The antiatherosclerotic effect of exercise and development of an exercise prescription

Atherosclerosis and its sequelae of MI, bypass surgery, and angioplasty can be affected positively in both the primary and secondary setting by the use of properly prescribed physical activity. Such activity in a higher weekly kilocalorie expenditure (usually involving greater intensity) seems to be effective in achieving regression of atherosclerosis and in improving LVEF. In general, any activity is better than none, but more energy expenditure seems associated with greater benefits. Regardless of these apparent beneficial effects of exercise, such benefits are much less apparent if modification of other coronary risk factors is not also achieved. These efforts must focus on cessation of smoking, control of abnormal blood lipids, and normalization of high blood pressure. With these less costly methods of controlling atherosclerosis, the future impact of this type of intervention will likely be of great importance as society adjusts to the cost constraints of managed (especially capitated) care in the near future.