Exercise prescription and proscription for patients with coronary artery disease.

Exercise training in patients with cardiovascular disease increases exercise capacity,1–3 reduces cardiac ischemia,1,2 delays the onset of or eliminates angina pectoris,4,5 and improves endothelial function.6 Meta-analyses of exercisebased, cardiac rehabilitation studies have suggested that exercise training reduces cardiac mortality in coronary artery disease (CAD) patients.7–10 A recent randomized, controlled comparison of exercise training and angioplasty in selected patients with angina documented fewer cardiac events in the exercise subjects over the year of follow-up.2 Despite these benefits, exercise training is rarely prescribed for cardiac patients, as evidenced by the fact that only 20%11,12 of qualified patients are referred to formal cardiac rehabilitation programs. Referral rates are even lower among women and older patients.13 The reasons for this underutilization are not defined but probably include health professionals’ underestimation of the benefits of exercise, a lack of training in exercise therapeutics among many healthcare providers, poor financial reimbursement, the absence of reimbursed advocates for exercise therapy,13 and the absence of a sufficiently large randomized clinical trial documenting a reduction in cardiac events. This review discusses the benefits of exercise training for patients with atherosclerotic cardiovascular disease.