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Exercise Helps Some Hearts More Than Surgery

Regular Exercise May Improved Survival Better Than Stenting

WebMD Health News

March 8, 2004 -- As little as 20 minutes a day on an exercise bike may help keep people with clogged arteries out of the operating room and free from chest pain.

A new study shows regular exercise may be better at improving exercise capacity and preventing heart attacks and other complications than a common surgical procedure that uses tiny metal mesh tubes called stents to prop open clogged arteries.

Researchers found men with clogged arteries caused by atherosclerosis who exercised for 20 minutes a day at an aerobic heart rate range had a lower risk of heart attack and other complications than those who had stents surgically implanted. The exercisers also experienced less chest pain and where able to increase their exercise capacity more than man who had had stents placed during angioplasty.

"The study was too small to make a general recommendation, but it suggests that patients with coronary artery disease can get the same symptom relief by exercising as they could with PCI [percutaneous coronary intervention] and stenting," says researcher Rainer Hambrecht, MD, of the University of Leipzig in Leipzig, Germany, in a news release.

Coronary artery disease is the most common form of heart disease and is usually caused by atherosclerosis, or hardening of the arteries. Reduced blood flow from a clogged heart artery can lead to heart attacks.

Researchers say stenting will remain the treatment of choice in the majority of people with coronary artery disease, but these results suggest that it should be combined with a more aggressive lifestyle intervention including daily exercise.

Exercise Instead of Stents

In the study, which appears in the March 9 issue of Circulation: Journal of the American Heart Association, researchers compared the effects of regular exercise vs. stenting in group of 101 men with stable coronary artery disease.

All of the men had narrowing of one of the coronary arteries at the start of the study. About half of them were assigned to receive exercise training or stenting.

Men in the exercise group worked out on an exercise bike for 10 minutes six times a day for the first two weeks in the hospital. They learned their target heart rate and were then asked to exercise at home on their bikes close to their target heart rate for 20 minutes per day and to participate in one 60-minute group aerobic exercise training session per week.

After one year, both groups experienced an improvement in their overall symptoms, but that improvement was much greater in the exercise group. Based on the Canadian Cardiovascular scale, the average chest pain score dropped from 1.5 at the start of the study to 0.4 a year later in the exercise group compared with a reduction of 1.7 to 0.7 in the stenting group.

Yet the men in the exercise group were less likely to suffer a heart attack or other complication during the study with 88% reporting no adverse events vs. 70% among the men in the stenting group.

In addition, the men in the exercise group improved their exercise tolerance by 20%. No improvement in exercise tolerance was found among the men who received stents.

Researchers say exercise would still offer greater benefits over the newer drug-coated stents because stents can only treat a small section of diseased arteries at a time, while exercise improves the overall health and slows disease progression in the entire cardiovascular system.

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