Exercise as Medicine for Cardiac Patients

  • Beth Parker


Exercise training is both a preventive and prescriptive countermeasure with which to treat cardiovascular disease (CVD) and associated physiological and behavioral risk factors. Exercise is efficacious for treating hypertension, hypercholesterolemia, obesity, insulin resistance, anxiety, depression, and stress as well as nontraditional CVD risk factors such as endothelial dysfunction and systemic inflammation. Resultantly, exercise training typically improves health outcomes in cardiac patients above and beyond those achieved with nonexercise care practices (i.e., other pharmacological and behavioral treatments) alone. However, despite the well-publicized benefits of exercise, patients struggle with adopting and maintaining physical activity, making clinicians hesitant to prescribe it as an effective treatment tool. There are, however, many factors that affect a patient’s adherence to an exercise program as well as strategies with proven effectiveness for increasing exercise compliance. In addition, an exercise prescription that is tailored to the patient’s goals and desired outcomes will improve long-term exercise compliance. The current chapter will thus present a brief summary of the benefits of exercise for behavioral and physiological health as well as the common physical and psychological ailments associated with the cardiac patient that can be mitigated by physical activity. The chapter will also address strategies and considerations for developing an appropriate exercise prescription and motivating the patient to successfully increase physical activity so as to optimize the effectiveness of exercise as medicine for the cardiac patient.


Physical Activity Resistance Training Resistance Exercise Aerobic Exercise Cardiac Rehabilitation 



One-repetition maximum


American College of Sports Medicine


American Heart Association


Beck Depression Inventory


Coronary artery disease


Cardiovascular disease




Implantable cardioverter-defibrillator


State-Trait Anxiety Inventory for adults


Studies of a Targeted Risk Reduction Intervention through Defined Exercise


  1. Adams, J., Cline, M. J., Hubbard, M., McCullough, T., & Hartman, J. (2006). A new paradigm for post-cardiac event resistance exercise guidelines. The American Journal of Cardiology, 97, 281–286.PubMedGoogle Scholar
  2. Allender, S., Hutchinson, L., & Foster, C. (2008). Life-change events and participation in physical activity: A systematic review. Health Promotion International, 23, 160–172.PubMedGoogle Scholar
  3. American Association of Cardiovascular and Pulmonary Rehabilitation. (2004). Guidelines for cardiac rehabilitation and secondary prevention programs (4th ed.). Champaign: Human Kinetics.Google Scholar
  4. American College of Sports Medicine. (2006). In M. E.Whaley, P. H. Brubaker, & R. M. Otto (Eds.), ACSM’s guidelines for exercise testing and prescription (7th ed., pp. 99–102). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  5. Anderson, E. S., Winett, R. A., Wojcik, J. R., & Williams, D. M. (2010). Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: Social support, self-efficacy, outcome expectations and self-regulation in the guide-to-health trial. Journal of Health Psychology, 15, 21–32.PubMedGoogle Scholar
  6. Audelin, M. C., Savage, P. D., & Ades, P. A. (2008). Changing clinical profile of patients entering cardiac rehabilitation/secondary prevention programs: 1996 to 2006. Journal of Cardiopulmonary Rehabilitation and Prevention, 28, 299–306.PubMedGoogle Scholar
  7. Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.Google Scholar
  8. Baum, K., Hildebrandt, U., Edel, K., Bertram, R., Hahmann, H., Bremer, F. J., et al. (2009). Comparison of skeletal muscle strength between cardiac patients and age-matched healthy controls. International Journal of Medical Sciences, 6, 184–191.PubMedGoogle Scholar
  9. Beavers, K. M., Brinkley, T. E., & Nicklas, B. J. (2010). Effect of exercise training on chronic inflammation. Clinica Chimica Acta, 411(11), 785–793.Google Scholar
  10. Benditt, D. G., & Nguyen, J. T. (2009). Syncope: Therapeutic approaches. Journal of the American College of Cardiology, 53, 1741–1751.PubMedGoogle Scholar
  11. Bibeau, W. S., Moore, J. B., Mitchell, N. G., Vargas-Tonsing, T., & Bartholomew, J. B. (2009). Effects of acute resistance training of different intensities and rest periods on anxiety and affect. Journal of Strength and Conditioning Research, 24, 2184–2191.Google Scholar
  12. Blair, S. N., Kampert, J. B., Kohl, H. W., III, Barlow, C. E., Macera, C. A., Paffenbarger, R. S., Jr., et al. (1996). Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA, 276, 205–210.PubMedGoogle Scholar
  13. Blair, S. N., Kohl, H. W., III, Barlow, C. E., Paffenbarger, R. S., Jr., Gibbons, L. W., & Macera, C. A. (1995). Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA, 273, 1093–1098.PubMedGoogle Scholar
  14. Blair, S. N., & Morris, J. N. (2009). Healthy hearts—and the universal benefits of being physically active: Physical activity and health. Annals of Epidemiology, 19, 253–256.PubMedGoogle Scholar
  15. Bock, B. C., Marcus, B. H., Pinto, B. M., & Forsyth, L. H. (2001). Maintenance of physical activity following an individualized motivationally tailored intervention. Annals of Behavioral Medicine, 23, 79–87.PubMedGoogle Scholar
  16. Bopp, M., Wilcox, S., Laken, M., Hooker, S. P., Parra-Medina, D., Saunders, R., et al. (2009). 8 Steps to fitness: A faith-based, behavior change physical activity intervention for African Americans. Journal of Physical Activity and Health, 6, 568–577.PubMedGoogle Scholar
  17. Borg, G. (1998). Borg’s perceived exertion and pain scales. Champaign: Human Kinetics.Google Scholar
  18. Braith, R. W., & Vincent, K. R. (1999). Resistance exercise in the elderly person with cardiovascular disease. American Journal of Geriatric Cardiology, 8, 63–70.PubMedGoogle Scholar
  19. Bravata, D. M., Smith-Spangler, C., Sundaram, V., Gienger, A. L., Lin, N., Lewis, R., et al. (2007). Using pedometers to increase physical activity and improve health: A systematic review. JAMA, 298, 2296–2304.PubMedGoogle Scholar
  20. Campbell, W. W., Crim, M. C., Young, V. R., & Evans, W. J. (1994). Increased energy requirements and changes in body composition with resistance training in older adults. The American Journal of Clinical Nutrition, 60, 167–175.PubMedGoogle Scholar
  21. Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N., & Buchner, D. M. (1999). Falls prevention over 2 years: A randomized controlled trial in women 80 years and older. Age and Ageing, 28, 513–518.PubMedGoogle Scholar
  22. Carney, R. M., Freedland, K. E., Jaffe, A. S., Frasure-Smith, N., Lesperance, F., Sheps, D. S., et al. (2004). Depression as a risk factor for post-MI mortality. Journal of the American College of Cardiology, 44, 472–474.PubMedGoogle Scholar
  23. Casey, A., Chang, B. H., Huddleston, J., Virani, N., Benson, H., & Dusek, J. A. (2009). A model for integrating a mind/body approach to cardiac rehabilitation: Outcomes and correlators. Journal of Cardiopulmonary Rehabilitation and Prevention, 29, 230–238.PubMedGoogle Scholar
  24. Chen, K. M., Chen, M. H., Hong, S. M., Chao, H. C., Lin, H. S., & Li, C. H. (2008). Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises. Journal of Clinical Nursing, 17, 2634–2646.PubMedGoogle Scholar
  25. Clarke, D. A., Medow, M. S., Taneja, I., Ocon, A. J., & Stewart, J. M. (2010). Initial orthostatic hypotension in the young is attenuated by static handgrip. The Journal of Pediatrics, 156, 1019–1022.PubMedGoogle Scholar
  26. Coen, P. M., Flynn, M. G., Markofski, M. M., Pence, B. D., & Hannemann, R. E. (2009). Adding exercise training to rosuvastatin treatment: Influence on serum lipids and biomarkers of muscle and liver damage. Metabolism, 58, 1030–1038.PubMedGoogle Scholar
  27. Cornelissen, V. A., & Fagard, R. H. (2005). Effect of resistance training on resting blood pressure: A meta-analysis of randomized controlled trials. Journal of Hypertension, 23, 251–259.PubMedGoogle Scholar
  28. Craft, L. L., Freund, K. M., Culpepper, L., & Perna, F. M. (2007). Intervention study of exercise for depressive symptoms in women. Journal of Women’s Health (Larchmt), 16, 1499–1509.Google Scholar
  29. Dale, K. S., Mann, J. I., McAuley, K. A., Williams, S. M., & Farmer, V. L. (2009). Sustainability of lifestyle changes following an intensive lifestyle intervention in insulin resistant adults: Follow-up at 2-years. Asia Pacific Journal of Clinical Nutrition, 18, 114–120.PubMedGoogle Scholar
  30. Daubenmier, J. J., Weidner, G., Sumner, M. D., Mendell, N., Merritt-Worden, T., Studley, J., et al. (2007). The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Annals of Behavioral Medicine, 33, 57–68.PubMedGoogle Scholar
  31. Davidson, K. W., Mostofsky, E., & Whang, W. (2010). Don’t worry, be happy: Positive affect and reduced 10-year incident coronary heart disease: The Canadian nova scotia health survey. European Heart Journal, 31(9), 1065–1070.PubMedGoogle Scholar
  32. Davy, K. P., Miniclier, N. L., Taylor, J. A., Stevenson, E. T., & Seals, D. R. (1996). Elevated heart rate variability in physically active postmenopausal women: A cardioprotective effect? The American Journal of Physiology, 271, H455–H460.PubMedGoogle Scholar
  33. DeBusk, R. F., Valdez, R., Houston, N., & Haskell, W. (1978). Cardiovascular responses to dynamic and static effort soon after myocardial infarction. Application to occupational work assessment. Circulation, 58, 368–375.PubMedGoogle Scholar
  34. Dedert, E. A., Calhoun, P. S., Watkins, L. L., Sherwood, A., & Beckham, J. C. (2010). Posttraumatic stress disorder, cardiovascular, and metabolic disease: A review of the evidence. Annals of Behavioral Medicine, 39, 61–78.PubMedGoogle Scholar
  35. Dew, M. A., & DiMartini, A. F. (2005). Psychological disorders and distress after adult cardiothoracic transplantation. The Journal of Cardiovascular Nursing, 20, S51–S66.PubMedGoogle Scholar
  36. Dishman, R. K., Dejoy, D. M., Wilson, M. G., & Vandenberg, R. J. (2009). Move to Improve: A randomized workplace trial to increase physical activity. American Journal of Preventive Medicine, 36, 133–141.PubMedGoogle Scholar
  37. Dishman, R. K., Vandenberg, R. J., Motl, R. W., Wilson, M. G., & Dejoy, D. M. (2009). Dose relations between goal setting, theory-based correlates of goal setting and increases in physical activity during a workplace trial. Health Education Research, 25, 620–631.PubMedGoogle Scholar
  38. Dressendorfer, R. H., Smith, J. L., Amsterdam, E. A., & Mason, D. T. (1982). Reduction of submaximal exercise myocardial oxygen demand post-walk training program in coronary patients due to improved physical work efficiency. American Heart Journal, 103, 358–362.PubMedGoogle Scholar
  39. Eston, R., & Connolly, D. (1996). The use of ratings of perceived exertion for exercise prescription in patients receiving beta-blocker therapy. Sports Medicine, 21, 176–190.PubMedGoogle Scholar
  40. Eyler, A. A., Matson-Koffman, D., Vest, J. R., Evenson, K. R., Sanderson, B., Thompson, J. L., et al. (2002). Environmental, policy, and cultural factors related to physical activity in a diverse sample of women: The women’s cardiovascular health network project—summary and discussion. Women & Health, 36, 123–134.Google Scholar
  41. Fagard, R. H. (2006). Exercise is good for your blood pressure: Effects of endurance training and resistance training. Clinical and Experimental Pharmacology and Physiology, 33, 853–856.PubMedGoogle Scholar
  42. Faulkner, M. S., Michaliszyn, S. F., & Hepworth, J. T. (2009). A personalized approach to exercise promotion in adolescents with type 1 diabetes. Pediatric Diabetes, 11, 166–174.PubMedGoogle Scholar
  43. Fraga, R., Franco, F. G., Roveda, F., de Matos, L. N., Braga, A. M., Rondon, M. U., et al. (2007). Exercise training reduces sympathetic nerve activity in heart failure patients treated with carvedilol. European Journal of Heart Failure, 9, 630–636.PubMedGoogle Scholar
  44. Franklin, B. A. (2009). Impact of psychosocial risk factors on the heart: Changing paradigms and perceptions. The Physician and Sportsmedicine, 37, 35–37.PubMedGoogle Scholar
  45. Franklin, B. A., Bonzheim, K., Gordon, S., & Timmis, G. C. (1998). Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: A 16-year follow-up. Chest, 114, 902–906.PubMedGoogle Scholar
  46. Franklin, B. A., Gordon, S., & Timmis, G. C. (1992). Amount of exercise necessary for the patient with coronary artery disease. The American Journal of Cardiology, 69, 1426–1432.PubMedGoogle Scholar
  47. Frasure-Smith, N., & Lesperance, F. (2005). Reflections on depression as a cardiac risk factor. Psychosomatic Medicine, 67(Suppl 1), S19–S25.PubMedGoogle Scholar
  48. Frasure-Smith, N., Lesperance, F., & Talajic, M. (1995). Depression and 18-month prognosis after myocardial infarction. Circulation, 91, 999–1005.PubMedGoogle Scholar
  49. Frisbee, J. C., Samora, J. B., Peterson, J., & Bryner, R. (2006). Exercise training blunts microvascular rarefaction in the metabolic syndrome. American Journal of Physiology. Heart and Circulatory Physiology, 291, H2483–H2492.PubMedGoogle Scholar
  50. Furber, S., Butler, L., Phongsavan, P., Mark, A., & Bauman, A. (2009). Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation. Patient Education and Counseling, 80, 212–218.Google Scholar
  51. Gaffney, F. A., Sjogaard, G., & Saltin, B. (1990). Cardiovascular and metabolic responses to static contraction in man. Acta Physiologica Scandinavica, 138, 249–258.PubMedGoogle Scholar
  52. Gardner, M. M., Robertson, M. C., & Campbell, A. J. (2000). Exercise in preventing falls and fall related injuries in older people: A review of randomised controlled trials. British Journal of Sports Medicine, 34, 7–17.PubMedGoogle Scholar
  53. Grandes, G., Sanchez, A., Sanchez-Pinilla, R. O., Torcal, J., Montoya, I., Lizarraga, K., et al. (2009). Effectiveness of physical activity advice and prescription by physicians in routine primary care: A cluster randomized trial. Archives of Internal Medicine, 169, 694–701.PubMedGoogle Scholar
  54. Green, D. J. (2009). Exercise training as vascular medicine: Direct impacts on the vasculature in humans. Exercise and Sport Sciences Reviews, 37, 196–202.PubMedGoogle Scholar
  55. Hale, B. S., & Raglin, J. S. (2002). State anxiety responses to acute resistance training and step aerobic exercise across eight weeks of training. The Journal of Sports Medicine and Physical Fitness, 42, 108–112.PubMedGoogle Scholar
  56. Hamer, M., Kivimaki, M., Lahiri, A., Marmot, M. G., & Steptoe, A. (2010). Persistent cognitive depressive symptoms are associated with coronary artery calcification. Atherosclerosis, 210(1), 209–213.PubMedGoogle Scholar
  57. Hegel, M. T., Griegel, L. E., Black, C., Goulden, L., & Ozahowski, T. (1997). Anxiety and depression in patients receiving implanted cardioverter-defibrillators: A longitudinal investigation. International Journal of Psychiatry in Medicine, 27, 57–69.PubMedGoogle Scholar
  58. Herring, M. P., O’Connor, P. J., & Dishman, R. K. (2010). The effect of exercise training on anxiety symptoms among patients: A systematic review. Archives of Internal Medicine, 170, 321–331.PubMedGoogle Scholar
  59. Hertogh, E. M., Vergouwe, Y., Schuit, A. J., Peeters, P. H., & Monninkhof, E. M. (2010). Behavioral changes after a 1-year exercise program and predictors of maintenance. Medicine and Science in Sports and Exercise, 42, 886–892.PubMedGoogle Scholar
  60. Hiitola, P., Enlund, H., Kettunen, R., Sulkava, R., & Hartikainen, S. (2009). Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. Journal of Human Hypertension, 23, 33–39.PubMedGoogle Scholar
  61. Hlatky, M. A., Chung, S. C., Escobedo, J., Hillegass, W. B., Melsop, K., Rogers, W., et al. (2010). The effect of obesity on quality of life in patients with diabetes and coronary artery disease. American Heart Journal, 159, 292–300.PubMedGoogle Scholar
  62. Hurley, B. F., Hagberg, J. M., Goldberg, A. P., Seals, D. R., Ehsani, A. A., Brennan, R. E., et al. (1988). Resistive training can reduce coronary risk factors without altering VO2max or percent body fat. Medicine and Science in Sports and Exercise, 20, 150–154.PubMedGoogle Scholar
  63. Joyner, M. J., & Green, D. J. (2009). Exercise protects the cardiovascular system: Effects beyond traditional risk factors. The Journal of Physiology, 587, 5551–5558.PubMedGoogle Scholar
  64. Kadoglou, N. P., Iliadis, F., Sailer, N., Athanasiadou, Z., Vitta, I., Kapelouzou, A., et al. (2009). Exercise training ameliorates the effects of rosiglitazone on traditional and novel cardiovascular risk factors in patients with type 2 diabetes mellitus. Metabolism, 59(4), 599–607.PubMedGoogle Scholar
  65. Kaiser, B. L., Brown, R. L., & Baumann, L. C. (2010). Perceived influences on physical activity and diet in low-income adults from two rural counties. Nursing Research, 59, 67–75.PubMedGoogle Scholar
  66. Kato, S., Onishi, K., Yamanaka, T., Takamura, T., Dohi, K., Yamada, N., et al. (2008). Exaggerated hypertensive response to exercise in patients with diastolic heart failure. Hypertension Research, 31, 679–684.PubMedGoogle Scholar
  67. Katz, D. A., Graber, M., Birrer, E., Lounsbury, P., Baldwin, A., Hillis, S. L., et al. (2009). Health beliefs toward cardiovascular risk reduction in patients admitted to chest pain observation units. Academic Emergency Medicine, 16, 379–387.PubMedGoogle Scholar
  68. Kelley, G. A., & Kelley, K. S. (2000). Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension, 35, 838–843.PubMedGoogle Scholar
  69. Kelley, G. A., & Kelley, K. S. (2010). Isometric handgrip exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Journal of Hypertension, 28, 411–418.PubMedGoogle Scholar
  70. Kesaniemi, Y. K., Danforth, E., Jr., Jensen, M. D., Kopelman, P. G., Lefebvre, P., & Reeder, B. A. (2001). Dose-response issues concerning physical activity and health: An evidence-based symposium. Medicine and Science in Sports and Exercise, 33, S351–S358.PubMedGoogle Scholar
  71. Kraus, W. E., & Slentz, C. A. (2009). Exercise training, lipid regulation, and insulin action: A tangled web of cause and effect. Obesity (Silver Spring), 17(Suppl 3), S21–S26.Google Scholar
  72. Kraus, W. E., Torgan, C. E., Duscha, B. D., Norris, J., Brown, S. A., Cobb, F. R., et al. (2001). Studies of a targeted risk reduction intervention through defined exercise (STRRIDE). Medicine and Science in Sports and Exercise, 33, 1774–1784.PubMedGoogle Scholar
  73. Lee, I. M., Hsieh, C. C., & Paffenbarger, R. S., Jr. (1995). Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA, 273, 1179–1184.PubMedGoogle Scholar
  74. Lichtman, J. H., Bigger, J. T., Jr., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lesperance, F., et al. (2008). Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association. Circulation, 118, 1768–1775.PubMedGoogle Scholar
  75. Lind, A. R., & McNicol, G. W. (1967). Muscular factors which determine the cardiovascular responses to sustained and rhythmic exercise. Canadian Medical Association Journal, 96, 706–715.PubMedGoogle Scholar
  76. Litt, M. D., Kleppinger, A., & Judge, J. O. (2002). Initiation and maintenance of exercise behavior in older women: Predictors from the social learning model. Journal of Behavioral Medicine, 25, 83–97.PubMedGoogle Scholar
  77. Low, P. A. (2008). Prevalence of orthostatic hypotension. Clinical Autonomic Research, 18(Suppl 1), 8–13.PubMedGoogle Scholar
  78. Maeda, S., Iemitsu, M., Miyauchi, T., Kuno, S., Matsuda, M., & Tanaka, H. (2005). Aortic stiffness and aerobic exercise: Mechanistic insight from microarray analyses. Medicine and Science in Sports and Exercise, 37, 1710–1716.PubMedGoogle Scholar
  79. Marcus, B. H., Lewis, B. A., Williams, D. M., Dunsiger, S., Jakicic, J. M., Whiteley, J. A., et al. (2007). A comparison of Internet and print-based physical activity interventions. Archives of Internal Medicine, 167, 944–949.PubMedGoogle Scholar
  80. Marcus, B. H., Napolitano, M. A., King, A. C., Lewis, B. A., Whiteley, J. A., Albrecht, A., et al. (2007). Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE. Health Psychology, 26, 401–409.PubMedGoogle Scholar
  81. Martens, E. J., Mols, F., Burg, M. M., & Denollet, J. (2010). Type D personality predicts clinical events after myocardial infarction, above and beyond disease severity and depression. Journal of Clinical Psychiatry, 71, 778–783.PubMedGoogle Scholar
  82. Mata, J., Silva, M. N., Vieira, P. N., Carraca, E. V., Andrade, A. M., Coutinho, S. R., et al. (2009). Motivational “spill-over” during weight control: Increased self-determination and exercise intrinsic motivation predict eating self-regulation. Health Psychology, 28, 709–716.PubMedGoogle Scholar
  83. Mathur, N., & Pedersen, B. K. (2008). Exercise as a mean to control low-grade systemic inflammation. Mediators of Inflammation, 2008, 109502.PubMedGoogle Scholar
  84. McAuley, E., Morris, K. S., Motl, R. W., Hu, L., Konopack, J. F., & Elavsky, S. (2007). Long-term follow-up of physical activity behavior in older adults. Health Psychology, 26, 375–380.PubMedGoogle Scholar
  85. McGowan, C. L., Levy, A. S., Millar, P. J., Guzman, J. C., Morillo, C. A., McCartney, N., et al. (2006). Acute vascular responses to isometric handgrip exercise and effects of training in persons medicated for hypertension. American Journal of Physiology-Heart and Circulatory Physiology, 291, H1797–H1802.PubMedGoogle Scholar
  86. Meyer, K., Samek, L., Schwaibold, M., Westbrook, S., Hajric, R., Beneke, R., et al. (1997). Interval training in patients with severe chronic heart failure: Analysis and recommendations for exercise procedures. Medicine and Science in Sports and Exercise, 29, 306–312.PubMedGoogle Scholar
  87. Milani, R. V., & Lavie, C. J. (2007). Impact of cardiac rehabilitation on depression and its associated mortality. The American Journal of Medicine, 120, 799–806.PubMedGoogle Scholar
  88. Milani, R. V., & Lavie, C. J. (2009). Reducing psychosocial stress: A novel mechanism of improving survival from exercise training. The American Journal of Medicine, 122, 931–938.PubMedGoogle Scholar
  89. Miles, D. S., Cox, M. H., & Bomze, J. P. (1989). Cardiovascular responses to upper body exercise in normals and cardiac patients. Medicine and Science in Sports and Exercise, 21, S126–S131.PubMedGoogle Scholar
  90. Millar, P. J., Bray, S. R., MacDonald, M. J., & McCartney, N. (2008). The hypotensive effects of isometric handgrip training using an inexpensive spring handgrip training device. Journal of Cardiopulmonary Rehabilitation and Prevention, 28, 203–207.PubMedGoogle Scholar
  91. Millar, P. J., Bray, S. R., McGowan, C. L., MacDonald, M. J., & McCartney, N. (2007). Effects of isometric handgrip training among people medicated for hypertension: A multilevel analysis. Blood Pressure Monitoring, 12, 307–314.PubMedGoogle Scholar
  92. Miller, J. P., Pratley, R. E., Goldberg, A. P., Gordon, P., Rubin, M., Treuth, M. S., et al. (1994). Strength training increases insulin action in healthy 50- to 65-year-old men. Journal of Applied Physiology, 77, 1122–1127.PubMedGoogle Scholar
  93. Miller, E. K., & Scofield, J. L. (2009). Slavic village: Incorporating active living into community development through partnerships. American Journal of Preventive Medicine, 37, S377–S385.PubMedGoogle Scholar
  94. Mlynarski, R., Wlodyka, A., & Kargul, W. (2009). Changes in the mental and physical components of the quality of life for patients six months after pacemaker implantation. Cardiology Journal, 16, 250–253.PubMedGoogle Scholar
  95. Mols, F., Martens, E. J., & Denollet, J. (2010). Type D personality and depressive symptoms are independent predictors of impaired health status following acute myocardial infarction. Heart, 96, 30–35.PubMedGoogle Scholar
  96. Mora, S., Cook, N., Buring, J. E., Ridker, P. M., & Lee, I. M. (2007). Physical activity and reduced risk of cardiovascular events: Potential mediating mechanisms. Circulation, 116, 2110–2118.PubMedGoogle Scholar
  97. Mosca, L., Mochari, H., Liao, M., Christian, A. H., Edelman, D. J., Aggarwal, B., et al. (2008). A novel family-based intervention trial to improve heart health: FIT Heart: Results of a randomized controlled trial. Circulation: Cardiovascular Quality and Outcomes, 1, 98–106.Google Scholar
  98. Munk, P. S., Staal, E. M., Butt, N., Isaksen, K., & Larsen, A. I. (2009). High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation A randomized controlled trial evaluating the relationship to endothelial function and inflammation. American Heart Journal, 158, 734–741.PubMedGoogle Scholar
  99. O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., et al. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 301, 1439–1450.PubMedGoogle Scholar
  100. Olvera, N., Bush, J. A., Sharma, S. V., Knox, B. B., Scherer, R. L., & Butte, N. F. (2010). BOUNCE: A community-based mother-daughter healthy lifestyle intervention for low-income Latino families. Obesity (Silver Spring), 18(Suppl 1), S102–S104.Google Scholar
  101. Orth-Gomer, K., Schneiderman, N., Wang, H. X., Walldin, C., Blom, M., & Jernberg, T. (2009). Stress reduction prolongs life in women with coronary disease: The Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). Circulation: Cardiovascular Quality and Outcomes, 2, 25–32.Google Scholar
  102. Pereira, M. A., Kriska, A. M., Day, R. D., Cauley, J. A., LaPorte, R. E., & Kuller, L. H. (1998). A randomized walking trial in postmenopausal women: Effects on physical activity and health 10 years later. Archives of Internal Medicine, 158, 1695–1701.PubMedGoogle Scholar
  103. Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Medicine and Science in Sports and Exercise, 36, 533–553.PubMedGoogle Scholar
  104. Pinto, B. M., Friedman, R., Marcus, B. H., Kelley, H., Tennstedt, S., & Gillman, M. W. (2002). Effects of a computer-based, telephone-counseling system on physical activity. American Journal of Preventive Medicine, 23, 113–120.PubMedGoogle Scholar
  105. Pollock, M. L., Franklin, B. A., Balady, G. J., Chaitman, B. L., Fleg, J. L., Fletcher, B., et al. (2000). AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: Benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation, 101, 828–833.PubMedGoogle Scholar
  106. Pollock, M. L., Miller, H. S., Jr., Janeway, R., Linnerud, A. C., Robertson, B., & Valentino, R. (1971). Effects of walking on body composition and cardiovascular function of middle-aged man. Journal of Applied Physiology, 30, 126–130.PubMedGoogle Scholar
  107. Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to addictive behaviors. The American psychologist, 47, 1102–1114.PubMedGoogle Scholar
  108. Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The transtheoretical model and stages of change. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, practice, and research (3rd ed., pp. 99–120). San Francisco: Jossey-Bass.Google Scholar
  109. Rider, R. A., & Daly, J. (1991). Effects of flexibility training on enhancing spinal mobility in older women. The Journal of Sports Medicine and Physical Fitness, 31, 213–217.PubMedGoogle Scholar
  110. Rigotti, N. A., McKool, K. M., & Shiffman, S. (1994). Predictors of smoking cessation after coronary artery bypass graft surgery. Results of a randomized trial with 5-year follow-up. Annals of Internal Medicine, 120, 287–293.PubMedGoogle Scholar
  111. Rosenbloom, J. I., Wellenius, G. A., Mukamal, K. J., & Mittleman, M. A. (2009). Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with coronary artery bypass grafts (CABG). American Heart Journal, 158, 867–873.PubMedGoogle Scholar
  112. Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99, 2192–2217.PubMedGoogle Scholar
  113. Rutledge, T., Linke, S. E., Krantz, D. S., Johnson, B. D., Bittner, V., Eastwood, J. A., et al. (2009). Comorbid depression and anxiety symptoms as predictors of cardiovascular events: Results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. Psychosomatic Medicine, 71, 958–964.PubMedGoogle Scholar
  114. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. The American Psychologist, 55, 68–78.PubMedGoogle Scholar
  115. Sacher, P. M., Kolotourou, M., Chadwick, P. M., Cole, T. J., Lawson, M. S., Lucas, A., et al. (2010). Randomized controlled trial of the MEND program: A family-based community intervention for childhood obesity. Obesity (Silver Spring), 18(Suppl 1), S62–S68.Google Scholar
  116. Sallis, J. F., Johnson, M. F., Calfas, K. J., Caparosa, S., & Nichols, J. F. (1997). Assessing perceived physical environmental variables that may influence physical activity. Research Quarterly for Exercise and Sport, 68, 345–351.PubMedGoogle Scholar
  117. Sillanpaa, E., Laaksonen, D. E., Hakkinen, A., Karavirta, L., Jensen, B., Kraemer, W. J., et al. (2009). Body composition, fitness, and metabolic health during strength and endurance training and their combination in middle-aged and older women. European Journal of Applied Physiology, 106, 285–296.PubMedGoogle Scholar
  118. Silva, M. N., Vieira, P. N., Coutinho, S. R., Minderico, C. S., Matos, M. G., Sardinha, L. B., et al. (2009). Using self-determination theory to promote physical activity and weight control: A randomized controlled trial in women. Journal of Behavioral Medicine, 33, 110–122.PubMedGoogle Scholar
  119. Singh, N. A., Clements, K. M., & Singh, M. A. (2001). The efficacy of exercise as a long-term antidepressant in elderly subjects: A randomized, controlled trial. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 56, M497–M504.Google Scholar
  120. Sirri, L., Potena, L., Masetti, M., Tossani, E., Magelli, C., & Grandi, S. (2010). Psychological predictors of mortality in heart transplanted patients: A prospective, 6-year follow-up study. Transplantation, 89(7), 879–886.PubMedGoogle Scholar
  121. Sjogren, T., Nissinen, K. J., Jarvenpaa, S. K., Ojanen, M. T., Vanharanta, H., & Malkia, E. A. (2006). Effects of a physical exercise intervention on subjective physical well-being, psychosocial functioning and general well-being among office workers: A cluster randomized-controlled cross-over design. Scandinavian Journal of Medicine & Science in Sports, 16, 381–390.Google Scholar
  122. Slentz, C. A., Duscha, B. D., Johnson, J. L., Ketchum, K., Aiken, L. B., Samsa, G. P., et al. (2004). Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE—a randomized controlled study. Archives of Internal Medicine, 164, 31–39.PubMedGoogle Scholar
  123. Slentz, C. A., Houmard, J. A., Johnson, J. L., Bateman, L. A., Tanner, C. J., McCartney, J. S., et al. (2007). Inactivity, exercise training and detraining, and plasma lipoproteins. STRRIDE: A randomized, controlled study of exercise intensity and amount. Journal of Applied Physiology, 103, 432–442.PubMedGoogle Scholar
  124. Smith, S. C., Jr., Blair, S. N., Bonow, R. O., Brass, L. M., Cerqueira, M. D., Dracup, K., et al. (2001). AHA/ACC Guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Journal of the American College of Cardiology, 38, 1581–1583.PubMedGoogle Scholar
  125. Stewart, J. M., Montgomery, L. D., Glover, J. L., & Medow, M. S. (2007). Changes in regional blood volume and blood flow during static handgrip. American Journal of Physiology - Heart and Circulatory Physiology, 292, H215–H223.PubMedGoogle Scholar
  126. Swain, D. P., & Franklin, B. A. (2002). Is there a threshold intensity for aerobic training in cardiac patients? Medicine and Science in Sports and Exercise, 34, 1071–1075.PubMedGoogle Scholar
  127. Tambalis, K., Panagiotakos, D. B., Kavouras, S. A., & Sidossis, L. S. (2009). Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: A systematic review of current evidence. Angiology, 60, 614–632.PubMedGoogle Scholar
  128. Tanaka, H., Monahan, K. D., & Seals, D. R. (2001). Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology, 37, 153–156.PubMedGoogle Scholar
  129. Tanasescu, M., Leitzmann, M. F., Rimm, E. B., Willett, W. C., Stampfer, M. J., & Hu, F. B. (2002). Exercise type and intensity in relation to coronary heart disease in men. JAMA, 288, 1994–2000.PubMedGoogle Scholar
  130. The Writing Group for the Activity Counseling Trial Research Group. (2001). Effects of physical activity counseling in primary care: The activity counseling trial: A randomized controlled trial. JAMA, 286, 677–687.Google Scholar
  131. Treuth, M. S., Ryan, A. S., Pratley, R. E., Rubin, M. A., Miller, J. P., Nicklas, B. J., et al. (1994). Effects of strength training on total and regional body composition in older men. Journal of Applied Physiology, 77, 614–620.PubMedGoogle Scholar
  132. Tucker, L. A., & Silvester, L. J. (1996). Strength training and hypercholesterolemia: An epidemiologic study of 8499 employed men. American Journal of Health Promotion, 11, 35–41.PubMedGoogle Scholar
  133. US Department of Health and Human Services. (2010). Healthy people 2010. Office of Disease Prevention and Health Promotion [Online]. http://www.healthypeople.gov/Document/HTML/Volume2/22Physical.htm Retrieved January 5, 2010.
  134. Varady, K. A., Bhutani, S., Church, E. C., & Phillips, S. A. (2010). Adipokine responses to acute resistance exercise in trained and untrained men. Medicine and Science in Sports and Exercise, 42, 456–462.PubMedGoogle Scholar
  135. Vincent, K. R., & Vincent, H. K. (2006). Resistance training for individuals with cardiovascular disease. Journal of Cardiopulmonary Rehabilitation, 26, 207–216.PubMedGoogle Scholar
  136. Webel, A. R., Okonsky, J., Trompeta, J., & Holzemer, W. L. (2010). A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. American Journal of Public Health, 100, 247–253.PubMedGoogle Scholar
  137. Wenthe, P. J., Janz, K. F., & Levy, S. M. (2009). Gender similarities and differences in factors associated with adolescent moderate-vigorous physical activity. Pediatric Exercise Science, 21, 291–304.PubMedGoogle Scholar
  138. Whelton, S. P., Chin, A., Xin, X., & He, J. (2002). Effect of aerobic exercise on blood pressure: A meta-analysis of randomized, controlled trials. Annals of Internal Medicine, 136, 493–503.PubMedGoogle Scholar
  139. Williams, M. A., Haskell, W. L., Ades, P. A., Amsterdam, E. A., Bittner, V., Franklin, B. A., et al. (2007). Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientific statement from the American Heart Association Council on clinical cardiology and council on nutrition, physical activity, and metabolism. Circulation, 116, 572–584.PubMedGoogle Scholar
  140. Williams, D. M., Lewis, B. A., Dunsiger, S., Whiteley, J. A., Papandonatos, G. D., Napolitano, M. A., et al. (2008). Comparing psychosocial predictors of physical activity adoption and maintenance. Annals of Behavioral Medicine, 36, 186–194.PubMedGoogle Scholar
  141. Wu, J. S., Yang, Y. C., Lu, F. H., Wu, C. H., & Chang, C. J. (2008). Population-based study on the prevalence and correlates of orthostatic hypotension/hypertension and orthostatic dizziness. Hypertension Research, 31, 897–904.PubMedGoogle Scholar
  142. Xu, X., Zhao, W., Lao, S., Wilson, B. S., Erikson, J. M., & Zhang, J. Q. (2010). Effects of exercise and L-arginine on ventricular remodeling and oxidative stress. Medicine and Science in Sports and Exercise, 42, 346–354.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Beth Parker
    • 1
    • 2
  1. 1.Henry Low Heart CenterHartford HospitalHartfordUSA
  2. 2.University of HartfordHartfordUSA

Personalised recommendations