Cycling or Angioplasty? Which is better?

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For patients who have narrowed coronary arteries, would it be better to recommend the standard surgical procedure or to recommend exercise? In most of our minds, there would be no way that an exercise protocol could ever be comparable to a surgical procedure, however, the following study offers a challenge to this perception. 


Study citation: 
Hambrecht R et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease. A randomized trial. Circulation 2004. pp 1371 - 1377



What was the objective of the study?

Comparing cycling vs coronary angiography, the researchers wanted to assess whether:

  1. heart symptoms improved or worsened
  2. the coronary artery would get narrower or not
  3. one treatment was cheaper than the other.


This was over a period of 12 months.

The cycling group involved about 20 minutes per day of stationary bike cycling at 70% of maximal heart rate + one 60-minute group training session of aerobic exercise per week. 
 


What were the results?

  • Event-free survival was 70% in the surgery group vs 88% in the exercise group
     
  • Exercise group had a 20% increase in maximal exercise tolerance, the surgery group had no change
     
  • Exercise group had a 16% increase in their maximal oxygen uptake (measure of aerobic fitness), the surgery group had no change in fitness
     
  • 32% in the exercise group had disease progression, but the surgery group had 47% of patients experience disease progression
     
  • 15% (7 out of 47 patients) in the surgery group experienced re-stenosis (as in the artery re-narrowed). There was no re-stenosis in the exercise group
     
  • Exercising training cost $3708 / patient vs $6086 / patient in the surgery group.

 

What were the authors' conclusions? 

The authors argue that this study demonstrates the need to consider physical activity as an important part of cardiac therapy. They write:

"In this sense, percutaneous coronary intervention without comprehensive risk factor modification should be viewed as a suboptimal therapeutic strategy." 


So the authors do not conclude that cycling is "better" than angioplasty. However, they do argue that physical activity should be part of therapy.

 

To read the full paper, click here

George Cho