Physical Exercise in Comprehensive Care

Abstract

The discussion of the subject of physical exercise as a secondary preventive measure may make the impression of being superfluous because such discussions have been held many times before with rather disappointing results. Nonetheless, newer studies have again renewed the interest and deepened the challenge in dealing with this subject. The implementation of Comprehensive Coronary Care (CCC) including multiple measures involving physical, psychological and pharmacological procedures together with a new concept of pharmacological and surgical re-vascularization have caused a remarkable improvement in the management of coronary heart disease.When discussing the role of physical training per sé as one measure of CCC one must observe the fact that a single factor cannot be expected to influence a multi-factorial disease. In my opinion the irrefutable evidence that shows that physical training has an effect on the longevity is lacking and will not be available for many years to come, if at all. On the other hand a number of important physiological and psychological benefits have been found to be accompanying prolonged physical training programme in a selected patient population suffering from coronary heart disease. The effect of training are an improvement of cardio-circulartory performance for given work tasks. This includes a decrease of heart rate, overall physical work performance, oxygen pulse and in some instances the rise of the angina pectoris threshold heart rate and threshold rate-pressure product in patients with angina pectoris.Of late there is additional evidence, mostly in the experimental animal, which show that daily exercise effect beneficially the susceptibility of sudden cardiac death and increases the threshold for ventricular fibrillation. Moreover, nuclear studies have shown that at least, in selected patients physical training may improve the left ventricular systolic performance and increase left ventricular ejection fraction. However, in summarizing the results of a large number of studies concerning the left ventricular performance and large number of studies concerning the left ventricular performance and myocardial perfusion it must be concluded that the outcome is equivocal.Recent analysis of prospective randomized trials concerning physical exercise training as a secondary measure have shown that from 6 studies 5 indicated that there may be a benefit from physical training for post-myocardial infarction patients. Unfortunately all these trials were too short and the sample size too small. This fact together with a number of difficulties concerning drop-out and drop-in rates make it impossible to reach a clear scientific verdict.In my opinion important data is accumulating, especially in the field which was rarely discussed in the past namely, ‘The Importance of Exercise Performance in Patients with Left Ventricular Dysfunction’ and cardiac failure. This information, when available, may add substantially to a more profound knowledge of the benefits and the long term effects of a single procedure in the management of chronic multi-factorial disease.KeywordsMyocardial PerfusionSudden Cardiac DeathCardiac RehabilitationPhysical TrainingTraining EffectThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.