Page 131 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 131
somatic effects, side effects are possible but rare, and contraindications are physical activity, physical fitness and prevention: role for the working population 129
all acute diseases (Vina et al., 2012). Consequently, exercise prescription for
health has now being introduced in many countries in Europe, North Amer-
ica and Australia /New Zealand. (Zupet et al., 2015; Vina et al., 2012; Löllgen
et al., 2015; www.efsma.eu). It is unanimously recommended that regular aero-
bic exercise is encouraged in patients with heart failure and cardiovascular dis-
ease, esp. CAD, to improve functional capacity and symptoms (Class I, Level
A, Grade: Strong).
Preparticipation examination
In patients, generally pre-participation examination is necessary, including
stress testing and echocardiography if indicated. Spiroergometry as the gold-
en standard improves informations on physical fitness. In patients with CVD,
available data now allow definition of anaerobic exercise training weekly vol-
ume (frequency, intensity, time) similar to that indicated for healthy subjects
(Table 3). This chapter and the following demonstrate the excellent positive ef-
fects of physical activities acting like a drug. Physical activity during rehabil-
itation after acute myocardial infarction reduces risk for death significantly
by about 20 to 30 %. Risk for reinfarction does not change. Most studies con-
firm that physical training is the most important component of rehabilitation
(Class I, level A). In a single randomised controlled trial, which enrolled 100
patients with single vessel coronary artery disease, intensive physical activity
(daily training) had similar or better effect as PCI.
A meta-analysis including mainly middle-aged men, most of whom had
a previous acute myocardial infarction and the rest with a previous CABG or
percutaneous transluminal coronary angioplasty or affected by stable angina
pectoris, showed a 30 % reduction in total cardiovascular mortality for aerobic
exercise training programmes of at least 3-months’ duration. This percentage
increased to 35 % when only deaths from CHD were considered. Insufficient
data were available on to the effects of aerobic exercise training on revascular-
ization rates; moreover, aerobic exercise training did show no effect on the oc-
currence of non-fatal myocardial infarction.
In any case, recent data confirm the existence of an inverse dose–response
relationship between cardiovascular fitness (evaluated by treadmill stress test-
ing) and all-cause mortality in large populations of both male and female car-
diovascular patients with a history of angiographically documented CHD, my-
ocardial infarction, CABG, coronary angioplasty (PCI), chronic heart failure,
peripheral vascular disease, or signs or symptoms suggestive of CHD during
an exercise testing. The results were the same irrespective of use of beta-block-
ing agents. With moderate physical activity, incidence of cardiac arrhythmias
may be reduced as has been shown in one single study. So, these findings are
significant for working persons returning to work after cardiac events such as
myocardial infarction.
all acute diseases (Vina et al., 2012). Consequently, exercise prescription for
health has now being introduced in many countries in Europe, North Amer-
ica and Australia /New Zealand. (Zupet et al., 2015; Vina et al., 2012; Löllgen
et al., 2015; www.efsma.eu). It is unanimously recommended that regular aero-
bic exercise is encouraged in patients with heart failure and cardiovascular dis-
ease, esp. CAD, to improve functional capacity and symptoms (Class I, Level
A, Grade: Strong).
Preparticipation examination
In patients, generally pre-participation examination is necessary, including
stress testing and echocardiography if indicated. Spiroergometry as the gold-
en standard improves informations on physical fitness. In patients with CVD,
available data now allow definition of anaerobic exercise training weekly vol-
ume (frequency, intensity, time) similar to that indicated for healthy subjects
(Table 3). This chapter and the following demonstrate the excellent positive ef-
fects of physical activities acting like a drug. Physical activity during rehabil-
itation after acute myocardial infarction reduces risk for death significantly
by about 20 to 30 %. Risk for reinfarction does not change. Most studies con-
firm that physical training is the most important component of rehabilitation
(Class I, level A). In a single randomised controlled trial, which enrolled 100
patients with single vessel coronary artery disease, intensive physical activity
(daily training) had similar or better effect as PCI.
A meta-analysis including mainly middle-aged men, most of whom had
a previous acute myocardial infarction and the rest with a previous CABG or
percutaneous transluminal coronary angioplasty or affected by stable angina
pectoris, showed a 30 % reduction in total cardiovascular mortality for aerobic
exercise training programmes of at least 3-months’ duration. This percentage
increased to 35 % when only deaths from CHD were considered. Insufficient
data were available on to the effects of aerobic exercise training on revascular-
ization rates; moreover, aerobic exercise training did show no effect on the oc-
currence of non-fatal myocardial infarction.
In any case, recent data confirm the existence of an inverse dose–response
relationship between cardiovascular fitness (evaluated by treadmill stress test-
ing) and all-cause mortality in large populations of both male and female car-
diovascular patients with a history of angiographically documented CHD, my-
ocardial infarction, CABG, coronary angioplasty (PCI), chronic heart failure,
peripheral vascular disease, or signs or symptoms suggestive of CHD during
an exercise testing. The results were the same irrespective of use of beta-block-
ing agents. With moderate physical activity, incidence of cardiac arrhythmias
may be reduced as has been shown in one single study. So, these findings are
significant for working persons returning to work after cardiac events such as
myocardial infarction.
