New insights in the prescription of exercise for coronary patients.

Prescribing exercise for cardiac patients is comparable in many ways to prescribing medications; that is, one recommends an optimal dosage according to individual needs and clinical status. Recent research has shown that it is more accurate to prescribe exercise as a percentage of the oxygen uptake reserve (VO2R), which is the difference between resting and maximal or peak oxygen consumption, rather than as a percentage of the VO2 max. Moreover, it appears that a minimum of 1600 kcal/week of leisure-time physical activity may halt the progression of coronary artery disease, whereas regression may be achieved with a gross energy expenditure of 2200 kcal/week. Upper body and resistance training have also been shown to be safe and effective for clinically stable patients. Aerobic capacity serves as an independent predictor of all cause and cardiovascular mortality in patients referred to an outpatient cardiac rehabilitation program, with each 1 metabolic equivalent increase in aerobic fitness conferring an approximate 10% reduction in mortality. The goal of preventing recurrent cardiac events is, to a large extent, based on sustained compliance to multifactorial interventions, which can be influenced by numerous socioeconomic and clinical variables, and enhanced by home-based or group cardiac rehabilitation programs that are designed to circumvent or attenuate barriers to participation and adherence, so that many more individuals may realize the benefits that secondary prevention can provide.