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March 11, 1988, Vol 259, No. 10 >
ARTICLE | March 11, 1988

The Benefits and Risks of Exercise Training in Patients With Chronic Coronary Artery Disease FREE

Paul D. Thompson, MD
[+] Author Affiliations

This article is one in a series sponsored by the American Heart Association.

Reprint requests to The Miriam Hospital, 164 Summit Ave, Providence, RI 02906 (Dr Thompson).


JAMA. 1988;259(10):1537-1540. doi:10.1001/jama.1988.03720100055038
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Article
References

WILLIAM Heberden, in his Commentaries on the History and Cure of Diseases published in 1802, had "little or nothing to advance..." for the treatment of angina pectoris but did know of one patient "who set himself a task of sawing wood for half an hour every day and was nearly cured."1 Heberden's observation that physical training can nearly cure angina in some patients has been confirmed in recent studies,2-4 and physical training remains one of the most effective methods for improving the functional capacity and psychological well-being of selected patients with coronary artery disease (CAD). This article summarizes the effect of CAD on exercise tolerance and the benefits and risks of exercise training in patients with CAD.

ACUTE CARDIOVASCULAR RESPONSE TO EXERCISE 

Healthy Subjects  A brief review of the normal cardiovascular response to exercise is necessary to understand how CAD alters exercise performance. Functional capacity during dynamic exercise

REFERENCES

1 +
Heberden W:  Commentary on the history and cure of diseases , in Willius FA, Keys TE (eds): Cardiac Classics . St Louis, CV Mosby Co, 1941;, p 224.
2 +
Clausen JP, Trap-Jensen J:  Heart rate and arterial blood pressure during exercise in patients with angina pectoris: Effects of training and of nitroglycerin. Circulation 1976;;53:436-442.
3 +
Hagberg JM, Ehsani AA, Holloszy J:  Effect of 12 months of intense exercise training on stroke volume in patients with coronary artery disease. Circulation 1983;;67:1194-1199.
4 +
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.
5 +
Mitchell JH, Blomqvist G:  Maximal oxygen uptake. NEngl JMed 1971;;284:1018-1022.
6 +
Thompson PD, Dorsey DL:  The heart of the masters athlete , in Sutton JR, Brock RM (eds): Sports Medicine for the Mature Athlete . Indianapolis, Benchmark Press Inc, 1986;, pp 309-318.
7 +
Rowell LB: Human Circulation: Regulation During Physical Stress . New York, Oxford University Press Inc, 1986;, pp 213-286.
8 +
Clausen JP:  Circulatory adjustments to dynamic exercise and effects of physical training in normal subjects and in patients with coronary artery disease , in Sonnenblick EH, Lesch M (eds): Exercise and Heart Disease . New York, Grune & Stratton, 1977;, pp 39-75.
9 +
Amsterdam EA, Hughes JL III, DeMaria AN, et al:  Indirect assessment of myocardial oxygen consumption in the evaluation of mechanisms and therapy of angina pectoris. Am J Cardiol 1974;;33:737-743.
10 +
American College of Sports Medicine: Guidelines for Exercise Testing and Prescription , ed 3. Philadelphia, Lea & Febiger, 1986;.
11 +
Gobel FL, Nordstrom LA, Nelson RR, et al:  The rate pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 1978;;57:549-556.
12 +
Klocke FJ:  Coronary blood flow in man. Prog Cardiovasc Dis 1976;;19:117-166.
13 +
Lazarus B, Cullinane E, Thompson PD:  Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris. Am J Cardiol 1981;;47:1075-1079.
14 +
Vatner SF, Pagani M:  Cardiovascular adjustments to exercise: Hemodynamics and mechanisms. Prog Cardiovasc Dis 1976;;19:91-108.
15 +
Bygdeman S, Wahren J:  Influence of body position on the anginal threshold during leg exercise. Eur J Clin Invest 1974;;4:201-206.
16 +
Yasue H, Omote S, Takizawa A, et al:  Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: Role of exercise-induced coronary arterial spasm. Circulation 1979;;59:938-948.
17 +
Ades PA, Brammell HL, Greenberg JH, et al:  Effect of beta blockade and intrinsic sympathomimetic activity on exercise performance. Am J Cardiol 1984;;54:1337-1341.
18 +
β-Blocker Heart Attack Trial Research Group:  A randomized trial of propranolol in patients with acute myocardial infarction: I. Mortality results. JAMA 1982;;247:1707-1714.
19 +
Choong CYP, Roubin GS, Shen W-F, et al:  Effects of nifedipine on systemic and regional oxygen transport and metabolism at rest and during exercise. Circulation 1985;;71:787-796.
20 +
Detry J-MR, Rousseau M, Vandenbroucke G, et al:  Increased arteriovenous oxygen difference after physical training in coronary heart disease. Circulation 1971;;44:109-118.
21 +
Lewis S, Thompson P, Areskog N-H, et al:  Transfer effects of endurance training to exercise with untrained limbs. Eur J Appl Physiol 1980;;44:25-34.
22 +
Thompson PD, Cullinane E, Lazarus B, et al:  Effect of exercise training on the untrained limb exercise performance of men with angina pectoris. Am J Cardiol 1981;;48:844-850.
23 +
Wilson JR, Martin JL, Ferraro N, et al:  Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation 1983;;68:425-432.
24 +
Ehsani AA, Martin WH III, Heath GW, et al:  Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease. Am J Cardiol 1982;;50:246-254.
25 +
Redwood DR, Rosing DR, Epstein SE:  Circulatory and symptomatic effects of physical training in patients with coronary artery disease and angina pectoris. N Engl J Med 1972;;286:959-965.
26 +
Adams WC, McHenry MM, Bernauer EM:  Long-term physiology adaptations to exercise with special reference to performance and cardiorespiratory function in health and disease. Am J Cardiol 1974;;33:765-775.
27 +
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;;34:764-769.
28 +
Conner JF, LaCamera F, Swanick EJ, et al:  Effects of exercise on coronary collateralization—angiographic studies of six patients in a supervised exercise program. Med Sci Sports Exerc 1976;;8:145-151.
29 +
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.
30 +
Franklin BA, Besseghini I, Golden LH:  Low intensity physical conditioning: Effects on patients with coronary heart disease. Arch Phys Med Rehabil 1978;;59:276-280.
31 +
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;;62:147-150.
32 +
Pollock ML, Wilmore JH, Fox SM III: Health and Fitness Through Physical Activity . New York, John Wiley & Sons Inc, 1978;.
33 +
Oldridge NB, Nagle FJ, Balke B, et al:  Aortocoronary bypass surgery: Effects of surgery and 32 months of physical conditioning on treadmill performance. Arch Phys Med Rehabil 1978;;59:268-275.
34 +
Frick MH, Harjola P-T, Valle M:  Persistent improvement after coronary bypass surgery: Ergometric and angiographic correlations at five years. Circulation 1983;;67:491-496.
35 +
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.
36 +
Nolewajka AJ, Kostuk WJ, Rechnitzer PA, et al:  Exercise and human collateralization: An angiographic and scintigraphic assessment. Circulation 1979;;60:114-121.
37 +
Kennedy CC, Spiekerman RE, Lindsay MI, et al:  One-year graduated exercise program for men with angina pectoris. Mayo Clin Proc 1976;; 51:231-236.
38 +
Bove AA, Dewey JD:  Proximal coronary vasomotor reactivity after exercise training in dogs. Circulation 1985;;71:620-625.
39 +
Conn EH, Williams RS, Wallace AG:  Exercise responses before and after physical conditioning in patients with severely depressed left ventricular function. Am J Cardiol 1982;;49:296-300.
40 +
Pratt CM, Welton DE, Squires WG Jr, et al:  Demonstration of training effect during chronic β-adrenergic blockade in patients with coronary artery disease. Circulation 1981;;64:1125-1129.
41 +
Sable DL, Brammell DL, Sheehan MW, et al:  Attenuation of exercise conditioning by beta-adrenergic blockade. Circulation 1982;;65:679-683.
42 +
Dishman RK:  Medical psychology in exercise and sport. Med Clin North Am 1985;;69:123-143.
43 +
May GS, Eberlein DA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long-term trials. Prog Cardiovasc Dis 1982;;24:331-352.
44 +
Roman O, Gutierrez M, Luksic I, et al:  Cardiac rehabilitation after acute myocardial infarction: Nine-year controlled follow-up study. Cardiology 1983;;70:223-231.
45 +
Lamm G, Denolin H, Dorossiev D, et al:  Rehabilitation and secondary prevention of patients after acute myocardial infarction: WHO collaborative study. Adv Cardiol 1982;;31:107-111.
46 +
Thompson PD:  The cardiovascular risks of cardiac rehabilitation. J Cardiopulmonary Rehabil 1985;;5:321-324.
47 +
Van Camp SP, Peterson RA:  Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 1986;;256:1160-1163.
48 +
Miller NH, Haskell WL, Bera K, et al:  Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulation 1984;;70:645-649.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Heberden W:  Commentary on the history and cure of diseases , in Willius FA, Keys TE (eds): Cardiac Classics . St Louis, CV Mosby Co, 1941;, p 224.
2 +
Clausen JP, Trap-Jensen J:  Heart rate and arterial blood pressure during exercise in patients with angina pectoris: Effects of training and of nitroglycerin. Circulation 1976;;53:436-442.
3 +
Hagberg JM, Ehsani AA, Holloszy J:  Effect of 12 months of intense exercise training on stroke volume in patients with coronary artery disease. Circulation 1983;;67:1194-1199.
4 +
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.
5 +
Mitchell JH, Blomqvist G:  Maximal oxygen uptake. NEngl JMed 1971;;284:1018-1022.
6 +
Thompson PD, Dorsey DL:  The heart of the masters athlete , in Sutton JR, Brock RM (eds): Sports Medicine for the Mature Athlete . Indianapolis, Benchmark Press Inc, 1986;, pp 309-318.
7 +
Rowell LB: Human Circulation: Regulation During Physical Stress . New York, Oxford University Press Inc, 1986;, pp 213-286.
8 +
Clausen JP:  Circulatory adjustments to dynamic exercise and effects of physical training in normal subjects and in patients with coronary artery disease , in Sonnenblick EH, Lesch M (eds): Exercise and Heart Disease . New York, Grune & Stratton, 1977;, pp 39-75.
9 +
Amsterdam EA, Hughes JL III, DeMaria AN, et al:  Indirect assessment of myocardial oxygen consumption in the evaluation of mechanisms and therapy of angina pectoris. Am J Cardiol 1974;;33:737-743.
10 +
American College of Sports Medicine: Guidelines for Exercise Testing and Prescription , ed 3. Philadelphia, Lea & Febiger, 1986;.
11 +
Gobel FL, Nordstrom LA, Nelson RR, et al:  The rate pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 1978;;57:549-556.
12 +
Klocke FJ:  Coronary blood flow in man. Prog Cardiovasc Dis 1976;;19:117-166.
13 +
Lazarus B, Cullinane E, Thompson PD:  Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris. Am J Cardiol 1981;;47:1075-1079.
14 +
Vatner SF, Pagani M:  Cardiovascular adjustments to exercise: Hemodynamics and mechanisms. Prog Cardiovasc Dis 1976;;19:91-108.
15 +
Bygdeman S, Wahren J:  Influence of body position on the anginal threshold during leg exercise. Eur J Clin Invest 1974;;4:201-206.
16 +
Yasue H, Omote S, Takizawa A, et al:  Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: Role of exercise-induced coronary arterial spasm. Circulation 1979;;59:938-948.
17 +
Ades PA, Brammell HL, Greenberg JH, et al:  Effect of beta blockade and intrinsic sympathomimetic activity on exercise performance. Am J Cardiol 1984;;54:1337-1341.
18 +
β-Blocker Heart Attack Trial Research Group:  A randomized trial of propranolol in patients with acute myocardial infarction: I. Mortality results. JAMA 1982;;247:1707-1714.
19 +
Choong CYP, Roubin GS, Shen W-F, et al:  Effects of nifedipine on systemic and regional oxygen transport and metabolism at rest and during exercise. Circulation 1985;;71:787-796.
20 +
Detry J-MR, Rousseau M, Vandenbroucke G, et al:  Increased arteriovenous oxygen difference after physical training in coronary heart disease. Circulation 1971;;44:109-118.
21 +
Lewis S, Thompson P, Areskog N-H, et al:  Transfer effects of endurance training to exercise with untrained limbs. Eur J Appl Physiol 1980;;44:25-34.
22 +
Thompson PD, Cullinane E, Lazarus B, et al:  Effect of exercise training on the untrained limb exercise performance of men with angina pectoris. Am J Cardiol 1981;;48:844-850.
23 +
Wilson JR, Martin JL, Ferraro N, et al:  Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation 1983;;68:425-432.
24 +
Ehsani AA, Martin WH III, Heath GW, et al:  Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease. Am J Cardiol 1982;;50:246-254.
25 +
Redwood DR, Rosing DR, Epstein SE:  Circulatory and symptomatic effects of physical training in patients with coronary artery disease and angina pectoris. N Engl J Med 1972;;286:959-965.
26 +
Adams WC, McHenry MM, Bernauer EM:  Long-term physiology adaptations to exercise with special reference to performance and cardiorespiratory function in health and disease. Am J Cardiol 1974;;33:765-775.
27 +
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;;34:764-769.
28 +
Conner JF, LaCamera F, Swanick EJ, et al:  Effects of exercise on coronary collateralization—angiographic studies of six patients in a supervised exercise program. Med Sci Sports Exerc 1976;;8:145-151.
29 +
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.
30 +
Franklin BA, Besseghini I, Golden LH:  Low intensity physical conditioning: Effects on patients with coronary heart disease. Arch Phys Med Rehabil 1978;;59:276-280.
31 +
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;;62:147-150.
32 +
Pollock ML, Wilmore JH, Fox SM III: Health and Fitness Through Physical Activity . New York, John Wiley & Sons Inc, 1978;.
33 +
Oldridge NB, Nagle FJ, Balke B, et al:  Aortocoronary bypass surgery: Effects of surgery and 32 months of physical conditioning on treadmill performance. Arch Phys Med Rehabil 1978;;59:268-275.
34 +
Frick MH, Harjola P-T, Valle M:  Persistent improvement after coronary bypass surgery: Ergometric and angiographic correlations at five years. Circulation 1983;;67:491-496.
35 +
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.
36 +
Nolewajka AJ, Kostuk WJ, Rechnitzer PA, et al:  Exercise and human collateralization: An angiographic and scintigraphic assessment. Circulation 1979;;60:114-121.
37 +
Kennedy CC, Spiekerman RE, Lindsay MI, et al:  One-year graduated exercise program for men with angina pectoris. Mayo Clin Proc 1976;; 51:231-236.
38 +
Bove AA, Dewey JD:  Proximal coronary vasomotor reactivity after exercise training in dogs. Circulation 1985;;71:620-625.
39 +
Conn EH, Williams RS, Wallace AG:  Exercise responses before and after physical conditioning in patients with severely depressed left ventricular function. Am J Cardiol 1982;;49:296-300.
40 +
Pratt CM, Welton DE, Squires WG Jr, et al:  Demonstration of training effect during chronic β-adrenergic blockade in patients with coronary artery disease. Circulation 1981;;64:1125-1129.
41 +
Sable DL, Brammell DL, Sheehan MW, et al:  Attenuation of exercise conditioning by beta-adrenergic blockade. Circulation 1982;;65:679-683.
42 +
Dishman RK:  Medical psychology in exercise and sport. Med Clin North Am 1985;;69:123-143.
43 +
May GS, Eberlein DA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long-term trials. Prog Cardiovasc Dis 1982;;24:331-352.
44 +
Roman O, Gutierrez M, Luksic I, et al:  Cardiac rehabilitation after acute myocardial infarction: Nine-year controlled follow-up study. Cardiology 1983;;70:223-231.
45 +
Lamm G, Denolin H, Dorossiev D, et al:  Rehabilitation and secondary prevention of patients after acute myocardial infarction: WHO collaborative study. Adv Cardiol 1982;;31:107-111.
46 +
Thompson PD:  The cardiovascular risks of cardiac rehabilitation. J Cardiopulmonary Rehabil 1985;;5:321-324.
47 +
Van Camp SP, Peterson RA:  Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 1986;;256:1160-1163.
48 +
Miller NH, Haskell WL, Bera K, et al:  Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulation 1984;;70:645-649.

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