John Naughton

Refinements in method of evaluation and physical conditioning before and after myocardial infarction

Abstract A 54 year old white man with hypertension, obesity and an elevated serum cholesterol level volunteered for a physical training program. During the sixth week he became ill, and a repeated work-capacity test revealed physiologic evidences of myocardial insufficiency. The pre-exercise serum glutamic oxaloacetic transaminase level was elevated. A routine electrocardiogram four hours later revealed evidence of an acute inferoseptal myocardial infarction. The course of the disease was uneventful and uncomplicated. Two months after infarction the patient resumed a physical activity program which provided for a slow increase in metabolic demands compatible with his capacity. Repeated work-capacity tests 20 and 23 weeks after infarction showed that he responded to training in exactly the same manner as has been observed in normal, healthy individuals. At that time he was normotensive, with a normal serum cholesterol concentration and near-normal body weight. The capacity for adequate cardiorespiratory adjustments to high metabolic demands was rated as “good.” This study illustrates how performance tests can be used in evaluating the work capacity and progress of a cardiac patient.

Observations on the relationship of physical activity to the serum cholesterol concentration of healthy men and cardiac patients

Forty-eight men, 24 presumably healthy and 24 who had recovered from myocardial infarctions, had serum cholesterol determinations performed at rest and following vigorous exercise during two evaluations 8 months apart. Half of the group continued to lead a sedentary life while the other half initiated a program of regular physical activity. No alterations in dietary patterns were encouraged or recorded. Weight did not fluctuate significantly during the study. n nThe mean serum cholesterol level was significantly reduced (P < 0.005) for all subjects 8 months later. At both evaluations the sedentary groups had higher cholesterol concentrations than those subjects who volunteered for physical conditioning. n nThe state of health did not differentiate the men. Regardless of their health or physical condition, all of the men had an elevation of the serum cholesterol concentration following acute exercise.

Rehabilitation following myocardial infarction

Abstract During the past twenty years the approaches toward ambulating and restoring the patient with a healed myocardial infarction to an active way of life have become more positive. Cardiac rehabilitation is now regarded as a long-term process which includes all the requirements of good patient care; careful assessment of each patients physiologic and emotional limitations and potentials at periodic intervals with objective tests; continuous education of the patient through well supervised programs which include physical activity; and an awareness of how the day to day interactions of the patient with his disease, his physician, his spouse and family and his occupation may influence the success or failure of the rehabilitative effort. A rehabilitation program should include concern for both a patients physiologic and social psychologic status. Such a program should ideally be led by a physician who would coordinate the efforts of a collaborating team composed of physiologists, physical therapists, occupational therapists, psychologists, sociologists, physical educators and technicians. An outline of such a program is given here (Table I).

Emotional stress, physical activity and ischemic heart disease

Summary Ischemic heart disease occurs at near-epidemic proportions in Western civilization. Although all persons, especially Caucasian males, are “at risk,” there is a constellation of factors that apparently characterizes those individuals whose lives may be jeopardized prematurely. Available epidemiologic evidence indicates that the presence of hypertension, hypercholesterolemia and heavy cigarette smoking, either singly or in combination, are definite risk factors in the over-all population. Factors such as excessive obesity, heavy coffee drinking, diabetes mellitus and a positive family history of ischemic heart disease are also important, even though additional clarification of their over-all importance is still needed. In more recent years, two other areas of the life pattern have been strongly implicated as risk factors; namely, behavioral characteristics and habits of physical activity, either occupational or leisure-time. Unfortunately, these two areas were not well explored in some of the earliest large-scale epidemiologic studies, and further documentation of their influence on the natural history of ischemic heart disease is still required. The evidence available at present strongly suggests that individuals can be classified prospectively according to their behavioral traits and habits of activity. In general, the individuals with overzealous, poorly directed drive, increased Hypochondriasis (MMPI) and increased Activity Drive (TTS) have a higher incidence of myocardial infarction than do those subjects who lack these characteristics. Rosenman and Friedman labeled such individuals as possessing personality pattern Type A, whereas Wolf et al. suggested that their life style was patterned after that of the Greek mythologic character Sisyphus. The rate of myocardial infarction appears to be approximately one-half that of the sedentary population in men who are either regularly physically active throughout life or who enjoy an occupation that demands regular physical activity; i.e., bus conductors, mailmen, etc. In general, lifelong physically active men are characterized by a paucity of risk factors, whereas the sedentary population and Type A individuals often possess one or more. These findings suggest that the clinical manifestations of ischemic heart disease should be preventable if a suitable program were instituted in early life, preferably in the adolescent years. Such a program should be multifaceted and should include appropriate dietary manipulation, psychotherapy or improved education regarding behavioral traits, and supervised programs of regular physical activity. Of the three approaches, physical activity might be considered the keystone, since it offers a positive approach to health maintenance and can serve as the source around which an individual modifies the remainder of his life style. Coordination of the educational system and family structure with the efforts of the physician will be required to make such a preventive program feasible and successful.0