Aerobic exercise reduces mortality:
Aerobic exercise done along with or without a cardiac rehab program reduces mortality in coronary artery disease.
A systematic review and meta-analysis of randomized controlled trials by Taylor et al found that exercise based cardiac rehabilitation reduces all cause and cardiac mortality and improves a number of cardiac risk factors in patients with coronary heart disease according to this meta-analysis of 48 randomized controlled trials (RCTs) (8940 patients, mean age 55 y). Intervention duration ranged from 0.25–30 months and follow up was between 6–72 months. Patients who received exercise-based cardiac rehab had a significant reduction in all cause mortality of 20% and cardiac mortality of 26% than did patients who received usual care. Groups did not differ for rates of non-fatal heart attack (odds ratio [OR]= 0.79), coronary artery bypass grafting (OR=0.87), or percutaneous coronary intervention (OR=0.81). Cardiac rehabilitation was associated with significant reductions in total cholesterol of 0.37 mmol/L and triglyceride concentrations by 0.23 mmol/L; no significant differences were seen in low \’bad\’ or high-density \’good\’ lipoprotein concentrations. Systolic blood pressure was significantly reduced by 3.2 mm Hg. A significant 36% reduction in patient smoking was reported with cardiac rehabilitation. (8) Silberman and colleagues reported the results of an analysis of patients (n=2974) participating in an intensive cardiac rehabilitation program. The authors reported significant improvements in body mass index (BMI), triglycerides, low density lipoprotein cholesterol, total cholesterol, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, depression, hostility, exercise, and functional capacity at 12 weeks and 1 year. (23) Medicare Part B insurance covers the “Dean Ornish Program for Reversing Heart Disease,” under a new benefit category, “Intensive Cardiac Rehabilitation (ICR). The Ornish program, which teaches a plant-based, meatless diet, meditation and regular exercise, is the only program scientifically proven to reverse heart disease currently offered in hospitals, clinics and physicians offices the Medicare and other private insurance companies are covering. People are empowered with a proven program that can quickly reverse their heart disease and other chronic conditions, allowing them to sustainably transform their lives for the better. Additionally, overall adherence to the program has been 85 to 90%, after one year in hospitals and clinics that have offered it. Findings of 3,780 patients at a program in PA found that the average patient lost 13.3 pounds in the first 12 weeks and 15.9 pounds after 1 year. Significant reductions in systolic blood pressure (BP), diastolic BP, total cholesterol, triglycerides, and LDL-cholesterol after 12 weeks were still significant after 1 year. Exercise capacity increased by 18% after 12 weeks and 24% after one year. Reductions in depression and hostility were still significant after 1 year. Hemoglobin A1C in diabetics continued to decrease after one year. Furthermore, 5% of patients reported improvement in severity of angina (chest pain) after 1 year. Eligibility for the program includes one of the following: a) an acute myocardial infarction within the preceding 12 months; b) a coronary artery bypass surgery; c) current stable angina pectoris; d) heart valve repair or replacement; e) percutaneous transluminal coronary angioplasty or coronary stenting; f) a heart or heart-lung transplant; or, g) other cardiac conditions as specified through a national coverage determination. (24)