Chest
exercise and the heartSafety of Medically Supervised Outpatient Cardiac Rehabilitation Exercise Therapy: A 16-Year Follow-up
Section snippets
Subjects
The subjects in this study included 3,335 patients who were referred for exercise-based cardiac rehabilitation (phases 2 and 3) during a 16-year period between 1982 and February 13, 1998. Average age was 61.6 ± 11.3 years; men made up approximately 70% of the population. Overall, referrals included MI, coronary bypass, and angioplasty patients, as well as patients with or without residual ischemia, compensated heart failure, cardiomyopathy, and threatening ventricular arrhythmias; patients with
RESULTS
Between 1982 and February 13, 1998, 292,254 patient exercise hours (45,679 phase 2; 246,575 phase 3) were recorded. Overall, 5 major cardiovascular complications (3 nonfatal MIs and 2 cardiac arrests) occurred. These involved 4 men and 1 woman ( ± SD age=58.0 ± 18.3 years) with a history of previous MI, bypass surgery, angioplasty, or combinations thereof (Table 1). Estimated fitness levels ranged from 8 to 15 METs.8 Both patients who experienced cardiac arrest were successfully
DISCUSSION
Pathophysiologic evidence suggests that vigorous physical exertion may evoke transient oxygen deficiency at the subendocardial level that is exacerbated by venous pooling in recovery (Fig 1). Symptomatic or silent myocardial ischemia9 can alter depolarization, repolarization, and conduction velocity, triggering threatening ventricular arrhythmias which may degenerate into ventricular tachycardia or fibrillation. The risk of cardiac arrest during strenuous exercise, compared with that at other
REFERENCES (24)
- et al.
Instantaneous electrocardiography: a simple screening technique for cardiac exercise programs.
Chest
(1989) - et al.
Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease.
Am Heart J
(1973) - et al.
Silent myocardial ischemia as a potential link between lack of premonitoring symptoms and increased risk of cardiac arrest during physical stress.
Am J Cardiol
(1990) - et al.
Exercise: a risk for sudden death in patients with coronary heart disease.
J Am Coll Cardiol
(1986) - et al.
Safety of medically supervised exercise in a cardiac rehabilitation center.
Am J Cardiol
(1996) - et al.
Various intensities of leisure time physical activity in patients with coronary disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions.
J Am Coll Cardiol
(1993) Cardiovascular complications during exercise training of cardiac patients.
Circulation
(1978)- et al.
Cardiovascular complications of outpatient cardiac rehabilitation programs.
JAMA
(1986) American Association of Cardiovascular and Pulmonary Rehabilitation.
Guidelines for cardiac rehabilitation programs.
(1995)- et al.
The effects of training on heart rate: a longitudinal study.
Ann Med Exp Biol Fenn
(1957)
Guidelines for exercise testing and prescription.
Psychophysical bases of perceived exertion.
Med Sci Sports Exerc
Cited by (154)
Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation
2022, American Journal of CardiologyCitation Excerpt :We showed a similar decrease over our study period (78% to 34%). The reason for this decrease is likely multifactorial and may include equipoise in the value of a GXT for CR,10 low event rates in CR,26,27 and a lack of data on the benefits and risks of CR with and without a GXT, respectively. We are aware of just 2 related studies.
Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology
2019, Journal of the American College of CardiologyCitation Excerpt :Exercise training was not associated with the occurrence of implantable cardioverter-defibrillator shock (hazard ratio: 0.9 [95% CI: 0.7–1.2]). Finally, indirect support for the safety of HBCR can be found in studies of CBCR (including both lower- and higher-risk patients) that have reported that serious CVD events occur rarely: ≈1 event per 50,000 patient-hours (62,99). A study by Pavy et al (62) evaluated 25,420 patients undergoing CR at 65 different facilities.
Cardiac Rehabilitation
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and RehabilitationEditorial commentary: Cardiac rehabilitation: Major benefits and minor risks
2017, Trends in Cardiovascular MedicineInterpreting the Impact of Cardiac Rehabilitation Without a "True" Control Group? Proceed with Caution
2023, Journal of Cardiopulmonary Rehabilitation and Prevention
Manuscript received March 20, 1998; accepted March 23, 1998.