiological adaptations that enhance cardiovascular fitness. This review appears to be the first to present this conclusion and, therefore, it may help stimulate a changing paradigm addressing the misnomer of ‘cardiovascular’ exercise as being determined by modality.