More evidence for the benefit of exercise in cardiovascular disease -- and even in heart failure

Exercise is one of eight preventive measures identified by the European Heart Health Charter and features prominently in the scientific programme of EuroPRevent 2009, the congress of the European Association of Cardiovascular Prevention and Rehabilitation.1 EuroPRevent 2009 takes place in Stockholm, Sweden, on 6-9 May. In new studies presented at the congress exercise is shown to improve markers of heart disease in patients following coronary artery bypass surgery (CABG), to improve event-free survival rate in coronary patients better than stent angioplasty, and to improve markers of disease in heart failure patients, a group usually thought amenable to little more than palliative care.

1. In rehabilitation following CABG

A study performed by Dr Tomasz Mikulski and colleagues from the Medical Research Centre in Warsaw, Poland, found that aerobic training using a cycloergometer (a static bike whose pedal load can be set and user performance measured) improved the physical capacity of cardiac patients following CABG, with reduction in the levels of lipids and markers of inflammation. Sixty optimally treated patients, with a mean age of 56 years and an average of two months following heart surgery, were randomised to either six weeks of aerobic training three times per week on the cycloergometer or to a non-exercise control group. At the end of the study period only the exercise group showed improvement in exercise duration and maximum workload. Other measures taken during a stationary handgrip test – heart rate, blood pressure and stroke volume – were all improved in the exercise group, as were some metabolic markers such as LDL cholesterol.

2. In comparison to PCI in patients with stable coronary disease

Percutaneous coronary intervention (PCI) with balloon angioplasty and stent is now the gold standard of care in most types of acute coronary events (heart attack).

But its role in stable coronary disease – such as angina – is less clear, and in such cases regular physical exercise training has been shown to improve work capacity, cardiac function, and event-free one-year survival. A pilot study, to be reported from Leipzig, Germany, has now compared event-free survival rate in 101 stable angina patients either treated "conservatively" with an exercise programme or with PCI. After five years of follow-up, results from this pilot randomised trial showed that daily exercise training as part of "optimal medical treatment" leads to a better event-free survival rate than PCI with stent angioplasty. In the "conservative" exercise group, 63% of patients met the event-free survival criteria, but only 40% in the PCI group. Within the five years of follow-up, 36 cardiovascular events (including heart attack, stroke and death) had occurred in the exercise group in comparison to 55 in the PCI group.

3. In heart failure