Predicting the exercise catastrophe in the post-coronary patient.

A total of 230 patients attending an exercise-centred rehabilitation program have been divided into those engaged in physical activity and those inactive, at the time of their first infarction. The two groups have identical physical characteristics, initial fitness levels, and responses to laboratory exercise; the only distinguishing features of the 'active' group is a somewhat longer and more sharply localized pain during infarction and a greater response to exercise training. Since the potential victim of the exercise catastrophe cannot be identified, prevention rests upon careful counselling of all 'post-coronary' patients. Excessive and unusual exertion should be avoided, particularly when this is associated with competition and emotional excitement. Patients should also learn to recognize the symptoms associated with dysrhythmia and angina, and should moderate their physical activity schedule if they sense ischemial prodromata, mental tension or depression.Despite the large size of the exercise class, a good training response (13%-21% gain of aerobic power in one year) is being sustained. Despite objective evidence of effective cardiorespiratory training, systemic blood pressures remain unchanged, both at rest and during standard laboratory exercise.