Time to Reevaluate Risk Stratification Guidelines for Medically Supervised Exercise Training in Patients With Coronary Artery Disease

Exercise training is an effective treatment for coronary artery disease. Medically supervised exercise has been demonstrated to halt progression and enhance regression of angiographic stenoses,¹ reduce myocardial stress perfusion defects,² enhance quality of life,³ and reduce mortality.^4- 5 Compared with other currently available therapies for coronary artery disease, the 25% risk reduction observed with exercise is comparable with the 20% achieved with aspirin,⁶ the 20% with β blockers,⁷ and the 15% observed with angiotensin-converting enzyme inhibitors.⁸ Because the studies demonstrating overall mortality reduction were performed prior to the use of thrombolysis and aggressive revascularization therapy, the net additional benefit of supervised exercise in these lower-risk populations is unknown. Nevertheless, based on these and other randomized controlled trial data, the Agency for Health Care Policy and Research Cardiac Rehabilitation Guidelines⁹ call for universal application of medically supervised exercise for the more than 12 million patients with established coronary artery disease.