PHYSICAL-ACTIVITY IN THE CARDIAC PATIENT

It is well established that a sedentary lifestyle is a risk factor for coronary heart disease. Regular physical activity has a proven beneficial effect in the general population, reducing, in particular, the risk of myocardial infarction. In patients who have had a myocardial infarction, long-term physical exercise at a sufficiently intense level has a beneficial effect on morbidity and mortality. Although there is no statistical proof, it appears that this effect is accompanied by a slight increase in the risk for nonfatal myocardial infarction. The effects of physical activity on other heart diseases are not well known. The mechanisms by which physical exercise exerts its protective effect are not yet well established. Among the proposed hypotheses are the effect on peripheral muscle of physical training, the reduction of myocardial ischemia, and modifications of the adrenergic response to effort and stress. Moreover, physical training has a favorable effect on certain risk factors for coronary heart disease (e.g., lipids profile, arterial hypertension, smoking). The risks involved with physical training in cardiac patients can be evaluated from the data collected from rehabilitation programs. These risks are very slight, provided that the patients are carefully selected.