Exercise as cardiovascular therapy.

For many years, cardiac physicians were strongly influenced by Thomas Hilton’s “Rest and Pain” and advocated prolonged rest for the majority of their patients. However, the past 3 decades have seen a complete revolution in this thinking, and moderate to vigorous exercise is now prescribed not only for the prevention of ischemic heart disease1 but also as a major component of treatment after myocardial infarction,2 angioplasty and coronary bypass surgery, and heart transplantation3 and in congenital heart disease4 and stable congestive heart failure.5,6 This report defines exercise and physical activity, considering their impact on susceptibility to cardiovascular disease. It also examines the physiological effects of regular exercise, suggesting how exercise-induced changes might improve cardiac performance. It discusses the influence of the type, intensity, frequency, duration, and volume of exercise and their respective contributions to the development of a rational exercise prescription, commenting on problems of sustaining compliance and the potential dangers of excessive exercise. A final section of the article suggests possible avenues for future research.