Better Late Than Never: Exercise as Primary and Secondary Prevention in CVD

Exercise as Secondary Prevention

When considering exercise for secondary prevention in patients with established CVD, the American College of Cardiology and American Heart Association (ACC/AHA) offer guidelines based on cardiac history. Evidence points to improved quality of life and cardiopulmonary fitness with the addition of resistance exercise. However, the guidelines include a recommendation for a risk assessment possibly including an exercise test to guide the exercise prescription (Class IB recommendation).

A Cochrane review of nearly 50 clinical trials that evaluated the benefits of cardiac rehabilitation for patients with coronary heart disease demonstrated a reduction in CVD (relative risk [RR]: 0.74; 95% CI: 0.63-0.87) and all-cause mortality (RR: 0.87; 95% CI: 0.75-0.99) after 1 year of follow-up.1,2  Likewise, a meta-analysis of trials involving post-myocardial infarction patients found lower CVD mortality (OR: 0.61; 95% CI: 0.40-0.91),1,3 all-cause mortality (OR:  0.75; 95% CI: 0.58-0.95), and reinfarction (OR: 0.54; 95% CI: 0.38-0.76) in those with rehabilitation with exercise.1,3  

With respect to patients with a history of systolic heart failure, another Cochrane review found exercise and cardiac rehabilitation were associated with reductions in heart failure-related hospitalization (RR: 0.61; 95% CI: 0.46-0.80) and all-cause mortality (RR: 0.75; 95% CI: 0.62-0.92) with improvements in quality of life.1,4 

Dr Shah added, “Large studies have suggested that exercise training may benefit individuals with heart failure, specifically in terms of preventing hospitalizations. The mechanisms of benefit for exercise in heart failure remain under intense investigation, and recent studies suggest that comprehensive diet and exercise programs may benefit exercise capacity in individuals with specific types of heart failure. Again, before any individual with heart failure embarks on an exercise program, an in-depth discussion with his/her cardiologist about the risks and benefits of exercise is critical to ensure safety.”

Risks associated with modern cardiac rehabilitation have been estimated at 1 death per 752 365 patient-hours and 1 cardiac arrest per 116 906 patient-hours. However, these data were obtained from supervised patients who could be monitored for symptoms and initiated for resuscitation.1