Summary and conclusionsA group of patients with angina pectoris were investigated prospectively using a simple and well-recognised exercise test protocol, and S-T segment displacements during exercise were correlated with the results of coronary arteriography. Definitive

suMMARY The effects of a simple physical training programme were investigated in a prospective and randomised trial in patients with stable angina pectoris using a modified exercise test. Twenty-four patients with ischaemic heart disease and an ischaemic response to conventional exercise electrocardiography were randomised into two groups: 12 patients took part in a training programme and 12 patients were allocated to a control group (no training). Exercise testing was performed sequentially at entry to the study and six months afterwards. At both studies we determined the heart rate at the same level of ischaemic ST segment depression (HR/ST threshold), the duration of the test, and relation of heart rate to the exercise load.The HR/ST threshold increased only in patients who underwent the exercise programme, suggesting indirectly that training resulted in the ability to do more work and attain a higher degree of myocardial oxygen consumption at the same level of myocardial ischaemia. In addition, training led to an increase in the duration of the test and to a reduction in heart rate at any level of submaximal exercise load.It is concluded that physical training in anginal patients results in an enhancement of myocardial oxygen availability.Clinical exercise testing has been extensively used to provoke electrocardiographic changes attributed to ischaemia and to assess changes in functional capacity in patients with ischaemic heart disease,' 2 and, by serial exercise testing, to assess the results of physical training programmes.2-4 However, most of these studies have been limited to the consideration of improvement in exercise capacity, or the consequences of the reduction in heart rate and blood pressure at a given level of exercise, that is the ability to perform more work before the onset of angina at the same heart rate and blood pressure.2 5 6 A relatively smaller number of studies have investigated levels of heart rate and blood pressure during myocardial ischaemia using subjective criteria, for example anginal pain,5-7 thus investigating the ability to perform more work and attain a higher heart rate and blood pressure at the occurrence of anginal pain. Received for publication 29 August 1979 In this report, the effect of a convenient physical training programme known to improve cardiorespiratory fitness was investigated in patients with stable angina pectoris.8 A modified exercise test relating levels of heart rate and systemic blood pressure to an objectively determined level of myocardial ischaemia was shown to be sensitive enough to detect improvement in the ability to attain a higher heart rate and blood pressure at the same objective level of myocardial ischaemia. Subjects and methodsTwenty-four patients in whom the diagnosis of stable angina pectoris was confirmed by obtaining an ischaemic response during exercise electrocardiography in each, and in addition by selective coronary arteriography in 11 patients, were selected for the investigation. Patients with hypertension, valve disease, cardi...

Since the effect of cardiac rehabilitation (CR) on morbidity and mortality due to myocardial infarction on a long-term basis appears controversial, a controlled follow-up survey was conducted from 1973 to 1981 in 193 patients suffering a first acute myocardial infarction (AMI). The admission criteria included absence of contraindications to CR during the acute phase of AMI. Patients were divided into two matched groups: 93 patients followed a CR program, exercising 30 min three times a week (x 42; range 6–108 months) and the remaining 100 patients served as controls. Age, sex, location and extension of the myocardial damage, frequency of coronary risk factors and complications during the acute phase were comparable. At 9 years, there were 24 cardiac deaths (15 AMI, 7 sudden deaths and 2 heart failures) among the controls and 13 deaths in the CR group (7 AMI, 4 sudden deaths, 2 heart failures), mortality rates being 5.2 and 2.9% per year (p < 0.1 > 0.05; NS), respectively. There were 23 recurrent AMI in the control versus 16 in the CR patients, the corresponding rates being 4.9 and 3.6% per year, respectively (NS). Nor were any differences observed in the incidence of myocardial ischemia, severe arrhythmias or cerebrovascular strokes between both groups, but the appearance of angina was significantly lower in the CR group compared with the controls (5.1 and 10.2% per year, respectively, p < 0.005). It is concluded that CR on a long-term basis seems to improve the mortality rate of AMI and to reduce the frequency of anginal pain.

The value of an objective exercise test for the assessment of the functional results of aortocoronary bypass was investigated in 19 patients who were studied before and six months after the operation. For positive tests the end point was defined as a net ST segment depression of 0-1 mv 80 ms after the J point of the ECG. For negative tests the end point was 85% of the age-predicted maximal heart rate response. One patient who was not able to attain either of these points after the operation was excluded. In the remaining 18 patients three indices were used in the analysis. First, the heart rate (HR) and the product of heart rate and systolic blood pressure (RPP)

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