The importance of physical activity in coronary heart disease

Several meta-analyses give evidence that adequate levels of physical activity after cardiac events confer clear health benefits. The responsible mechanisms have to some extent been explored, particularly concerning glucose and fat metabolism. New studies show training-induced positive effects on the vessel wall, esp. on the endothelium. Furthermore, a reduction of endothelial dysfunction and repair mechanisms/angiogenesis by endothelial progenitor cells result. A unique rehabilitation system, the so-called "rehabilitation street" has been established in Germany. After treatment in the acute hospital, the rehabilitation phase II follows either in a rehabilitation clinic or as an out-patient programme. Phase III consists of a rehabilitation programme in ambulatory coronary training groups (AHG) to stabilize the benefit. Data dealing with the effects of AEG are rare. They underline several positive consequences for [oder effects on] the cardiovascular system, but only few on cardiovascular risk factors. Moreover, results are influenced by selection bias. To optimise the multicomponent therapy and due to changing structural circumstances, new concepts have to be developed and tested. Special groups of patients, younger people and women, and those with diabetes mellitus and heart failure should be included. Additional measures focussing on "further education" with emphasis on health behaviour contents and strategies on nutrition, and stress management have to be intensified and optimised. A central register for cardiac patients should be established to document the cost effectiveness and health outcomes comparable to the register for diabetic and obese individuals.