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September 14, 1984, Vol 252, No. 10 >
ARTICLE | September 14, 1984

A Randomized Trial of Exercise Training in Patients With Coronary Heart Disease FREE

Victor Froelicher, MD; David Jensen, MS; Fredric Genter, PhD; Michael Sullivan, MA; M. Dan McKirnan, PhD; Kathryn Witztum, MD; Julie Scharf; Mary Lou Strong, MA; William Ashburn, MD
[+] Author Affiliations

Reprint requests to Long Beach VA Medical Center (111 C), Cardiology Section Chief, 5901 E Seventh St, Long Beach, CA 90822 (Dr Froelicher).


JAMA. 1984;252(10):1291-1297. doi:10.1001/jama.1984.03350100021023
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References

In order to determine whether or not regular exercise could alter myocardial perfusion or function, we randomized 146 male volunteers with stable coronary heart disease to either a supervised exercise program (n=72) or to a usual care program (n=74). Subjects underwent exercise tests initially and one year later. Significant differences between the two groups included improved aerobic capacity, thallium ischemia scores, and ventricular function in the exercise intervention group. It was not possible to classify the conditions of patients as to the likelihood of improvement or deterioration. This study demonstrated changes in myocardial perfusion and function in a select group of middle-aged men with coronary heart disease who underwent a medically appropriate exercise program lasting one year, but these changes were relatively modest.

(JAMA 1984;252:1291-1297)

REFERENCES

1 +
Froelicher VF: Exercise Testing and Training . Chicago, Year Book Medical Publishers Inc, 1983;.
2 +
Scheuer J:  Effects of physical training on myocardial vascularity and perfusion . Circulation 1982;;66:491-495.
3 +
Claussen J:  Circulatory adjustment to dynamic exercise and effect of physical training in heart disease , in Sonnenblick E, Lesch M (eds): Exercise and Heart Diseases . New York, Grune & Stratton Inc, 1977;, p 39.
4 +
Sim DN, Neill WA:  Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning . J Clin Invest 1974;;54:763-770.
5 +
Mock M:  Summary statement , in Mock M, Cohn L, Rinquist I, et al (eds): Physical Conditioning and Cardiovascular Rehabilitation . New York, John Wiley & Sons Inc, 1981;.
6 +
Shaw L:  Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction . Am J Cardiol 1981;;48:39-46.
7 +
Rechnitzer PA, Cunningham DA, Andrew GM, et al:  Relation of exercise to the recurrence rate of myocardial infarction in men . Am J Cardiol 1983;;51:65-69.
8 +
Wolthius RA, Froelicher VF, Fischer J, et al:  New practical treadmill protocol for clinical use . Am J Cardiol 1977;;39:697-706.
9 +
Borg GAV: Physical Performance and Perceived Exertion . Lund, Sweden, CWK Gleerup Publishers, 1962;.
10 +
Bhargava V, Watanabe K, Froelicher VF:  Progress in computer analysis of the exercise electrocardiogram . Am J Cardiol 1981;;47:1143-1151.
11 +
Atwood JE, Jensen D, Froelicher VF, et al:  Agreement in human interpretation of analog thallium myocardial perfusion images . Circulation 1981;;64:601-609.
12 +
Pfisterer T, Battler A, Swanson SM, et al:  Reproducibility of ejection-fraction determinations by equilibrium radionuclide angiography in response to supine bicycle exercise: Concise communication . J Nucl Med 1979;;20:491-503.
13 +
Slutsky R, Karliner J, Ricci D, et al:  Left ventricular volumes by gated equilibrium radionuclide angiography: A new method . Circulation 1979;;60:556-563.
14 +
Bloor CM, White FC, Sanders TM:  Effects of exercise on collateral development in myocardial ischemia in pigs . J Appl Physiol 1984;; 56:656-665.
15 +
Ferguson RJ, Petitclerc R, Choquette G, et al:  Effect of physical training on treadmill exercise capacity, collateral circulation and progression of coronary disease . Am J Cardiol 1974;;34:764-772.
16 +
Nolewajka AJ, Kostuk WJ, Rechnitzer PA, et al:  Exercise and human collateralization: An angiographic and scintigraphic assessment . Circulation 1979;;60:114-122.
17 +
Scholl JM, Chairman BR, David PR, et al:  Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty . Circulation 1982;;66:380-389.
18 +
Berger BC, Watson DD, Barwell LR, et al:  Redistribution of thallium at rest and in patients with stable and unstable angina and the effect of coronary artery bypass surgery . Circulation 1979;;60:1125-1132.
19 +
Kent KM, Borer JS, Green MV, et al:  Effects of coronary-artery bypass on global and regional left ventricular function during exercise . N Engl J Med 1978;;298:1434-1442.
20 +
Verani MS, Hartung GH, Hoepfel-Harris J, et al:  Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease . Am J Cardiol 1981;;47:797-805.
21 +
Cobb FR, Williams RS, McEwan P, et al:  Effects of exercise training on ventricular function in patients with recent myocardial infarction . Circulation 1982;;66:100-111.
22 +
DeBusk RF, Hung J:  Exercise conditioning soon after myocardial infarction: Effects on myocardial perfusion and ventricular function . Ann NY Acad Sci 1982;;382:343-351.
23 +
Jensen D, Atwood JE, Froelicher V, et al:  Improvement in ventricular function during exercise studied with radionuclude ventriculography after cardiac rehabilitation . Am J Cardiol 1980;;46:770-778.
24 +
Froelicher V, Jensen D, Atwood JE, et al:  Cardiac rehabilitation: Evidence for improvement in myocardial perfusion and function . Arch Phys Med Rehabil 1980;;61:5117-5122.
25 +
Hartung GH, Rangel R:  Exercise training in post-myocardial infarction patients: Comparison of results with high risk coronary and post-bypass patients . Arch Phys Med Rehabil 1981;;62:147-153.
26 +
Paterson DH, Shephard RJ, Cunningham D, et al:  Effects of physical training on cardiovascular function following myocardial infarction . J Appl Physiol 1979;;47:482-489.
27 +
Hagberg JM, Ehsani AA, Holloszy JO:  Effect of 12 months of intense exercise training on stroke volume in patients with coronary artery disease . Circulation 1983;;67:1194-1201.
28 +
Hossack KF, Hartwick R:  Cardiac arrest associated with supervised cardiac rehabilitation . J Cardiac Rehab 1982;;2:402-410.

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1 +
Froelicher VF: Exercise Testing and Training . Chicago, Year Book Medical Publishers Inc, 1983;.
2 +
Scheuer J:  Effects of physical training on myocardial vascularity and perfusion . Circulation 1982;;66:491-495.
3 +
Claussen J:  Circulatory adjustment to dynamic exercise and effect of physical training in heart disease , in Sonnenblick E, Lesch M (eds): Exercise and Heart Diseases . New York, Grune & Stratton Inc, 1977;, p 39.
4 +
Sim DN, Neill WA:  Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning . J Clin Invest 1974;;54:763-770.
5 +
Mock M:  Summary statement , in Mock M, Cohn L, Rinquist I, et al (eds): Physical Conditioning and Cardiovascular Rehabilitation . New York, John Wiley & Sons Inc, 1981;.
6 +
Shaw L:  Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction . Am J Cardiol 1981;;48:39-46.
7 +
Rechnitzer PA, Cunningham DA, Andrew GM, et al:  Relation of exercise to the recurrence rate of myocardial infarction in men . Am J Cardiol 1983;;51:65-69.
8 +
Wolthius RA, Froelicher VF, Fischer J, et al:  New practical treadmill protocol for clinical use . Am J Cardiol 1977;;39:697-706.
9 +
Borg GAV: Physical Performance and Perceived Exertion . Lund, Sweden, CWK Gleerup Publishers, 1962;.
10 +
Bhargava V, Watanabe K, Froelicher VF:  Progress in computer analysis of the exercise electrocardiogram . Am J Cardiol 1981;;47:1143-1151.
11 +
Atwood JE, Jensen D, Froelicher VF, et al:  Agreement in human interpretation of analog thallium myocardial perfusion images . Circulation 1981;;64:601-609.
12 +
Pfisterer T, Battler A, Swanson SM, et al:  Reproducibility of ejection-fraction determinations by equilibrium radionuclide angiography in response to supine bicycle exercise: Concise communication . J Nucl Med 1979;;20:491-503.
13 +
Slutsky R, Karliner J, Ricci D, et al:  Left ventricular volumes by gated equilibrium radionuclide angiography: A new method . Circulation 1979;;60:556-563.
14 +
Bloor CM, White FC, Sanders TM:  Effects of exercise on collateral development in myocardial ischemia in pigs . J Appl Physiol 1984;; 56:656-665.
15 +
Ferguson RJ, Petitclerc R, Choquette G, et al:  Effect of physical training on treadmill exercise capacity, collateral circulation and progression of coronary disease . Am J Cardiol 1974;;34:764-772.
16 +
Nolewajka AJ, Kostuk WJ, Rechnitzer PA, et al:  Exercise and human collateralization: An angiographic and scintigraphic assessment . Circulation 1979;;60:114-122.
17 +
Scholl JM, Chairman BR, David PR, et al:  Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty . Circulation 1982;;66:380-389.
18 +
Berger BC, Watson DD, Barwell LR, et al:  Redistribution of thallium at rest and in patients with stable and unstable angina and the effect of coronary artery bypass surgery . Circulation 1979;;60:1125-1132.
19 +
Kent KM, Borer JS, Green MV, et al:  Effects of coronary-artery bypass on global and regional left ventricular function during exercise . N Engl J Med 1978;;298:1434-1442.
20 +
Verani MS, Hartung GH, Hoepfel-Harris J, et al:  Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease . Am J Cardiol 1981;;47:797-805.
21 +
Cobb FR, Williams RS, McEwan P, et al:  Effects of exercise training on ventricular function in patients with recent myocardial infarction . Circulation 1982;;66:100-111.
22 +
DeBusk RF, Hung J:  Exercise conditioning soon after myocardial infarction: Effects on myocardial perfusion and ventricular function . Ann NY Acad Sci 1982;;382:343-351.
23 +
Jensen D, Atwood JE, Froelicher V, et al:  Improvement in ventricular function during exercise studied with radionuclude ventriculography after cardiac rehabilitation . Am J Cardiol 1980;;46:770-778.
24 +
Froelicher V, Jensen D, Atwood JE, et al:  Cardiac rehabilitation: Evidence for improvement in myocardial perfusion and function . Arch Phys Med Rehabil 1980;;61:5117-5122.
25 +
Hartung GH, Rangel R:  Exercise training in post-myocardial infarction patients: Comparison of results with high risk coronary and post-bypass patients . Arch Phys Med Rehabil 1981;;62:147-153.
26 +
Paterson DH, Shephard RJ, Cunningham D, et al:  Effects of physical training on cardiovascular function following myocardial infarction . J Appl Physiol 1979;;47:482-489.
27 +
Hagberg JM, Ehsani AA, Holloszy JO:  Effect of 12 months of intense exercise training on stroke volume in patients with coronary artery disease . Circulation 1983;;67:1194-1201.
28 +
Hossack KF, Hartwick R:  Cardiac arrest associated with supervised cardiac rehabilitation . J Cardiac Rehab 1982;;2:402-410.

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