UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Exercise assessment and measurement of exercise capacity in patients with coronary heart disease

Authors
Lynne T Braun, PhD, RN, CNP
Robert S Rosenson, MD
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

Epidemiologic studies have shown an inverse association between physical activity and coronary heart disease (CHD) incidence and mortality [1-3]. Fitness also appears to be important, as a graded relation has been noted between the degree of fitness and the reduction in coronary risk (figure 1) [4,5]. Among men with and without cardiovascular disease who were referred for treadmill exercise testing, peak exercise capacity measured in metabolic equivalents (METS) was the strongest predictor of the risk of death, during an average of 6.2 years follow-up [6]. For each 1-MET increase in exercise capacity, there was a 12 percent improvement in survival. Similarly, exercise capacity was shown to be an independent predictor of death in asymptomatic women [5]. (See "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease", section on 'Exercise training'.)

Exercise is also a key component of cardiac rehabilitation following myocardial infarction (MI). (See "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)

The benefits of aerobic exercise are mediated through hemodynamic and metabolic effects [7] (see "The benefits and risks of exercise"):

Aerobic exercise increases physical work capacity, lowers resting and submaximal exercise heart rate, facilitates the loss of excess weight, and reduces blood pressure. Aerobic exercise also increases the dilating capacity of coronary arteries [8], and may promote regression or minimize progression of coronary lesions [9,10]. (See "Exercise in the treatment and prevention of hypertension" and "Coronary artery endothelial dysfunction: Clinical aspects".)

Aerobic exercise improves glycemic control and induces favorable lipoprotein changes (with a reduction in plasma triglycerides and an elevation in HDL-cholesterol being the most consistent changes) [11]. (See "Effects of exercise in adults with diabetes mellitus".)

            

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Oct 12 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Blair SN. Physical activity, fitness, and coronary heart disease. In: Physical Activity, Fitness, and Health, Bouchard C, Shephard RJ, Stephens T (Eds), Human Kinetics Publishers, Champaign 1994.
  2. Paffenbarger RS Jr, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328:538.
  3. Wannamethee SG, Shaper AG, Alberti KG. Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes. Arch Intern Med 2000; 160:2108.
  4. Sandvik L, Erikssen J, Thaulow E, et al. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993; 328:533.
  5. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation 2003; 108:1554.
  6. Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346:793.
  7. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107:3109.
  8. Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 2000; 342:454.
  9. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96:2534.
  10. Hambrecht R, Walther C, Möbius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004; 109:1371.
  11. Couillard C, Després JP, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol 2001; 21:1226.
  12. Henriksson J. Effects of physical training on the metabolism of skeletal muscle. Diabetes Care 1992; 15:1701.
  13. Seki Y, Berggren JR, Houmard JA, Charron MJ. Glucose transporter expression in skeletal muscle of endurance-trained individuals. Med Sci Sports Exerc 2006; 38:1088.
  14. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med 2000; 21:1.
  15. Ogawa T, Spina RJ, Martin WH 3rd, et al. Effects of aging, sex, and physical training on cardiovascular responses to exercise. Circulation 1992; 86:494.
  16. Ades PA, Waldmann ML, Meyer WL, et al. Skeletal muscle and cardiovascular adaptations to exercise conditioning in older coronary patients. Circulation 1996; 94:323.
  17. Arena R, Myers J, Williams MA, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007; 116:329.
  18. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription, Eighth edition, Wolters Kluwer/Lippincott Williams Wilkins, Philadelphia 2010.
  19. Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873.
  20. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106:1883.
  21. Balady GJ, Arena R, Sietsema K, et al. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122:191.
  22. Gulati M, Shaw LJ, Thisted RA, et al. Heart rate response to exercise stress testing in asymptomatic women: the st. James women take heart project. Circulation 2010; 122:130.
  23. Dennis C. Rehabilitation of patients with coronary artery disease. In: Heart Disease: A Textbook of Cardiovascular Medicine, 4, Braunwald E (Ed), Saunder, Philadelphia 1992.
  24. McElroy PA, Janicki JS, Weber KT. Cardiopulmonary exercise testing in congestive heart failure. Am J Cardiol 1988; 62:35A.
  25. American College of Sports Medicine. ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia 2010.
  26. Goodman J. Assessment of exercise capacity and principles of exercise prescription. In: Exercise and the Heart in Health and Disease, Shephard RJ, Miller HS (Eds), Marcel Dekker, New York 1992.
  27. Reddy HK, Weber KT, Janicki JS, McElroy PA. Hemodynamic, ventilatory and metabolic effects of light isometric exercise in patients with chronic heart failure. J Am Coll Cardiol 1988; 12:353.