(Circulation. 1999;99:963-972.)
© 1999 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
Exercise as Cardiovascular Therapy
From the Faculty of Physical Education and Health (R.J.S.) and Department of Public Health Sciences (R.J.S.), University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Centre (R.J.S.), North York, Ontario, Canada; and the Section of Cardiology (G.J.B.), Boston University Medical Center, Boston, Mass.
Correspondence to Prof Roy J. Shephard, MD, PhD, DPE, PO Box 521, Brackendale, BC V0N 1H0 (courier to 41390, Dryden Rd, Brackendale, BC V0N 1H0). E-mail royjshep@mountain-inter.net (Circulation. 1999;99:963-972.)
Key Words: fitness • ischemic heart disease • physical activity • prevention • rehabilitation • risk factors • training
For many years, cardiac physicians were strongly influenced by Thomas Hilton's "Rest and Pain" and advocated prolonged rest for the majority of their patients. However, the past 3 decades have seen a complete revolution in this thinking, and moderate to vigorous exercise is now prescribed not only for the prevention of ischemic heart disease1 but also as a major component of treatment after myocardial infarction,2 angioplasty and coronary bypass surgery, and heart transplantation3 and in congenital heart disease4 and stable congestive heart failure.5 6
This report defines exercise and physical activity, considering their impact on susceptibility to cardiovascular disease. It also examines the physiological effects of regular exercise, suggesting how exercise-induced changes might improve cardiac performance. It discusses the influence of the type, intensity, frequency, duration, and volume of exercise and their respective contributions to the development of a rational exercise prescription, commenting on problems of sustaining compliance and the potential dangers of excessive exercise. A final section of the article suggests possible avenues for future research.
Physical Activity, Exercise, and Fitness
To understand how physical activity and exercise fit into the
model of modern cardiovascular health, it is important
to understand specific terms and concepts. Physical
activity has been defined as any bodily movement produced by
skeletal muscles that results in energy expenditure.
Exercise can be defined as a subset of physical activity
that is planned, structured, repetitive, and purposeful in the sense
that improvement or maintenance of physical fitness is the
objective. Physical fitness includes cardiorespiratory
fitness, muscle strength, body composition, and
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