"If someone could prove to me today," says Dr. Allan Ross, "that the life of a person with heart disease was not prolonged a single day by an exercise program, I would still want my patients to get into condition because they'd be able to do more with what they've got . . . My patients are healthier and happier when they're supervised into condition . . ."
Ross, director of the cardiology division at George Washington University Hospital, says that no matter what you may read or hear, it has not been proven that exercise permits the post-heart attack patient to live longer.
But, he says, "There is unequivocal proof that it will help the patient to live better."
Studies show that patients in exercise programs can improve their ability to consume oxygen and do physical work by as much as 30 percent. "This means," said Ross, "that the body can do more work with less demand on the heart."
George Washington isin the vanguard of cardiac rehabilitation, and its recent participation in a national, federally-financed study to determine the effects of programmed exercise on people who have had heart attacks, has led to a newly strengthened clinical rehabilitation program of its own, as well as a second experimental program dealing with higher-risk heart-disease patients.
Dr. Patrick Gorman, GW's director of cardiac rehabilitation, was the overall chief of GW's role in the National Exercise and Heart Disease Program which initially set out to establish whether or not exercise did have an impact on the longevity of persons with heart disease. The clinical portion of that program ended in May, but it will be some months before the reports from GW and three other universities (University of Alabama, Case Western Reserve and Emory University) on the 600 participants in the program nationwide will be analyzed and published.
Neither Gorman nor Ross expect significant information on the relation of exercise to the life expectancy of the heart patient, mostly because the scope of the national study was cut drastically (for financial reasons) before it ever got started. But in between qualifiers like "too early to say, of course" and "can't know until the final tabulations," there are hints that the results may show some demonstrable link between exercise programs and prevention of new heart attacks.
In any case, as Ross puts it, whatever its relationship to "quantity and duration of life, it certainly betters the quality of life," both physiologically and psychologically. What the national study will do, the physicians hope, is establish an absolute relationship between exercise and reduced risk of new heart attacks, lowered blood pressure, more stable heart rates, ability to resume a normal (probably more sensible) life style and general overall fitness, mental and physical.
And the program left George Washington with a group of eight long distance runners -- with heart-disease histories, of course. These men, ranging in age from 36 to 61, have been meeting three mornings a week since July 1, at 6:30 on the Mall and, with two cardiac health practitioners, run between 3 and 7 miles a session.
The University's new research program is designed to test the efficacy of exercise against psychiatric group counseling and therapy and against a control group with no special program.
Participants -- and the university is actively seeking more -- are men and women between the ages of 30 and 70 who have had a documented heart attack or heart bypass surgery within the past year.Applicants will be screened, stress-tested and randomly assigned to small groups for either supervised exercise conditioning, psychological counseling or to a control group with no special program beyond medical supervision. The program lasts 12 weeks with additional follow-up sessions at periodic intervals.
Dr. Melvin Stern, psychiatrist on the new study and co-chairman of it with Gorman, says that in the study sessions already completed there are already signs that the patients in the exercise study and the patients in the group-therapy study are doing better than patients who receive neither exercise nor psychological therapy.
He conducts the group-therapy sessions, and he cannot conceal the excitement he is feeling about the study so far. In fact, he says that about half the patients actively want to continue sessions after the 12 weeks are up and he finds, somewhat to his own surprise, that this desire is being reflected in his private practice.
While the exercise groups are moving slowly from carefully monitored exercise on wired-for-heartbeat rowing machines, steps, cycle-exercisers, treadmills and arm ergometers, to randomly monitored, less-restrictive exercises, the patients in the psychological counseling group are meeting to talk with each other about their illness, why they think they were subject to heart attacks, the stress in their lives, what has happened since the illness, how they relate to others, how others relate to them or, and this may not be the same, how they perceive others are relating to them.
Over the weeks the patients will explore their body-image problems, depressions, resentments -- all the difficulties of changing their lives. They also will learn deep-muscle relaxation exercises and, possibly most important, that they are not unique.
Something of that sort happens in the camaraderie and chemistry of the exercise groups as well, so that the two programmed groups have certain similarities. The group-therapy patients are encouraged to do some exercising on their own and the exercise group, almost without knowing it, will have some unstructured psychological rap sessions. In a way, each group is getting some benefit from the other.
Persons interested in participating in the study may call 676-3107 or 676-3110 to discuss eligibility and schedule a screening evaluation. The study is being conducted on a federal grant, so there is no charge for participation.