Coronary Artery Disease

A summary of the ACSM Position Stand

George Cho, MFSc, CEP, CSCS





It is redundant to emphasize how much of a public health concern coronary artery disease has become in Canada and the western world. But perhaps more important than mere epidemiological stats is the individual suffering experienced by patients and family. Thus,  ways to alleviate symptoms and improve quality of life in such individuals is a crucial conversation to have. This article seeks to bring physical activity and exercise into that conversation. 

Patients may ask: "Is it safe for me to be physically active?"  "If so, are there guidelines that can help me get started on an exercise program?" Primary care health providers like medical doctors and naturopathic doctors may also have questions regarding how to discuss exercise with their patients. To answer these important questions, one can turn to the American College of Sports Medicine (ACSM) Position stand entitled: "Exercise for Patients with Coronary Artery Disease." I provide here a brief summary of that paper, and a link to the full document can be found at the bottom. It is my hope that this brief article will help both patients and doctors alike to appreciate the potentially impactful role a safely applied exercise program may have in the patient care of coronary artery disease. 



Coronary artery disease (CAD) is linked to many clinical markers and lifestyle behaviors such as blood lipids, smoking, blood pressure, etc. Physical activity may help patients with CAD by beneficially impacting these risk factors. Physical activity and exercise has been shown to:

  • reduce total cholesterol, low-density lipoproteins, triglycerides, and increase high-density lipoproteins. 
  • may benefit in the process of smoking cessation (a major risk factor for CAD)
  • help manage weight (obesity is an independent risk factor) thereby potentially helping to lower blood pressure (another risk factor)
  • decrease depression in clinically depressed patients following an acute myocardial infarction (heart attack)
  • reduce fatal cardiovascular events and total mortality by 20-25% in those undergoing exercise-based rehabilitation



Before starting to increase physical activity levels, patients should see their physician to complete a medical history, physical examination and a graded exercise test. The doctor will be able to ascertain if further testing is necessary, or he/she will clear the patient for activity.

High Risk Patients: these patients should defer exercise until the below conditions have been controlled. Though not a full list, some of the major high risk conditions are:  

  • unstable angina
  • severe aortic stenosis
  • uncontrolled cardiac arrhythmias
  • decompensated congestive heart failure
  • acute myocarditis and or infective disease


Increased Risk patients: these individuals should exercise under direct medical supervision:

  • severely depressed left ventricular function
  • resting complex ventricular arrhythmias
  • ventricular arrhythmias appearing or increasing with exercise
  • decrease in systolic blood pressure with exercise
  • survivors of sudden cardiac arrest
  • recent myocardial infarction complicated by congestive heart failure
  • marked exercise-induced ischemia

Re-evaluation of patients should be undertaken generally every 2 - 3 months at the start of a program, then yearly thereafter. 



Below are some basic exercise guidelines for patients with coronary artery disease.

  1. Large-muscle group continuous or interval exercise for 20 - 40 minutes
  2. Strength training: 10 - 12 exercises/session; 10 - 12 repetitions
  3. Exercise on 3 non-consecutive days
  4. Include warm-up and cool-down
  5. moderate, comfortable intensity: approximately 40 - 85% of max heart rate*
  6. start slowly at first and gradually increase intensity and duration.
  7. programs should be individualized (matched to patient's unique circumstance)

*max heart rate is roughly estimated by the following equation: 220 - age = max heart rate



The following are some concluding statements from the ACSM: "It is the position of the American College of Sports Medicine that most patients with coronary artery disease should engage in individually designed exercise programs to achieve optimal physical and emotional health. It is recommended that programs include comprehensive preexercise evaluation, including a graded exercise test; and an individualized exercise prescription




Exercise for Patients with Coronary Artery Disease. Medicine & Science in Sports & Exercise: March 1994 - Volume 26 - Issue 3, pp 400

Click here for the full article

Note: If you or someone you know has CAD and are interested in starting an exercise program, consider one of our services on the "clinic" page. 

George Cho