Exercise: the neglected risk factor and the neglected treatment

To the editor: We read with interest, the editorial by Jelinek1 on exercise as a neglected risk factor and treatment in coronary artery disease. The studies by Stamatakis et al2 and Redfern et al3 emphasise the importance of exercise therapy in the effective management of coronary artery disease. We would like to suggest that the health benefits of exercise also apply to adults with congenital heart disease (CHD). At least 80% of children with CHD can now expect to reach adult life. Moreover, there are now at least as many adults as children with CHD. Although surgery improves the heart function and exercise capacity in patients with congenital heart disease, overall exercise capacity usually remains lower than in subjects with normal hearts.4 In addition, adults with CHD may have a poorer quality of life, more psychosocial problems and may feel physically impaired by their CHD. The quality of life in adults with CHD has also been found to be lower than in a healthy adult population. It has been suggested that future studies should include measurements of quality of life in this patient population. It has been seen that adults with CHD receive either little or wrong advice about exercise and physical activity levels. The consensus document of the European Society of Cardiology states that regular exercise at recommended levels can be performed and should be encouraged in all patients with CHD. In the past we studied this group of adults with CHD and identified reduced exercise capacity and participation. Most of them participated in significantly less than the recommended 30 min of moderate to vigorous physical activity on at least 5 days a week.5 We recently demonstrated that a simple 10-week exercise prescription improved overall physical fitness, self-esteem and quality of life (as assessed by various validated questionnaires) in adults with a range of congenital heart defects—including severe disease.6 In this sample, there was also a significant increase in moderate to vigorous physical activity across the study population and the majority of participants met the UK national guidelines for physical activity at follow-up after exercise training. This work suggests that exercise is a neglected treatment for CHD as much as for coronary artery disease and this should encourage us to develop exercise prescription as part of standard medical treatment.