Circulatory and Symptomatic Effects of Physical Training in Patients with Coronary-Artery Disease and Angina Pectoris

A six-week program of intensive training in seven patients with angina was carried out to determine the relative contributions to the improved exercise performance of altered circulatory response and enhanced myocardial oxygen delivery. Training resulted in a marked increase in exercise capacity: time to onset of angina (± S.E.M.) rose an average of 6.8 ± 1.5 minutes (p less than 0.01), and the intensity of exercise (measured by total body oxygen consumption) attained before the onset of angina increased 56 ± 19 per cent (p less than 0.005). The "triple product" (an index of myocardial oxygen consumption) at any level of exercise was less after training, thus accounting for part of the improved exercise capacity. In addition after training, a higher triple product could be achieved at the onset of angina, 4885 vs. 4300 (p less than 0.05), suggesting that training might improve myocardial oxygen delivery. Physical training thus seems to improve exercise performance consistently by reducing the responses of heart rate and arterial pressure to exercise. The data also suggest that myocardial oxygen delivery may be enhanced.