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September 5, 1986, Vol 256, No. 9 >
ARTICLE | September 5, 1986

Cardiovascular Complications of Outpatient Cardiac Rehabilitation Programs FREE

Steven P. Van Camp, MD; Richard A. Peterson, PhD
[+] Author Affiliations

Reprint requests to the Alvarado Medical Group Inc, 6386 Alvarado Ct, Suite 310, San Diego, CA 92120-4902 (Dr Van Camp).


JAMA. 1986;256(9):1160-1163. doi:10.1001/jama.1986.03380090100025
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References

To determine the incidence of major cardiovascular complications in outpatient cardiac rehabilitation programs, we obtained data from 167 randomly selected cardiac rehabilitation programs via mailed questionnaires and follow-up telephone calls. These 167 programs reported that 51 303 patients exercised 2 351 916 hours from January 1980 through December 1984. Twenty-one cardiac arrests (18 in which the patient was successfully resuscitated and three fatal) and eight nonfatal myocardial infarctions were reported. The incidence rates per million patient hours of exercise were 8.9 for cardiac arrests (one per 111 996 patient-hours), 3.4 for myocardial infarctions (one per 293 990 patient-hours), and 1.3 for fatalities (one per 783 972 patient-hours). There was no statistically significant difference in frequency of these events among programs of varying size or extent of electrocardiographic monitoring. These data indicate that current cardiac rehabilitation practice allows for prescribed supervised exercise by patients with cardiovascular disease to be performed at a low risk of major cardiovascular complications.

(JAMA 1986;256:1160-1163)

REFERENCES

1 +
Oberman A:  Rehabilitation of patients with coronary artery disease , in: Braunwald E (ed): Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1984;, pp 1384-1398.
2 +
Shaw LW:  Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction: National Exercise and Heart Disease Project . Am J Cardiol 1981;;48:39-46.
3 +
Clausen JP:  Circulatory adjustments to dynamic exercise and the effect of physical training in normal subjects and in patients with coronary artery disease . Prog Cardiovasc Dis 1976;;18:459-495.
4 +
Stern MJ, Cleary P:  National Exercise and Heart Disease Project: Psychosocial changes observed during a low-level exercise program . Arch Intern Med 1981;;141:1463-1467.
5 +
Hartung GH, Squires WG, Gotto AM:  Effect of exercise training on plasma high-density lipoprotein cholesterol in coronary disease patients . Am Heart J 1981;;101:181-184.
6 +
Froelicher V, Jensen D, Genter F, et al:  A randomized trial of exercise training in patients with coronary heart disease . JAMA 1984;;252:1291-1297.
7 +
Mead WF, Pyfer HR, Trombold JC, et al:  Successful resuscitation of two near simultaneous cases of cardiac arrest with a review of 15 cases occurring during supervised exercise . Circulation 1976;;53:187-189.
8 +
Fletcher GF, Cantwell JD:  Ventricular fibrillation in a medically supervised cardiac exercise program . JAMA 1977;;238:2627-2629.
9 +
Haskell WL:  Cardiovascular complications during exercise training of cardiac patients . Circulation 1978;;57:920-924.
10 +
Hossack KF, Hartwig R:  Cardiac arrest associated with supervised cardiac rehabilitation . J Cardiac Rehabil 1982;;2:402-408.
11 +
Shephard RJ, Kavanagh T, Tuck J, et al:  Marathon jogging in post-myocardial infarction patients . J Cardiac Rehabil 1983;;3:321-329.
12 +
Thompson PD, Funk EJ, Carleton RA, et al:  Incidence of death during jogging in Rhode Island from 1975 through 1980 . JAMA 1982;;247:2535-2538.
13 +
Siscovick DS, Weiss NS, Fletcher RH, et al:  The incidence of primary cardiac arrest during vigorous exercise . N Engl J Med 1984;;311:874-877.
14 +
Miller RR, Olson HG, Pratt CM, et al:  Efficacy of beta-adrenergic blockade in coronary heart disease: Propranolol in angina pectoris . Clin Pharmacol Ther 1975;;18:598-605.
15 +
Furberg CD, Friedewald WT, Eberlein KA (eds):  Proceedings of the workshop on implications of recent beta-blocker trials for post-myocardial infarction patients . Circulation 1983;;67( (suppl 1) ):1-111.
16 +
Abrams J:  Nitroglycerin and long-acting nitrates . N Engl J Med 1980;;302:1234-1237.
17 +
Krikler DM, Rowland E:  Clinical value of calcium antagonists in treatment of cardiovascular disorders . J Am Coll Cardiol 1983;;1:355-364.
18 +
Gruentzig AR, Senning A, Siegenthaler WE:  Nonoperative dilatation of coronary-artery stenosis: Percutaneous transluminal angioplasty . N Engl J Med 1979;;301:61-68.
19 +
Rentrop P, Blank H, Karsch KR, et al:  Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris . Circulation 1981;;63:307-317.
20 +
European Coronary Surgery Study Group:  Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris . Lancet 1982;;2:1173-1180.
21 +
Takaro T, Peduzzi P, Detre KM, et al:  Survival in subgroups of patients with left main coronary artery disease: Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease . Circulation 1982;;66:14-22.
22 +
Alderman EL, Fisher LD, Litwin P, et al:  Results of coronary artery surgery in patients with poor left ventricular function (CASS) . Circulation 1983;;68:785-795.
23 +
Cantwell JD, Fletcher GF:  Instant electrocardiography: Use in cardiac exercise programs . Circulation 1974;;50:962-966.
24 +
McNeer JF, Margolis JR, Lee KL, et al:  The role of the exercise test in the evaluation of patients for ischemic heart disease . Circulation 1978;;57:64-70.
25 +
Theroux P, Waters DD, Halphen C, et al:  Prognostic value of exercise testing soon after myocardial infarction . N Engl J Med 1979;;301:341-345.
26 +
Pitt B, Kalff V, Rabinovitch MA, et al:  Impact of radionuclide techniques on evaluation of patients with ischemic heart disease . J Am Coll Cardiol 1983;;1:63-72.
27 +
Patterson RE, Horowitz SF, Eng C, et al:  Can noninvasive exercise test criteria identify patients with left main or three-vessel coronary disease after a first myocardial infarction? Am J Cardiol 1983;;51:361-372.
28 +
Erb B, Fletcher GF, Sheffield TL:  Standards for cardiovascular exercise treatment programs . Circulation 1979;;59:1084A-1090A.
29 +
American College of Sports Medicine: Guidelines for Graded Exercise Testing and Exercise Prescription , ed 2. Philadelphia, Lea & Febiger, 1980;.
30 +
Fry G, Berra K: YMCArdiac Therapy: National Council of YMCAs . San Francisco, Carolyn Bean Associates, 1981;.
31 +
 Council on Scientific Affairs: Physician-supervised exercise programs in rehabilitation of patients with coronary heart disease . JAMA 1981;; 245:1463-1466.

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1 +
Oberman A:  Rehabilitation of patients with coronary artery disease , in: Braunwald E (ed): Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1984;, pp 1384-1398.
2 +
Shaw LW:  Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction: National Exercise and Heart Disease Project . Am J Cardiol 1981;;48:39-46.
3 +
Clausen JP:  Circulatory adjustments to dynamic exercise and the effect of physical training in normal subjects and in patients with coronary artery disease . Prog Cardiovasc Dis 1976;;18:459-495.
4 +
Stern MJ, Cleary P:  National Exercise and Heart Disease Project: Psychosocial changes observed during a low-level exercise program . Arch Intern Med 1981;;141:1463-1467.
5 +
Hartung GH, Squires WG, Gotto AM:  Effect of exercise training on plasma high-density lipoprotein cholesterol in coronary disease patients . Am Heart J 1981;;101:181-184.
6 +
Froelicher V, Jensen D, Genter F, et al:  A randomized trial of exercise training in patients with coronary heart disease . JAMA 1984;;252:1291-1297.
7 +
Mead WF, Pyfer HR, Trombold JC, et al:  Successful resuscitation of two near simultaneous cases of cardiac arrest with a review of 15 cases occurring during supervised exercise . Circulation 1976;;53:187-189.
8 +
Fletcher GF, Cantwell JD:  Ventricular fibrillation in a medically supervised cardiac exercise program . JAMA 1977;;238:2627-2629.
9 +
Haskell WL:  Cardiovascular complications during exercise training of cardiac patients . Circulation 1978;;57:920-924.
10 +
Hossack KF, Hartwig R:  Cardiac arrest associated with supervised cardiac rehabilitation . J Cardiac Rehabil 1982;;2:402-408.
11 +
Shephard RJ, Kavanagh T, Tuck J, et al:  Marathon jogging in post-myocardial infarction patients . J Cardiac Rehabil 1983;;3:321-329.
12 +
Thompson PD, Funk EJ, Carleton RA, et al:  Incidence of death during jogging in Rhode Island from 1975 through 1980 . JAMA 1982;;247:2535-2538.
13 +
Siscovick DS, Weiss NS, Fletcher RH, et al:  The incidence of primary cardiac arrest during vigorous exercise . N Engl J Med 1984;;311:874-877.
14 +
Miller RR, Olson HG, Pratt CM, et al:  Efficacy of beta-adrenergic blockade in coronary heart disease: Propranolol in angina pectoris . Clin Pharmacol Ther 1975;;18:598-605.
15 +
Furberg CD, Friedewald WT, Eberlein KA (eds):  Proceedings of the workshop on implications of recent beta-blocker trials for post-myocardial infarction patients . Circulation 1983;;67( (suppl 1) ):1-111.
16 +
Abrams J:  Nitroglycerin and long-acting nitrates . N Engl J Med 1980;;302:1234-1237.
17 +
Krikler DM, Rowland E:  Clinical value of calcium antagonists in treatment of cardiovascular disorders . J Am Coll Cardiol 1983;;1:355-364.
18 +
Gruentzig AR, Senning A, Siegenthaler WE:  Nonoperative dilatation of coronary-artery stenosis: Percutaneous transluminal angioplasty . N Engl J Med 1979;;301:61-68.
19 +
Rentrop P, Blank H, Karsch KR, et al:  Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris . Circulation 1981;;63:307-317.
20 +
European Coronary Surgery Study Group:  Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris . Lancet 1982;;2:1173-1180.
21 +
Takaro T, Peduzzi P, Detre KM, et al:  Survival in subgroups of patients with left main coronary artery disease: Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease . Circulation 1982;;66:14-22.
22 +
Alderman EL, Fisher LD, Litwin P, et al:  Results of coronary artery surgery in patients with poor left ventricular function (CASS) . Circulation 1983;;68:785-795.
23 +
Cantwell JD, Fletcher GF:  Instant electrocardiography: Use in cardiac exercise programs . Circulation 1974;;50:962-966.
24 +
McNeer JF, Margolis JR, Lee KL, et al:  The role of the exercise test in the evaluation of patients for ischemic heart disease . Circulation 1978;;57:64-70.
25 +
Theroux P, Waters DD, Halphen C, et al:  Prognostic value of exercise testing soon after myocardial infarction . N Engl J Med 1979;;301:341-345.
26 +
Pitt B, Kalff V, Rabinovitch MA, et al:  Impact of radionuclide techniques on evaluation of patients with ischemic heart disease . J Am Coll Cardiol 1983;;1:63-72.
27 +
Patterson RE, Horowitz SF, Eng C, et al:  Can noninvasive exercise test criteria identify patients with left main or three-vessel coronary disease after a first myocardial infarction? Am J Cardiol 1983;;51:361-372.
28 +
Erb B, Fletcher GF, Sheffield TL:  Standards for cardiovascular exercise treatment programs . Circulation 1979;;59:1084A-1090A.
29 +
American College of Sports Medicine: Guidelines for Graded Exercise Testing and Exercise Prescription , ed 2. Philadelphia, Lea & Febiger, 1980;.
30 +
Fry G, Berra K: YMCArdiac Therapy: National Council of YMCAs . San Francisco, Carolyn Bean Associates, 1981;.
31 +
 Council on Scientific Affairs: Physician-supervised exercise programs in rehabilitation of patients with coronary heart disease . JAMA 1981;; 245:1463-1466.

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