ABSTRACT

Exercise training, increased lifestyle physical activity, or both, have been reported in numerous randomized controlled trials and meta-analyses to reduce the overall morbidity and mortality associated with atherosclerotic coronary artery disease (CAD). For patients with atherosclerotic CAD, each 1-MET increase in exercise capacity is associated with a 15% reduction in cardiovascular mortality, which compares favorably with the survival benefit conferred by commonly prescribed cardioprotective medications after acute myocardial infarction. The patient at greatest risk for an exercise-related acute cardiac event is likely a habitually sedentary individual who performs unaccustomed vigorous physical exertion, often with simultaneous superimposed environmental and/or hyperadrenergic stressors. Acute cardiac events can be triggered by vigorous-to-high intensity physical activity; it appears that the relative risk of acute myocardial infarction and sudden cardiac death decreases with increasing frequencies of regular strenuous exercise. Structured exercise after an acute cardiovascular event is often prescribed as an integral component of a comprehensive secondary prevention program in outpatient cardiac rehabilitation.