CORRESPONDENCE: LETTER TO THE EDITOR
Cardiac Rehabilitation and Prevention of Cardiovascular DiseaseA Role for Autonomic Cardiovascular Regulation
Ferdinando Iellamo, MD*,
Massimo Pagani, MD, FACC and
Maurizio Volterrani, MD
* Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Pisana, 00163 Rome, Italy (Email: iellamo{at}med.uniroma2.it).
It is with interest that we read the state-of-the-art paper on cardiac rehabilitation by Dr. Wenger (1). The article focuses on several important issues related to exercise training and quoted a number of factors that can contribute to the benefits of exercise training in ameliorating cardiovascular risk level, ranging from improvement in lipid profile and endothelial function to a more favorable fibrinolytic balance and anti-inflammatory action. We believe that it also is important to mention the potential benefits of exercise training on autonomic cardiovascular regulation. Patients with heart disease are at risk for life-threatening arrhythmias and sudden death, and it is well documented that alterations in the neural control of the heart characterized by decreased vagal activity and concurrent sympathetic predominance may have a critical role in the occurrence of arrhythmic events (2). A reduced baroreflex sensitivity (BRS), a measure of baroreceptor reflex vagal control of heart rate, has an independent prognostic value for cardiac mortality and cardiac events after myocardial infarction (3). The negative prognostic role of a depressed BRS and of an impaired autonomic control of the heart extends to patients with heart failure (4).
Several studies have indicated that exercise training improves BRS and heart rate variability parameters in different populations of cardiac patients, from post-myocardial infarction to coronary artery bypass graft surgery and heart failure (5–9), for whom, in all, exercise training is highly recommended (1). Notably, improvement in BRS by exercise training was related to a greater 10-year survival rate after myocardial infarction (10). These findings could by now be considered consolidated experimental evidences. Cardiac rehabilitation also improves depression and stress, with additional potential benefits on autonomic risk profile.
We believe that physicians should be informed on studies demonstrating the beneficial effects of exercise training on autonomic cardiovascular regulation, particularly those who are not familiar with this topic. Stressing the beneficial effects of exercise training on autonomic cardiovascular risk profile would contribute to boost further referral for cardiac rehabilitation by health care professionals.
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1. Wenger NK. Current status of cardiac rehabilitation J Am Coll Cardiol 2008;51:1619-1631.[Abstract/Free Full Text]2. Barron HV, Lesh, MD. Autonomic nervous system and sudden cardiac death J Am Coll Cardiol 1996;27:1053-1060.[Abstract] 3. La Rovere MT, Bigger Jr. JT, Marcus FI, et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction Lancet 1998;351:478-484.[CrossRef][Web of Science][Medline] 4. Mortara A, La Rovere MT, Pinna GD, et al. Arterial baroreflex modulation of heart rate in chronic heart failure. Clinical and hemodynamic correlates and prognostic implications. Circulation 1997;96:3450-3458.[Abstract/Free Full Text] 5. Malfatto G, Facchini M, Sala L, et al. Effects of cardiac rehabilitation and beta-blocker therapy on heart rate variability after first acute myocardial infarction Am J Cardiol 1998;81:834-840.[CrossRef][Web of Science][Medline] 6. Lucini D, Milani RV, Costantino G, et al. Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease Am Heart J 2002;143:977-983.[CrossRef][Web of Science][Medline] 7. Mimura J, Yuasa F, Yuyama R, et al. The effect of residential exercise training on baroreflex control of heart rate and sympathetic nerve activity in patients with acute myocardial infarction Chest 2005;127:1108-1115.[CrossRef][Web of Science][Medline] 8. Iellamo F, Legramante JM, Massaro M, et al. Effects of a residential exercise training on baroreflex sensitivity and heart rate variability in patients with coronary artery disease Circulation 2000;102:2588-2592.[Abstract/Free Full Text] 9. Gademan MGJ, Swenne CA, Verwey HF, et al. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure J Cardiac Fail 2007;13:294-303.[CrossRef][Web of Science][Medline] 10. La Rovere MT, Bersano C, Gnemmi M, et al. Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction Circulation 2002;106:945-949.
Related Article
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Reply
- Nanette K. Wenger
J. Am. Coll. Cardiol. 2008 52: 1105-1106.
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