In the last 20 years, the angioplasty has reduced the mortality from coronary artery disease. However, shortly after the introduction of CA, it became evident that even the most skilled operators cannot avoid the problem of restenosis, and 25% to 40% of patients need re-intervention within 6 to 12
months. In the USA alone, about 25,000 patients who had angioplasty or
stent in 1995 had to repeat the procedure within one year.
	Restenosis creates other problems. One is an increase in cost. Assuming an average cost of $10,000 per procedure and a restenosis rate requiring re-intervention of 40% per year, restenosis costs just below $2 billion annually. Another dilemma is the impact on quality of life and outcome. Almost half of patients, after an encouraging improvement 1 to 2 months after the procedure, must face chest pain once again.
	We studied moderate-intensity exercise on the restenosis rate after angioplasty or stent, functional capacity, quality of life, and prognosis.

	We studied patients with coronary artery disease who had angioplsty or stent on one or more coronary arteries. Of the 130 patients, 118 (average age 57 years) completed the study. Patients were in 2 matched groups. One group (T) did exercise training and the other group (S) did not. The S group was encouraged to be couch potatos.
	The exercise training was supervised exercise sessions 3 times a week for 6 months, at an intensity of 60% of peak VO2. Control patients were asked to avoid strenuous activity such as climbing stairs or carrying heavy objects. At 1 month after the procedure and within 1 week from the end of the study, all patients had an exercise test with gas exchange, as well as thallium test.
	In the thallium test, thallium uptake was graded on a 5 point scale from 0 (normal) to 4 (no uptake). Angiograms were done in all patients right after the procedure and was repeated in 84 patients after 6 months. Quality of life was checked by questionnaire. Questionnaires were done the week before
enrollment and at 6 and 12 months.

	Only exercising (T) patients had significant improvement in peak VO2, ventilation and O2 pulse. Defects on thallium images increased by 14% in the T group and by 44% in those not excerising (S). The restenosis rate was unaffected by exercise training. However, in patients with restenosis, the thallium uptake score was significantly improved in T patients compared with S patients. Quality of life significantly improved in T patients, but not in S patients.
	Patients were followed for 33 months. T patients had a
significantly higher event-free rate. Among T patients, 3 had a new procedure, 2 had bypass, and 1 had angina on exertion. Among S patients, 11 had a new PTCA, 5 had bypass, and 3 had exertional angina. T patients also had a lower rate of hospital re-admission than did S patients. Of patients
with diabetes, those untrained had a higher restenosis rate than those in the T group.

	CONCLUSIONS: Moderate exercise training improves functional capacity and quality of life after angioplasty. These important benefits seem to translate into more favorable outcomes. Although restenosis rate was
not much reduced by exercise, trained patients had less angina and less hospital re-admission, as well as feeling better.
	This suggests that long-term regular moderate exercise may improve endothelial function. Even if restenosis is stopped by exercise, the
increased heart thallium uptake is suggests an improvement of the capacity of small coronary vessels, which can compensate. Also, the new blockages are reduced in T patients, who had an improved coronary risk factors after physical conditioning.
	Patients who have angioplasty receive important benefits from exercising regularly. A post-training improvement in cardiac blood flow happens even when restonosis occurs.

Title: Moderate Exercise Training Improves Outcomes Following Coronary
Angioplasty or Stenting
Speaker: Romualdo Belardinelli, MD, Azienda Ospedaliera Lancisi Institute