Should someone with Coronary Artery Disease exercise?

Written By: Daniel Kao, AGACNP-BC

The number one cause of mortality in both men and women in the U.S. is heart disease, which accounts for 23.1% of deaths. Much of the patient education we see everywhere around us revolves around the prevention of heart disease through diet, exercise, smoking cessation and medications. Once a patient is diagnosed with heart disease their chances of a cardiac event such as a heart attack goes up exponentially. Coronary Artery Disease (CAD) is a specific disease which falls under the umbrella of cardiovascular diseases.

Atherosclerosis can be simply defined as the build-up of fatty deposits and plaque inside coronary arteries; restricting blood flow which oxygenates the muscles of the heart. As blood flow becomes more and more restricted it may result in symptoms such as chest pain that goes away with rest, shortness of breath, dizziness, nausea or heart palpitations. Ultimately, once the artery becomes occluded the patient will have a heart attack. Once someone develops coronary artery disease and has symptoms, many patients question whether it is safe to exercise again. In fact, not only is exercise alright for patients in early stages of CAD or stable CAD, but it is encouraged. A 2018 study of over 1700 CAD patients evaluated leisure time physical activity and risk for cardiac death over the course of 2 years. They found that patients who did not engage in physical activity still had 4.9-Fold (95% CI 2.4 To 9.8, P <0.001) chance of cardiac death, while those who at least engaged in physical activity but stopped had 2.4-Fold (95% CI 1.3 To 4.5, P <0.01) risk for cardiac death compared to those who irregularly worked out.
The question then becomes what type of rehabilitative exercise is not only safe for CAD patients but the most effective?
One study compared compared 21 patients on a walking treadmill at high intensity (80-90% Of VO2 Peak) to moderate intensity (50-60% of VO2 Peak) at three times a week for 10 weeks. They found that VO2 peak (Aerobic Capacity) increased by 17.9% in the high intensity group compared to the 7.9% moderate intensity group[2].  
Another meta-analysis study using the same end variable of VO2 peak, compared High-Intensity Interval Workouts (HIIT) to Moderate Intensity Continuous Training (MCT). Ten studies with 472 Patients were analyzed. They found that HIIT resulted in increased VO2 Peak more than MCT but the advantages of MCT were that the subjects had increased weight loss and decreased resting heart rate[3]. Although the long term benefits of increase in parameters such as aerobic capacity remains to be seen, the short term benefits provide plenty of reason for an individual to begin a rehabilitative exercise program. The ability to perform daily activities without becoming short of breath or dizzy will dramatically increase the quality of life in a person affected by CAD. Prior to starting any workout regimen or rehabilitative program, especially in persons with CAD, they should see a Physician to be medically cleared.

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Lahtinen, M., Toukola, T., Junttila, M. J., Piira, O., Lepojärvi, S., Kääriäinen, M., . . . Kiviniemi, A. M. (2018). Effect Of Changes In Physical Activity On Risk For Cardiac Death In Patients With Coronary Artery Disease. The American Journal Of Cardiology, 121(2), 143-148.

Doi:10.1016/J.Amjcard.2017.10.002Rognmo, Ø, Hetland, E., Helgerud, J., Hoff, J., & Slørdahl, S. A. (2004). High Intensity Aerobic Interval Exercise Is Superior To Moderate Intensity Exercise For Increasing Aerobic Capacity In Patients With Coronary Artery Disease. European Journal Of Cardiovascular Prevention & Rehabilitation, 11(3), 216-222.

Doi:10.1097/01.Hjr.0000131677.96762.0cLiou, K., Ho, S., & Fildes, J. (2016). High Intensity Interval Versus Moderate Intensity Continuous Training In Patients With Coronary Artery Disease: A Meta-Analysis Of Physiological And Clinical Parameters. Heart Lung Circ., 166-174. Doi:doi: 10.1016/J.Hlc.2015.06.828

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