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
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Manuscript received March 20, 1998; accepted March 23, 1998.