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Physical activity underutilized for patients with stable ischemic heart disease
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Structured exercise and increased physical activity are underutilized as treatment strategies for patients with stable ischemic heart disease, experts wrote in a viewpoint published in JAMA.
“Exercise is powerful medicine that has a comparable effect as standard medications prescribed for patients with stable ischemic heart disease,” Cardiology Today Editorial Board member Nanette K. Wenger, MD, of the division of cardiology at Emory University School of Medicine and Grady Memorial Hospital and Emory University School of Medicine, said in a phone interview.
Nanette K. Wenger
Wenger, along with William E. Boden, MD, of the Samuel Stratton VA Medical Center and Albany Medical College in New York, and Barry A. Franklin, PhD, of William Beaumont Hospital and Oakland University William Beaumont School of Medicine in Michigan, wrote about the importance of structured exercise and increased physical activity for patients with stable ischemic heart disease, noting that they are undervalued and underutilized by this patient population as a part of the recovery process.
Simple, affordable intervention
“One of the most puzzling aspects of the medical community’s failure to recommend regular exercise for patients with stable ischemic heart disease may be the fundamental simplicity and affordability of this intervention, particularly compared with other widely accepted preventive measures,” Boden, Franklin and Wenger wrote.
Research has shown that exercise is a central and indispensible component of a comprehensive strategy for the primary prevention of CAD. For example, in the COURAGE trial, researchers found no difference in clinical outcomes during a mean 55-month follow-up period in patients with stable ischemic heart disease assigned PCI and optimal medical therapy or those treated with optimal medical therapy and lifestyle modifications.
William E. Boden
Thirty to 60 minutes of moderate-intensity aerobic activity at least 5 days a week, along with complementary resistance training, is a current guideline recommendation for patients with stable ischemic heart disease to modify CV risk factors. “Patients who are limited by angina symptoms may be intimidated by these exercise recommendations,” Boden, Franklin and Wenger wrote. They suggest that modest goals, such as 10 to 15 minutes of exercise two to three times a day initially, may encourage patients to be more receptive to exercise. “Even modest increases in physical activity reduce morbidity and mortality and create an aggregate conditioning effect that improves functional capacity and quality of life.”
Barriers to utilization
Most patients with stable ischemic heart disease who quality for and require exercise training as part of the recovery process are not receiving this therapy because of a lack of awareness by patients, health care professionals and payers. Nonadherence to structured exercise and increased physical activity has been shown to be especially high in cardiac patients, especially women and those who are older, have a lower education level, live in rural areas and do not speak English.
The writers of the viewpoint highlighted the poor prognosis of patients with stable ischemic heart disease who are the least fit (bottom 20%) of the physical activity cohort.
‘Exercise is medicine’
Boden, Franklin and Wenger wrote that the medical community should “embrace this clinically effective and cost-effective strategy as a first-line therapy, thereby enabling patients to realize the health benefits from a lifestyle intervention that must become more mainstream in US medical practice.”
“If the ‘exercise is medicine’ adage is to be applied and optimized, the prescription at present remains underfilled for too many patients with stable ischemic heart disease,” they wrote.
According to Wenger, physicians can refer patients to alternative activities or exercises that can be done at home to help improve adherence. “The key is dual emphasis, patient and family education, and provider education,” she said. – by Deb Dellapena
For more information:
Boden WE. JAMA. 2013;309:143-144.
Disclosure:Boden, Franklin and Wenger report financial ties with Arbor Pharmaceuticals. See the viewpoint for a complete list of their financial disclosures.