The role of exercise in rehabilitation after uncomplicated myocardial infarction

Literature is reviewed on the role of exercise in cardiac rehabilitation (CR) for patients after uncomplicated post myocardial infarction (MI). Exercise plays a role in each of the four phases of CR. Meta-analysis demonstrated a 20% reduction in mortality following an exercise programme but no significant reduction in recurrence of MI. Physiological benefits include increased aerobic capacity with reduced exercise heart rate and blood pressure, reduced angina and ST segment depression, increased levels of high density lipoprotein and sometimes increased myocardial contractility. The extent of these changes depends on the amount of exercise undertaken. Depression and anxiety, where diagnosed, may be reduced by exercise although other factors such as group support may contribute. Recent studies report benefits following two to four months exercise starting three to six weeks after MI. Non-exercising controls generally reach a similar stage at one year after MI. The role of exercise in such programmes may be one of encouraging motivation to exercise rather than to achieve significant increases in aerobic capacity. Home exercise programmes, correctly prescribed, are a real possibility for suitable low-risk patients and may facilitate long-term adherence to exercise. Strategies to reduce drop-out from CR and encourage under-represented groups to participate should be formulated.