Effect of exercise training on the total ischaemic burden: an assessment by 24 hour ambulatory electrocardiographic monitoring

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Abstract
Objective—To examine the effect of prolonged high intensity exercise training on total ischaemic burden in men with chronic stable angina pectoris. Design—A randomised controlled trial based on 24 hour ambulatory electrocardiographic monitoring of patients on two occasions a year apart. Setting—Cardiology department of a large general hospital. Subjects—40 men under 60 years of age with chronic stable angina pectoris and no previous myocardial infarction. Results—After training the exercise group showed a 30% reduction in frequency of ST segment depression. There were significant reductions in painful episodes of ischaemia and those triggered by changes in heart rate. There was also a trend towards a reduction in silent ischaemia and episodes not triggered by changes in heart rate. The duration of ischaemic episodes was also reduced. No significant change in frequency or severity of dysrhythmia was shown. Conclusions—Exercise training reduces total ischaemic burden in patients with angina pectoris by reducing the frequency and duration of all types of ischaemic episode.