Criticisms of exercise after heart attack--variations on an old theme?

In many countries it is accepted medical practice for selected patients to undertake carefully prescribed programmes of physical exercise after acute myocardial infarction or coronary bypass surgery. This situation has evolved despite considerable initial and ongoing medical resistance, some of which is now surfacing in this country. The most popular criticisms of exercise programmes for cardiac patients are that such programmes are unsafe, do not provide any medical benefit and are too costly, and that there are insufficient facilities and trained personnel to develop a realistic nationwide rehabilitation service. It is of interest that these criticisms are the same as those which were initially used to counter the proponents of coronary bypass surgery. It can be shown that these arguments are not scientifically valid. The risks of exercise for cardiac patients are minimal and considerably less than those posed by cardiac surgery. There is encouraging evidence that exercise training may reduce morbidity and mortality, but even if such hopes are not fulfilled the improved quality of life enjoyed by cardiac patients who take part in an exercise programme is sufficient to justify this therapy. The additional costs imposed by these programmes are minimal, as are the staffing requirements. It seems likely that just as coronary bypass surgery has overcome widespread medical opposition in this and other countries, so too will the concept of formal exercise training programmes for selected patients after heart attack or coronary bypass surgery.