Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention

Abstract

Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.

Figure 1.

Median changes in high-sensitivity C-reactive protein concentration in control patients with coronary heart disease (CHD) and cardiac rehabilitation patients (data adapted from Milani RV et al).

Figure 2.

Mean concentration of high-sensitivity C-reactive protein before and after cardiac rehabilitation and exercise training in 393 overweight and obese patients with coronary heart disease (CHD) divided by median weight loss (data adapted from Lavie CJ).

Figure 3.

Effect of formal cardiac rehabilitation and exercise training programs on prevalence of adverse psychological stress parameters (depression, anxiety, and hostility) in younger and older patients with coronary heart disease (data adapted from Lavie and Milani).

Figure 4.

Prevalence of depression and subsequent mortality based on changes in peak oxygen consumption ($\stackrel{.}{\mathrm{V}}$O₂) during cardiac rehabilitation and exercise training. *P<0.001 compared with $\stackrel{.}{\mathrm{V}}$O₂ loss (data adapted from Milani and Lavie).