Regression and non-progression of coronary artery disease with exercise

Metabolic interventions using low-fat diets and lipid level-lowering drugs were successful in controlling the progression rate of coronary artery disease and reduced the number of clinical events. Only a few studies have examined the role of regular physical exercise as a therapeutic instrument to enhance these beneficial effects. The design of the available studies did not permit differentiation among the effects of physical exercise, lowering of serum cholesterol level and stress management. The decrease in total serum cholesterol level ranged from 10 to 24%, the change in high-density lipoprotein cholesterol level from -3 to +12%. There was predominant regression of coronary artery lesions in one study (the Lifestyle trial); in the other two trials, progression was either halted (in the Heidelberg trial) or reduced (in the Stanford trial). In contrast, significant progression was noted in all of the control groups. In addition to the beneficial effects on progression of coronary artery disease, patients taking regular physical exercise experienced significant improvements in their physical work capacity (+25%) and in myocardial perfusion, and reduction in anginal pain. There were fewer clinical events in the intervention group in the Stanford study only, whereas clinical events tended to be more frequent in the other studies because of exercise-induced arrhythmias.