Secondary Prevention
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Abstract Cardiac rehabilitation (CR) and exercise prescription in secondary prevention patients is a class I indication in
most clinical guidelines. CR programs not only include exercise
components but also provide comprehensive care and education about cardiovascular risk factors, cigarette smoking, and
behavioral interventions. However, CR programs are scarce or
inexistent in many developing countries; in the United States
and Europe, where they do exist, they are underused.
Keywords Exercise . Cardiac rehabilitation . Secondary
prevention
Introduction
Coronary heart disease (CHD) is the leading cause of death in
both men and women worldwide. Most success in the past
decade has been done in treating modifiable risk factors of
CHD, such as high blood pressure and dyslipidemia.
However, the treatment of those risk factors that depend more
on lifestyle modifications, such as overweight, obesity, and
physical inactivity, has been less successful.
M. Acevedo (*) : V. Kramer : M. J. Bustamante : F. Yaez
Preventive Cardiology and Cardiac Rehabilitation,
Division of Cardiovascular Diseases, Pontificia Universidad
Catlica de Chile, Santiago, Chile,
Lira 85, 1st floor,
Santiago, Chile
e-mail: macevedo@med.puc.cl
V. Kramer
e-mail: vkramer@med.puc.cl
M. J. Bustamante
e-mail: mjbustam@puc.cl
F. Yaez
e-mail: fyanez@med.puc.cl
Exercise Training
Exercise training refers to the physical activity in which
planned, structured, and repetitive body movements are
performed to maintain or improve one or more attributes of
physical fitness [7]. Therefore, it is a structured intervention over a defined period of time. The risk of cardiovascular complications of exercise must be assessed before
initiation of exercise training using standardized methods to
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Resistance Exercise
Resistance training refers to training designed to increase
strength, power, and muscle endurance by lifting weight
[7]
Exercise programs have emphasized dynamic lowerextremity exercise. However, mild to moderate resistance
training can provide an effective method for improving
muscular strength and endurance, preventing and managing
several medical conditions, modifying cardiovascular risk
factors, and enhancing psychosocial well-being. Also, this
type of exercise has demonstrated to attenuate the ratepressure product for any load that is lifted [30]. Strength
training is especially important for the frailest patients who
may have difficulty performing aerobic training because of
leg weakness. CHD patients should perform this training
with caution, and close monitoring of adverse cardiovascular signs and symptoms should be pursued. Unfortunately,
there is a lack of data on resistance exercise training
Conclusions
CR and exercise are key components of secondary
prevention programs in patients with cardiovascular disease.
Physical activity not only confers cardiovascular benefits,
such as the improvement in exercise tolerance, cardiac
symptoms, blood lipids, and reduction in cigarette smoking,
but also promotes a better quality of life. Unfortunately, there
is still a need for more randomized trials to clearly confirm the
role of exercise therapy alone or as part of CR in reducing
cardiac mortality in CHD and heart failure patients. Health
agendas must advocate for CR programs to be included in the
care of all CHD patients.
References
Papers of particular interest, published recently, have been
highlighted as:
Of importance,
Of major importance
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