CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Nanette K. Wenger, MD*
* Professor of Medicine (Cardiology), Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, Georgia 30303 (Email: nwenger{at}emory.edu).
Dr. Iellamo and colleagues have provided an excellent summary of the beneficial effects of exercise training on autonomic cardiovascular regulation in response to my article (1). It is well accepted that reduced baroreflex sensitivity and impaired heart rate autonomic control negatively impact the prognosis of coronary heart disease and other cardiovascular illnesses. However, the improvement in baroreflex sensitivity and in parameters of heart rate variability in association with exercise training and their relationship to improved cardiovascular prognosis cannot be attributed solely to the exercise training component of cardiac rehabilitation, although they are likely substantially mediated by exercise training.
Cardiac rehabilitation is a multifactorial intervention that involves, in addition to prescribed exercise, cardiac risk factor modification and multiple components of education and counseling; these concomitant processes are designed to limit the adverse physiological and psychological effects of cardiac illness, reduce the risk of sudden death or reinfarction, control cardiac symptoms, stabilize or reverse progression of the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients (2). Because this panoply of interventions, including the medical therapies, all likely contribute to the improved outcomes of cardiac patients receiving rehabilitation services, it is not possible to identify the contributions of individual components of cardiac rehabilitation to cardiovascular benefit, although exercise training, with its diverse favorable physiologic outcomes, including the beneficial effect on autonomic cardiovascular regulation, likely plays a pivotal role.
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References
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- Wenger NK. Current status of cardiac rehabilitation J Am Coll Cardiol 2008;51:1619-1631.[Abstract/Free Full Text]
- Wenger NK, Froelicher ES, Smith LK, et al. Cardiac rehabilitation. Clinical practice guideline no. 17. Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, and the National Heart, Lung, and Blood Institute, AHCPR Publication No. 96-0672; 1995October.[Abstract]
Related Article
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Cardiac Rehabilitation and Prevention of Cardiovascular Disease: A Role for Autonomic Cardiovascular Regulation
- Ferdinando Iellamo, Massimo Pagani, and Maurizio Volterrani
J. Am. Coll. Cardiol. 2008 52: 1105.
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