AN OFFICIAL JOURNAL oftie AMERICAN HEART ASSOCIATION Physical Training in the Management of Coronary Artery Disease

The effects of 4 to 6 weeks ' physical conditioning on the cardiovascular and respiratory response to exercise were studied in nine patients with coronary artery disease. Clinical improvement and increased physical working capacity were observed in all patients. The average cardiac output during exercise was unchanged. The stroke volume increased and the myocardial work, assessed by the tension-time index, de-creased during exercise at a given work load. It is suggested that at submaximal work loads a reduction of the blood flow to the working muscles occurs after training. Such change might be fundamental for the altered circulatory regulation by allowing a reduced general sympathetic vasoconstriction during exercise. It is concluded that the hemodynamic changes form a rational physiologic basis for the use of physical training in the management of patients with coronary artery disease. Additional Indexing Words: Cardiac output Tension-time index WxZ ITHIN the last decade several investiga-tors have demonstrated that physical conditioning programs have an incontestable beneficial effect on the majority of patients with coronary artery disease.'-10 When it is considered that the management of patients with angina pectoris presents an unsolved problem, it is astonishing that the use of this active therapeutic principle has not gaine