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LITTLE FALLS, N.J., May 8 -- Researchers have found more evidence that exercise is beneficial in cardiovascular disease, even in heart failure.

Three studies presented in Stockholm at EuroPRevent, the congress of the European Association of Cardiovascular Prevention and Rehabilitation, found that exercise improved measures of heart disease after coronary artery bypass graft (CABG) surgery, in stable coronary artery disease, and in heart failure.

Clyde W. Yancy, M.D., of Baylor University, co-author of recent updates to treatment guidelines for chronic heart failure, said the abstracts are consistent with the growing body of evidence about the benefits of exercise.

He said they give added weight to the notion that "our original view of exercise and heart failure has been and needs to continue to be revisited."

In patients with stable heart failure, exercise improved endothelial function, Marcus Sandri, M.D., of the University of Leipzig in Germany, and colleagues reported at the conference.

The effects of exercise did not diminish with age, Dr. Sandri said.

The researchers randomized 50 patients with stable heart failure to an exercise regimen of four short sessions daily for four weeks, or to a control group that didn't exercise. An additional 50 healthy subjects were also randomized to an exercise or control group.

In both young and old heart failure patients who exercised, flow-mediated dilation improved significantly (from 9.2 to 13.1 in young patients and from 9.0 to 12.4 in old patients, P
"The training effect was not significantly diminished among older patients with heart failure, underlining the potential of rehabilitation interventions in this patient group, where congestive heart failure is most prevalent," they said.

Another study found that daily exercise training resulted in better event-free survival rates than percutaneous coronary intervention with stent angioplasty, according to Sven Moebius-Winkler, M.D., of the University of Leipzig, and colleagues.

In the pilot study, 101 stable coronary artery disease patients were treated either "conservatively" with an exercise program or with stent angioplasty.

After five years of follow-up, event-free survival was 63% in the exercise group, compared with 40% in the PCI group (P=0.037).

During follow-up, 36 cardiovascular events occurred in 19 patients in the exercise group, compared with 55 events in 30 patients in the stent group.

"Daily exercise training in addition to optimal medical treatment in stable CAD patients leads to a better event-free survival rate compared with stent angioplasty," the researchers said.

In the third study, aerobic training improved physical capacity and hemodynamic response after coronary artery bypass graft (CABG) surgery compared with no exercise, according to Tomasz Mikkulski, M.D., of the Medical Research Center in Warsaw, Poland, and colleagues.

A total of 60 patients who had undergone surgery about two months prior were randomized to either six weeks of aerobic training on a cycloergometer three times per week or to a control group that didn't exercise.

Plasma levels of nitric oxide, a marker of endothelial function, increased significantly only in those who exercised (P
Exercise also significantly reduced LDL cholesterol levels compared with controls (2.61 versus 2.24 mmol/l, P
Those who exercised had significant improvements in markers of inflammation -- fibrinogen (4.0 versus 3.3 g/l PPP
C-reactive protein and IL-6 levels tended to be lower in the exercise group, but were not significantly different from controls.

The studies add to a growing body of literature that exercise improves outcomes in patients with heart failure.

In November 2008, researchers at the American Heart Association meeting reported preliminary findings of the HF-ACTION trial, which found that exercising for two hours a week on top of optimal treatment may decrease mortality and heart failure hospitalizations in heart failure patients. (See AHA: Exercise May Reduce Heart Failure Mortality and Morbidity)

Although the 2,331-patient trial failed to meet its primary endpoint of a reduction in all-cause mortality and hospitalizations, secondary analyses found that exercise could significantly reduce the mortality and heart failure hospitalizations combined.

Dr. Yancy said the latest studies give even more impetus to changes in heart failure treatment that have been taking hold over the years.

"There was a time when it was very reasonable to suggest the patient with heart failure needed to adopt a sedentary lifestyle because it was a concern that exercise might have worsened HF," Dr. Yancy said. "This represents research that was done or observations that were made many, many years ago, and over the last two decades there's been a growing clinical concern, and now a database to support that concern that, in fact, that original advice was not correct."

He said heart failure patients, unless they have abject heart failure, should be "encouraged to maintain a reasonable amount of activity."

In the April issue of Circulation, Dr. Yancy was a co-author of an update to ACC/AHA guidelines for the management of chronic heart failure. One of those Class-I recommendations stated that exercise "is beneficial as an adjunctive approach to improve clinical status in ambulatory patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction."

"Now there's a growing body of evidence to support our guideline statement, and I'm encouraged that these data points [from the conference] are out and all data points are consistent," Dr. Yancy said.