Exercise Your Way to a Healthier Heart
People with coronary artery disease (CAD) who regularly exercise may slow heart disease progression and have a better chance of survival than people who receive medical treatment, according to Circulation (2004;109:1371–8).
CAD, the most common form of heart disease, is the leading cause of death among men and women in the United States and Europe. Characterized by a narrowing and hardening of the vessels that supply blood to the heart, CAD reduces the amount of blood and oxygen available to the heart muscle. The disease may result in angina (chest pain caused by inadequate blood supply to the heart), heart attacks, abnormal heart rhythms, and heart failure.
Coronary angioplasty is the most common treatment for people with significant CAD. The procedure involves inserting a small balloon into the affected artery, and then inflating the balloon, in order to widen the blocked area. A wire mesh tube called a stent, may be placed in the widened vessel to help keep the area open. In people with severe CAD, the benefit of angioplasty is well established. However, the use of angioplasty is controversial in people with CAD whose symptoms are brought on only by exercise.
Previous studies have shown that regular physical exercise is associated with slower disease progression and improves exercise tolerance and enhances blood flow to the heart in people with CAD. The current study compared the effect of an exercise program versus coronary angioplasty on symptoms and disease progression in people with CAD. One hundred one men aged 59 to 63 years with CAD and exercise-induced angina took part in the study. The participants were randomly assigned to receive either (1) stent angioplasty or (2) an exercise training program consisting of 20 minutes of exercise per day on a stationary bicycle, plus one 60-minute group exercise session per week, for a period of one year. The following outcomes were measured in both groups: symptoms, exercise capacity (the amount of exercise participants were able to perform before experiencing angina), myocardial perfusion (a measure of how well the heart is supplied with blood), cost of therapy, and frequency of cardiac events. A cardiac event was defined as stroke, heart attack, bypass surgery, angioplasty, worsening angina, or death from a cardiac cause.
Participants in the exercise group had significantly fewer cardiac events than those in the angioplasty group (12% versus 30%, respectively). Of the exercise group participants, 32% had progression of CAD at the end of the year, versus 45% of the participants who received angioplasty. The costs associated with angioplasty were almost two times that of the exercise program during the one-year period. Both groups experienced an improvement in symptoms; however, only the exercise group had a significant increase in exercise capacity and in the amount of oxygen supplied to the heart. In addition, the exercise group participants had a significant increase in the level of HDL cholesterol (“good” cholesterol, which is associated with protection from heart disease).
This study is consistent with others that have shown that the overall rate of cardiovascular events was higher after angioplasty than with more conservative strategies (e.g. drug therapy). The results of this study demonstrate that exercise training may be a good alternative to coronary angioplasty for people with stable CAD.
Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Beauchamp is a co-founder and practicing physician at South County Naturopaths, Inc. in Wakefield, RI. Her emphasis is on women’s health, pediatrics, and detoxification.
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