# Exercise as it relates to Disease/The importance of exercise-based cardiac rehabilitation for coronary heart disease
## What is the background of this research?

The Cardiovascular system (CVS) is an organ system that permits blood to circulate and transport nutrients throughout the body. Issues may arise within this system such as Cardiovascular disease (CVD), which is highly prevalent in America and the leading cause of death and disease burden in Australia.
In particular, Coronary Heart Disease (CHD), the most common form of heart disease in Australia, with the two major forms of the disease being heart attack and angina. The stability in the health system across America & Australia provides a positive correlation between the two in the data gathered.

## Where is the research from?

This research article was published in the Journal of the American College of Cardiology, a peer reviewed medical journal covering aspects of CVD including original clinical studies, copyright and usage of American College of Cardiology Foundation. JACC, Volume 67, Issue 1, January 5th 2016

## What kind of research was this?

The study was conducted to update the Cochrane systematic review and meta-analysis of exercise-based CHD through trial registries and randomized controlled trials.

## What did the research involve?

The research involved a systematic review of randomized controlled trials of which compared exercise-based Cardiac Rehabilitation (CR) with a control adding a follow-up period of at least 6 months. (1). A combined total of 63 studies, 14,486 participants with a median follow-up period of 12 months were targeted. The research involved comparing CR to non-exercise controls following myocardial infarction focusing on angina or CHD. (1) Similarly analysis of patients to exercise-based cardiac rehabilitation or usual care, in the medium to long term reduced overall cardiovascular mortality and hospital omissions Strengths: • Extensive coverage in targeted research • Consistency in CR providing important health benefits that include reductions in CV mortality and hospitalization Weaknesses: • The 12 months follow-up is limited when assessing the effect on mortality and morbidity outcome measures • More targeted focus on recruitment of patients who are more representative of the broader CHD population, higher risk, major comorbidities & stable angina. • Poor level of reporting impacted on the quality of non-bias
An updated systematic review and meta-analysis of exercise based CR in people with existing CHD showed the importance of exercise to the target group.

## What were the basic results?

The combined research portrayed the positive correlation to that of exercise impacting those experiencing CHD. • Overall, CR lead to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). • No significant effect on total mortality or myocardial infarction • Over two thirds of the studies showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects

## What conclusions can we take from this research?

As a whole, the research compiled provides an insight into the effect exercise has through CR and those with CHD, supporting the recommendation of current international clinical guidelines that CR should be offered to CHD patients. Future trials may need to focus on recruitment of patients who are more representative of the broader CHD population which will allow for a more thorough understanding of the effects on those at either ends of the health spectrum (1). Physical activity has significant health benefits and contributes to prevent noncommunicable diseases such as: cardiovascular diseases.

## Practical advice

Early intervention & prevention of potential CVD can limit the effect the disease may have on the body if symptoms are found and appropriately addressed by a GP or trained professionals. The most appropriate means of exercise specific to those with CVD is through Exercise Physiologists who’re trained in formatting targeted physical activity plans for those effected. High levels of physical activity and aerobic capacity are associated with low risk of cardiovascular disease and mortality.

## Further information/resources

* Focuses on the importance of partaking in exercise & availability https://healthengine.com.au/info/physical-activity-with-cardiovascular-disease • An efficient search engine outlining National Department of Health availability https://www1.health.gov.au • Assists in understanding of those more susceptible to CVD https://www.heartresearch.com.au/heart-disease/what-is-heart-disease/

## References

* ↑ Exercise-based Cardiac Rehabilitation for Coronary Heart Disease, Cochrane Systematic Review, Balraj S Heran, 2011 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001800.pub2/abstract
* ↑ World Health Organization (1983) Rehabilitation and Comprehensive Secondary Prevention After Acute Myocardial Infarction: Report on a Study (World Health Organization, Regional Office for Europe, Copenhagen, Denmark)
* ↑ 1. Department of Health, Cardiovascular disease, www1.health.gov.au. 2019, 25 August https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio
* ↑ World Health Organization, Physical Activity, 23 February, 2018 http://www.who.int/mediacentre/factsheets/fs385/en/
* ↑ Cardiovascular Risk of High-Versus Moderate-Intensity Aerobic Exercise in Coronary Heart Disease Patients, Olivind Rognmo, Volume. 126, No. 12, September 18, 2012 https://www.ahajournals.org/doi/full/10.1161/circulationaha.112.123117