Regular physical activity results in cardiovascular changes that increase exercise capacity, endurance, and skeletal muscle strength. In so doing, increased levels of physical activity protect from coronary heart disease 1, as confirmed by epidemiological studies of physically active and fit individuals 2, while also reducing symptoms in patients with established cardiovascular disease – reducing mortality and risk factors for comorbid chronic diseases while enhancing cardiovascular fitness and quality of life 3. One study found that among patients having already suffered a heart attack, exercise-based cardiac rehabilitation reduced cardiovascular mortality, reduced the risk of hospital admission, and improved overall health-related quality of life 4,5.
Consistently, further studies have specifically lent support to the ability of physical activity to improve exercise capacity following a number of cardiovascular procedures, from coronary bypass surgery to percutaneous interventions 6. Physical activity is similarly beneficial to patients suffering from heart failure, peripheral arterial disease and claudication.
Given the benefits of physical activity on cardiovascular function in both health and disease, the maintenance of physical activity levels and exercise capacity is a central pillar of cardiac rehabilitation. However, research has suggested that such targeted cardiac rehabilitation has been greatly underused by patients with coronary heart disease. In particular, referral to and participation in exercise rehabilitation is insufficiently frequent among elderly patients, especially women, despite the lack of any significant complications or adverse outcomes. To bridge the gap in participation in physical activity among heart attack rehabilitation patients, such patients need to be strongly encouraged to participate in exercise-based cardiac rehabilitation 1. Furthermore, additional distance technology can also be leveraged to enhance participation in physical activity, having been shown to increase the duration of patient engagement in light physical activity at the beginning of a cardiac rehabilitation program in the first 6 months 7.
Physical activity in the context of heart attack rehabilitation presents with a certain degree of risk. Vigorous physical activity acutely increases the risk of sudden cardiac death and myocardial infarction among individuals with both diagnosed and undiagnosed heart disease 8,9 – therefore, patient-tailored moderate physical activity regimens should be thoughtfully developed. In so doing, increasing the volume of physical activity gradually over time is generally used as a guiding principle to minimize injury risk.
Not only is physical activity key to cardiac rehabilitation following a heart attack, but it also reduces the risk of other chronic diseases, including diabetes, osteoporosis, depression, and cancer. As such, the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine (ACSM) suggest that all individuals engage in 30 minutes or more of moderate intensity physical exercise on most weekdays, if not all 10. Meanwhile, physical activity has yet to be more consistently integrated into cardiac-specific rehabilitation programs. To this end, clinicians should receive thorough education with regard to the importance of physical activity in cardiac rehabilitation programs, while the best behavioral strategies need to be researched and developed in order to ensure consistent and sufficiently intense physical activity among heart attack rehabilitation patients as well as in the context of a healthy, sustainable lifestyle among all patient populations 11.
References
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2. Blair, S. N. & Jackson, A. S. Physical fitness and activity as separate heart disease risk factors: A meta-analysis. Med. Sci. Sports Exerc. (2001). doi:10.1097/00005768-200105000-00013
3. O’Donovan, G. et al. The ABC of physical activity for health: A consensus statement from the British association of sport and exercise sciences. J. Sports Sci. (2010). doi:10.1080/02640411003671212
4. O’Connor, G. T. et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation (1989). doi:10.1161/01.CIR.80.2.234
5. Anderson, L. et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews (2016). doi:10.1002/14651858.CD001800.pub3
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9. Giri, S. et al. Clinical and angiographic characteristics of exertion-related acute myocardial infarction. J. Am. Med. Assoc. (1999). doi:10.1001/jama.282.18.1731
10. Pate, R. R. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA J. Am. Med. Assoc. (1995). doi:10.1001/jama.273.5.402
11. Coull, A. & Pugh, G. Maintaining physical activity following myocardial infarction: a qualitative study. BMC Cardiovasc. Disord. (2021). doi:10.1186/s12872-021-01898-7