Cardiac Rehabilitation and Exercise Training in Secondary Coronary Heart Disease Prevention

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Abstract

Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs.

Section snippets

Potential benefits of CRET

Many patients may benefit from formal CRET programs (Table 1). Although, occasionally, some of the details of formal CRET programs are individualized to meet special needs of certain patients, generally, these programs begin as soon as possible after major CHD events and generally last for 12 weeks, consisting of 3 exercise and education classes weekly, for a total of 36 education and exercise sessions. Most of the attention in CRET programs is often directed at the exercise component; however,

Underuse of CRET programs

Despite the extremely beneficial impact of formal CRET on CHD risk factors and major CV morbidity and mortality reviewed above, many studies have documented that most eligible patients are not even referred to these programs, whereas others are not vigorously encouraged to attend CRET.7,9, 10, 11, 12, 13, 14 Therefore, a high percentage of survivors of acute CHD events and acute MI do not attend formal CRET programs. Even among Medicare-eligible patients where CRET services are generally

Risk of ET in CHD

Despite the well-proven effects of ET to reduce major CV events in both epidemiologic as well as in secondary CHD prevention studies, it is also recognized that, during short-term bouts of intense physical exertion, the risk of MI and SCD is transiently increased, which is often emphasized in the lay press.2, 68 However, in an analysis of 1,228 survivors of acute MI, only approximately 5% of cases seem to be triggered by physical exertion.69 Other studies have demonstrated that triggering

Exercise prescription and CHD

In CRET programs, as well as in many clinicians' offices, the prescription of aerobic and resistance exercises is frequently used and involves 4 major factors including mode of physical activity and ET and frequency, duration, and intensity of exercise, which are all summarized in Table 3.2 Although some controversy exists regarding the role of resistance training, this is usually recommended in addition to aerobic exercise and has been shown to be safe and to improve quality of life in our CV

Conclusions

Despite the very marked benefits of formal CRET on exercise capacity, obesity indices, plasma lipids, inflammation, psychological risk factors, as well as other factors including total CV morbidity and mortality, these services continue to be greatly underused in patients with CHD, including those after major CHD events. Through automatic referral and incentive-based systems as well as greater enthusiastic support from both primary and CV clinicians, greater emphasis must be placed on the

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

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