Advice for Professionals

Exercise and macrovascular complications.

In most people provided exercise is started at a low intensity and increased gradually then no harm will be done.

However there are some conditions where caution is required or action needs to be taken prior to starting exercise. The tables below summaries these in relation to macrovascular diseases.

Complications	Advice
*Stable known Coronary heart disease*	All activities fine
*Known exertional angina*	All activities okay, but heart rate should be kept >10 bpm below onset of exercise-related angina
*New chest pain*	Needs to be assessed by doctor before starting exercis
*Hypertension*	Both aerobic and resistance training may lower resting blood pressure. Some blood pressure medications can cause exercise-related hypotension Ensure adequate hydration during exercise
*Recent MI*	Restart exercise after myocardial infarction in a supervised cardiac rehabilitation program. Start at a low intensity and progress and increase intensity slowly Both aerobic and resistance exercise are okay
*Recent Stroke*	Restart exercise after stroke in a supervised environment/ program. Start at a low intensity and progress and increase intensity slowly Both aerobic and resistance exercise are okay
*Congestive heart disease*	Check symptoms are not worsening Low or moderate intense activity best Avoid activities that cause an excessive rise in heart rate
*Peripheral artery disease*	All Activities ok. Resistance training of affected limbs can improve functional performance [1]] Low intensity walking also improves symptoms [2] (Pena KE 2009).

References

McDermott MM, Ades P, Guralnik JM, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA 2009;301:165–174 162 - to see this paper click here.
Pena KE, Stopka CB, Barak S, Gertner HR Jr, Carmeli E. Effects of low-intensity exercise on patients with peripheral artery disease. Phys Sports med 2009;37:106–11 - to see this paper here.