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The Moving Crew

Taking Exercise Advice to Heart

Tuesday, August 31, 2004; Page HE03

Given medical advances, it's no wonder that heart disease patients expect doctors to address coronary problems with drugs, medical devices or both. But could it be that exercise -- and exercise alone -- may be the best treatment for some forms of heart disease?

A recent study by doctors in Germany showed just that: Regular exercise in people with stable coronary artery disease resulted in higher event-free survival rates (88 percent) over one year than did treating similar people who had received stents, those little round metal scaffolds that hold arteries open (70 percent).

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The study, published in the March issue of the journal Circulation, enrolled 101 men age 50 to 65. Half did 20 minutes of stationary cycling per day at 70 percent of their maximum heart rate, as adjusted for their heart disease symptoms. (Exceeding that 70 percent level, at least for coronary artery disease patients, could put too much stress on the heart, said study co-author Stephan Gielen, in the Department of Internal Medicine at the University of Leipzig Heart Center.)

The other half of the participants -- those who had received stents -- maintained a sedentary lifestyle throughout the one-year trial period.

Over the course of the study, the exercise group showed stronger increases than the stent group in maximal oxygen intake, or aerobic capacity -- a measure of how well the cardiovascular system transports and uses oxygen in the body. Exercising also proved more cost-effective than stenting: Each exerciser spent an average $3,429 (for treatment, hospital charges, supervised training sessions and other interventions) to achieve clinical gains. That compares to $6,956 spent by the average person in the stent group.

People in the exercise group showed significantly higher levels of HDL (good cholesterol) than those in the stent group; HDL serum levels declined in the stent group. Gielen said the shift in the HDL-to-LDL (bad cholesterol) ratio from exercise -- which has been shown in prior studies -- is clinically relevant and proves "a net reduction in cardiovascular risk" over time.

Prior studies have shown that exercise reduces the mortality rate in heart patients by 31 percent, but Gielen, said this is the first study to directly compare exercise training with medical intervention. Still, the authors recommended exercise therapy only for those patients likely to comply; many patients, Gielen said, will not exercise even if told to by their doctors.

"You need someone who is motivated and able to exercise. Patients come to a high-tech hospital, they expect a high-tech solution. You tell them, 'Go home and exercise,' and they won't believe you."

Gielen also accused doctors of suffering from "ocular-stentosis reflex: They see a lesion and, by reflex, they put in a stent." The authors contend that their outcome would be the same even if investigators had used drug-eluting stents -- which were not available during the 1997-2001 study -- because stenting, like other coronary interventions, only treats a specific part of the coronary system. Exercise, on the other hand, has much wider benefits.

As always, speak to your doctor before taking up any new workout regimen. But don't assume that exercise isn't for you just because you're a heart patient.

Join us for the Moving Crew chat Thursday at 11 a.m. at www.washingtonpost.com/wp-dyn/liveonline/health/movingcrew. Our topic, dovetailing on today's column: "Who Knew?" Fitness Findings.

-- John Briley


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