Physical training in coronary patients with poor left ventricular function

Physical training is beneficial in patients with coronary artery disease, and in those after myocardial infarction in whom left ventricular function and ejection fraction (LVEF) are relatively well preserved. However, little is known about the effect of physical training in coronary patients with impaired left ventricular function. 12 patients after myocardial infarction (range 42-60 years) with LVEF of 30% or less at rest were evaluated after 11 months of isotonic physical training. Mean LVEF increased from 28.0% to 33.0% (p less than 0.002) at rest and from 29.4% to 33.2% (p less than 0.002) on effort. Exercise tolerance increased 228 seconds by the end of the study (p less than 0.001); the double product at symptom limit effort increased (p less than 0.001) and the double product at the same work load decreased (p less than 0.002). During training there was no cardiovascular deterioration and all patients returned to work within a mean of 3.7 months. The results show that patients with severe left ventricular impairment should not necessarily be excluded from cardiac rehabilitation programs involving physical training.