Can high-risk patients after myocardial infarction participate in comprehensive cardiac rehabilitation?

Patients with large transmural infarctions (MI) and signs of congestive heart failure (CHF) are often excluded from physical training, because of the risk of malignant arrhythmia or cardiac overloading. From a non-selected MI population less than 65 years we enrolled 37 high-risk patients in a two-year comprehensive cardiac rehabilitation programme, including health education, follow-up at a post-MI clinic, and physical training in outpatient groups. The feasibility, effectiveness and safety of the physical training were evaluated: Twenty-one patients joined the physical training and participated with excellent compliance, reaching the preset levels of training. No adverse effects occurred during the 921 training sessions. The high-risk patients were compared with the remaining 228 patients and a subgroup of 86 low-risk patients with regard to mortality, morbidity, medication, effect on risk factors, exercise test performance and rate of return to work. The high-risk group showed a higher mortality (27.0 vs. 10.4%, p less than 0.05), a lower maximal work capacity at the exercise test 4 months after MI (126 W vs. 140 W, p less than 0.05), and a lower rate of early return to work (22.6 vs. 50% p less than 0.01) when compare with the low risk group. However, they showed a similar improvement in exercise test parameters. At the end of the programme a remarkable 63% had returned to work vs. 48.2% of the remaining patients. The reduction in smoking and the effect on blood pressure were equal in both groups. It is concluded that high-risk patients may well benefit from regular physical training in outpatient groups, if adequate medical supervision is available.