Medical complications of exercise training

The evidence of the physiological and psychosocial benefits of habitual exercise in people with CHD is substantial (Pate, et al., 1995; USA Department of Health and Human Services, 1996; Jolliffe, et al., 2004; Leon, et al., 2005) (see Chapter 1). It should be acknowledged that the incidence of cardiovascular complications during exercise is greater amongst persons with CHD than in the general population (Haskell, 1978; VanCamp and Peterson, 1986). Given that more patients at increased risk are now offered CR (Richardson, et al., 2000), it is essential to demonstrate that for appropriately assessed and managed cardiac patients exercise training can be relatively safe (Franklin, et al., 1998). A review of the literature questioning whether the overall benefits of regular exercise outweigh the risk of CV incident concludes, 'The overall absolute risk of cardiovascular complication during exercise is low, especially when weighed against the associated health benefits.'

However, there are sometimes medical complications.

Incidence of CV Complications During CR Exercise Training

Early surveys of cardiovascular complications by VanCamp and Peterson (1986) revealed an incidence of one cardiac arrest per 111996 patient hours of exercise, 1 MI per 293 990 patient hours and 1 fatality per 783 972 patient hours. It should be noted that these data pre-date the use of revascularisation procedures, improved screening and aggressive contemporary treatment of CHD. More recent studies suggest that the incidence of serious adverse events is low, a USA study citing only four major complications over a nine-year period (one non-fatal MI and three cardiac arrests), resulting in a rate of one complication per 67126 patient hours of exercise (Vongvanich, et al., 1996). Franklin et al. (1998) also report an average incidence of one cardiac arrest per 117000 patient hours, one non-fatal MI per 220000 patient hours and one death per 750000 patient hours of participation. These studies confirm the safety of CR exercise programmes as there are very low mortality and infarction rates during structured exercise.

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