Long-range strenuous sports training for cardiac reconditioning and rehabilitation

Abstract

An organization for the rehabilitation of cardiac patients (most of them afflicted with ischemic heart disease) and for reconditioning of sedentary middle-aged and elderly subjects by means of systematically graded and ultimately strenuous sports training has been conducted in Israel since 1955. After a specific procedure of testing for cardiovascular fitness and work tolerance (“circulatory profile”), the participants are exposed to several months' preparatory period of mild warm-up and strength-building exercises. Within approximately nine months they qualify for systematic training in rhythmic endurance and locomotive sports (hiking, swimming, cycling, rowing, running) and volley-ball. The program culminates in competitive team games for those who have progressed to the upper fitness categories. Physical activity is then continued either within the organization or independently. Of 1,103 trainees with ischemic heart disease who remained under our observation for five years, only 49 have died to date. Nine of these deaths occurred from noncardiac causes. Thus, the mortality rate over five years was only 3.6 per cent compared to 12 per cent in a comparable series of physically inactive postinfarction patients in Israel. The risk of supervised and systematically upgraded vigorous physical effort in middle-aged and elderly patients with cardiac disease has been greatly overrated in the past. Its cardioprotective and rehabilitative value is underscored by today's knowledge concerning myocardial pathophysiology and by the results of epidemiologic studies in various parts of the world.