Avoiding Repeat Cardiac Events: The ABCDESs of Tertiary Prevention

New Vision for Health Promotion within Sports Medicine

Providing medical care for the treatment and prevention of injuries and health problems for competitive or recreational athletes is the most widely recognized role of sports medicine. However, the field is much broader and includes clinical practice and research in many areas related to physical activity in the prevention and treatment of chronic disease. Sports medicine and exercise science involve not only physicians and other licensed health care practitioners but also physiologists, social scientists, epidemiologists, kinesiologists, and other public health and medical professionals. There is overwhelming scientific evidence that a physically active lifestyle is important for optimal health. A key role of sports medicine is to focus the attention of a wide variety of health professionals, educators, and policy makers on developing and implementing strategies to help more individuals enjoy the many health-promoting benefits of regular physical activity.

Effects of a contemporary, exercise-based rehabilitation and cardiovascular risk-reduction program on coronary patients with abnormal baseline risk factors

Phase II cardiac rehabilitation programs are associated with improvements in exercise tolerance, coronary risk factors, and psychosocial well-being. Nevertheless, previous reports have generally evaluated the global effectiveness of these programs (ie, on all subjects, collectively), which may serve to camouflage or attenuate the impact of these interventions on specific patient subsets. In this study, we investigated the effectiveness of a contemporary, exercise-based cardiac rehabilitation program that included a cardiovascular risk-reduction intervention, using a computerized database on 117 patients (average age, 66.5 years; 68% men; 96% white) who completed pre-phase II and post-phase II evaluations. Exercise training involved three 45- to 60-min sessions per week at minimum of 40 to 50% to a maximum of 75% oxygen uptake for 6 to 8 weeks. The effectiveness of the exercise training program was substantiated by significant (p <or= 0.05) reductions in heart rate (- 8 beats/min), systolic BP (- 11 mm Hg), and rating of perceived exertion (- 2, 6 to 20 scale) at a standard submaximal workload. Initial and follow-up ratings of overall health were improved: excellent (2.6 to 4.3%) and very good (20.7 to 35.7%). Average changes (p <or= 0.05 unless otherwise indicated) for all participants and those with abnormal baseline risk factors were as follows: systolic BP (- 4 mm Hg and - 16 mm Hg); diastolic BP (- 5 mm Hg and - 18 mm Hg); total cholesterol (- 19 mg/dL and - 75 mg/dL); low-density lipoprotein cholesterol (- 17 mg/dL and - 61 mg/dL); high-density lipoprotein cholesterol (- 1 mg/dL [not significant] and + 11 mg/dL); and triglycerides (- 5 mg/dL [not significant] and - 82 mg/dL), respectively. The present findings suggest that a positive correlation generally characterizes the change in coronary risk factors subsequent to a contemporary phase II cardiac rehabilitation program. Patients with the worst coronary risk factor profiles at baseline demonstrated the greatest improvements.

Reducing the risk of heart disease and stroke

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, responsible for almost 50% of all deaths. Compelling scientific evidence, including data from recent studies in patients with coronary artery disease (CAD), demonstrates that comprehensive risk factor interventions-including regular physical activity-augment physical work capacity, increase overall survival, improve quality of life, decrease the need for coronary revascularization procedures, and reduce the incidence of subsequent cardiovascular events ((1)). The rationale for this approach extends to patients with other documented atherosclerotic disease, (eg, transient ischemic attack, stroke ((2)), or aortic or peripheral vascular disease) because CAD is a leading cause of death and disability in these patient subsets. Not only do stroke and CAD share common risk factors (eg, hypertension, hypercholesterolemia, and diabetes mellitus), but 32% to 65% of stroke patients have CAD ((3)).