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Vigorous Exercise Mimics Remote Ischemic Preconditioning and Provides Benefit in Cardiac Rehabilitation Patients

Jayme Rock-Willoughby, Debra Boardley, Dalynn T. Badenhop and Jodi Tinkel

Remote ischemic preconditioning (rIPC) has been shown to reduce the extent of myocardial infarction during an ischemic event as well as prior to a planned cardiac intervention. Vigorous exercise has been shown to have similar cardiovascular benefits to remote ischemic preconditioning in healthy individuals. Despite this effect, many individuals who exercise regularly present with cardiovascular disease. Those individuals who participate in cardiac rehabilitation programs provide a unique opportunity to determine whether the effects of vigorous exercise prior to a cardiac event result in improved outcomes. This investigation analyzed a cardiac rehabilitation database and compared individuals with the highest and the lowest exercise capacity as determined by their peak oxygen consumption on a cardiopulmonary exercise testing (CPX) test prior to initiating a cardiac rehabilitation program to compare baseline characteristics and outcomes. Group 1 (VigEx) includes individuals with higher peak VO₂ (mean peak VO₂ 33 and METS 9) and Group 2 (LowEx) includes those with lower peak VO₂ (mean peak VO₂ 11 and METS 3). 72% of the subjects in VigEx had a preserved ejection fraction (EF) but only 50% of subjects in LowEx. None of the subjects in VigEx had severely reduced EF, while 28% of LowEx had an EF < 30%. In conclusion, individuals with cardiovascular disease who participate in vigorous exercise prior to their cardiac event have improved EF and may obtain a protective benefit similar to rIPC. Also, given the safety of vigorous exercise in the cardiac rehabilitation population and its similar effects to rIPC, cardiac rehabilitation programs should promote vigorous exercise in capable individuals.