Benefits and risks of physical activity in patients with coronary heart disease

Endurance training after myocardial infarction results in increased fitness and favours regression of coronary arteriosclerosis if the intensity of the training programme results in an expenditure of at least 2200 Kcalories per week. During physical exercise the risk of sudden death is increased, however the net effect of endurance training results in a decreased risk of sudden cardiac death and also of reinfarction. Very intense physical activity may trigger a myocardial infarction and should be avoided by patients with coronary artery disease. Patients with uncomplicated myocardial infarction benefit from a structured exercise programme lasting 6 months or longer. After a large anterior myocardial infarction moderate physical activity does not have an apparent effect on left ventricular size or remodelling. In patients with a low ejection fraction and borderline compensation, physical activity should be delayed until a better degree of cardiac compensation is achieved. The intensity of exercise most be closely supervised to avoid cardiac decompensation. Regular physical activity is an important component of secondary preventive measures in virtually all patients with established coronary artery disease.