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Exercise is valid treatment for patients with heart disease, says top physio

18 October 2008 - 5:35pm

Physiotherapists should prescribe moderate and well-monitored exercise programmes for patients with cardiovascular disease despite the unfounded fear that it can encourage cardiac arrest.

That was the message from eminent physiotherapist Patrick Doherty in a keynote speech to the CSP's Congress today.

Professor Doherty, professor of rehabilitation at York St John University, told the scientific conference attended by around 1,300 delegates, that studies had shown patients were 40 per cent more likely to die after cardiac arrest during their sleep than while exercising. He urged physios to champion exercise as a valid treatment for patients with heart disease.

Cardiologists often say that exercise is unsafe for patients with heart problems because of the risk of arrhythmia (when there is an alteration in the electrical rhythm of the heart), and argue that drugs and rest are the most appropriate forms of treatment.

Treadmill tests 'too extreme'

But Prof Doherty argued that the usual 'brutal' treadmill tests performed on patients are too extreme to give a clear picture of the effect of moderate exercise on a patient's heart. Such tests push patients to their maximum effort, which may well not be good for them, he said. But it gives no indication of the effect of moderate exercise.

Many tests measure the effect on oxygen uptake of exercise, Prof Doherty said, but it is the effect of the haemodynamic demand, or the pressure on the heart, that gives a better idea of potential danger to patients from exercise-related arrhythmia. The pressure on the heart can easily be calculated by multiplying a patient's heart rate by their systolic blood pressure.

Although jogging or similar aerobic exercise increases the patient's oxygen uptake, its pressure on the heart is relatively low. More patients are found dead from washing their car than taking exercise, Prof Doherty said. 

In fact, studies show that there is on average one non-fatal cardiac complication for every 35,000 hours of patient exercise, and one fatal episode for every 110,000 hours of patient exercise, so the risk is very small.

Heart disease patients at risk

Heart disease patients who are at risk from exercise tend to be those who suddenly shift from a sedentary lifestyle to vigorous activity, who don't warm up and cool down properly, and who undertake a form of exercise they are unused to.

Studies show that a patient is at greatest risk of cardiac arrest in the first 45 seconds after stopping abruptly from vigorous exercise, delegates heard.

Both clinicians and physios should champion exercise for patients with cardiovascular disease as long as it is moderate, self-monitored and includes proper warming up and cooling down, Prof Doherty told the conference.

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