Abstract
Dear Editor,
The review article by Sudhindra V., Anil P., and Monica Y. on the effects of exercise training and physical activity in patients with coronary artery disease, published in June 2023 in your journal makes an interesting reading. 1 I appreciate the authors endorsing the need for regular moderate aerobic exercise as a part of secondary prevention of coronary artery disease. Most hospitals in India do not have good cardiac rehabilitation services and physicians do not have time for appropriate exercise prescriptions for the patients during follow-up. On the other hand, the authors also mention that vigorous-intensity exercise is not better than moderate-intensity exercise in reducing calcium scores. They quoted Malik et al’s article in support of it. 2 The current review article has not commented upon resistance training in addition to aerobic exercises and there are no references beyond 2020. I would have been happier to see their comment on these controversial aspects. I chanced to see a recent paper on high-load versus low-load resistance training in cardiac patients, which caution against high-load resistance exercises. 3
Based on own practice for many years I have a few comments on this subject.
Many women (and also men) are reluctant to adopt an exercise program of brisk walking in the morning at least for 30 min. They have household chores and children/husbands to go to the office on time. Practical advice may be to walk down to a worship place or market close by brisk walk after their morning work or suggest walking in the evening hours in a park nearby. For busy professional women, I have no specific suggestions.
The use of step-counting watch-like devices or smartphone apps has to be encouraged for self-monitoring.
I have some patients who are happy to do some yoga “asanas” within their homes and feel happy that these are a substitute for aerobic exercise. Some have troublesome knee pains due to osteoarthritis. Such a group needs personalized exercise prescriptions and education.
During the Covid-19 pandemic, a few months later in the post-acute phase, there were increased reports of unexplainable cardiac deaths in apparently healthy individuals. It made many stop their regular exercise and walking. Here I wish to express my concerns. Though rare sub-clinical myocarditis was demonstrated on MRI even in normal athletes for about 6 months following Covid-19 affection. A 10-day waiting period is generally advocated for most of them to resume play and work. For cardiac patients who had Covid-19 and recovered there are no clear-cut guidelines. I feel 3 months to 6 months exercise-free period after the acute phase and a thorough cardiac evaluation prior to starting exercises may be reasonable for them.