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

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


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".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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