Rehabilitation of cardiac patients in the twenty-first century: changing paradigms and perceptions.

Rehabilitation of the coronary patient has changed dramatically over the past 40 years. The deleterious effects of prolonged bed rest have prompted the liberalization of activity soon after an acute cardiac event. Exercise-based cardiac rehabilitation has been shown to provide a 20-24% reduction in total and cardiovascular-related mortality. Adjunctive upper body aerobic exercise and mild to moderate resistance training can improve muscular strength and endurance in clinically stable coronary patients and attenuate the cardiovascular demands of occupational and leisure-time activities. Risk stratification has emerged as the centrepiece of strategies aimed at stabilizing or enhancing the clinical status of post-myocardial infarction patients, as well as vocational counselling. Moreover, randomized controlled trials have confirmed the hypothesis that lipid lowering is associated with, and possibly preceded by, plaque stabilization and a reduction in the risk of recurrent cardiac events.

Cardiac demands of heavy snow shoveling.

OBJECTIVE: To assess the physiologic responses to manual (shoveling) vs automated (electric snow thrower) snow removal in healthy, untrained men. DESIGN: Observational, controlled trial. SETTING: A community-based, acute care, teaching-research hospital. PARTICIPANTS: A volunteer sample of 10 apparently healthy untrained men (mean +/- SD age = 32.4 +/- 2.1 years) met all eligibility criteria and completed the study. INTERVENTION: Each subject cleared two 10 +/- 2-cm-high, 15-m-long tracts of heavy, wet snow in the cold (2 degrees C), using self-paced manual and automated methods, in random order, with 10- to 15-minute rest periods between each 10-minute bout of work. MAIN OUTCOME MEASURES: Heart rate, blood pressure, oxygen uptake, and perceived exertion during snow removal were compared with values obtained during maximal arm-ergometer and treadmill tests. RESULTS: Mean heart rate during shoveling was 154 and 173 beats per minute at 2 and 10 minutes, respectively, corresponding to 86% and 97% of maximal heart rate. Relative heart rate (percentage of maximal heart rate) during shoveling was inversely related to aerobic fitness (r = -0.65; P = .05). The highest heart rate and perceived exertion responses during shoveling, arm-ergometer, and treadmill testing were comparable. Systolic blood pressure during snow shoveling (198 +/- 17 mm Hg) was significantly greater (P < .003) than during arm ergometry or automated snow removal and slightly greater than during maximal treadmill testing (181 +/- 25 mm Hg). Oxygen uptake during shoveling was similar to that for arm ergometry (5.7 vs 6.3 metabolic equivalents), but lower than for treadmill testing (9.3 metabolic equivalents). Cardiorespiratory and perceived exertion responses were reduced during automated snow removal. CONCLUSION: Heavy snow shoveling elicits myocardial and aerobic demands that rival maximal treadmill and arm-ergometer testing in sedentary men. These responses may contribute to cardiovascular events reported after heavy snowfalls.

Exercise and fitness.

Exercise testing and prescription appear to play an important role in promoting health maintenance strategies for women. Multistage exercise tolerance testing provides invaluable information in assessing the patient's functional capacity. The diagnostic significance of exercise-induced ST-segment depression is tenuous, however, in women with a low likelihood of heart disease. Research suggests that numerous physiologic mechanisms act to increase fetal tolerance to the circulatory and respiratory challenges of moderate maternal exercise. Moreover, appropriately prescribed endurance exercise programs for women are associated with the same salutary effects as men. Even more encouraging is the fact that these benefits can be attained at moderate levels of exercise--if long-term compliance is maintained.