Exercise Training and Its Far-Reaching Effects

Over time I have been continually amazed at what is learned each year about the positive aspects of regular exercise training. When I began my career as a clinical exercise physiologist in 1985, I worked with patients in the cardiac rehabilitation setting. Like today, this is where most of the jobs were located. But participants were limited primarily to those who had suffered a recent myocardial infarction or underwent coronary bypass graft surgery. Over time research has accumulated at a swiftening pace to allow for the insurance coverage of many other cardiac conditions to participate in cardiac rehabilitation. These include percutaneous coronary interventions, systolic heart failure, valve procedures, angina, and heart transplant. Recent papers published in excellent journals point to the benefit for those with an implantable cardiac defibrillator (1) and those who have undergone an ablation procedure to treat atrial fibrillation (2). So, we may see these patients in our programs in the future.

And during the SARS-CoV-2 COVID pandemic we have learned about the value of exercise as it relates to immune function and severity of COVID (3). It appears that higher exercise capacities, as expressed by peak VO₂, are inversely related to the risk of hospitalization (4). Others have reported that regular physical activity is related to a reduced risk of SARS-CoV-2 infection, severe illness, and death (5).

With respect to general exercise the relationship between aerobic exercise and the risk of mortality in previously healthy individuals, and many of those with a chronic disease, has long been established. Recent data from the National Health Interview Survey (NHIS) found a unique association of reduced mortality (odds ratio = 0.90, 95% confidence interval = 0.83 – 0.97) in those who reported regular stretching routines (6). This is interesting and appears to be the first to report this association. The authors state that stretching may help individuals to keep exercising aerobically. This may also be related to the potential value of stretching to reduce injuries as reviewed in the September 2021 issue of this journal (7). But there may be other potential benefits related to vascular function (8).

I am excited to see what future research in exercise training will reveal to us. But I think it is safe to say that if someone with a chronic disease or condition can exercise safely, they should be encouraged as there is very likely a significant upside for them with little risk of a downside. And this is particularly true, I believe, when exercise is prescribed by a clinical (or accredited) exercise physiologist and when necessary, applied in a supervised setting.