title: The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease.
abstract: BACKGROUND
  Although exercise training improves cardiovascular disease (CVD) risk factors, few studies have evaluated its potential long-term cost-effectiveness.
  
  
  METHODS
  Using the Cardiovascular Disease Life Expectancy Model, a validated disease simulation model, we calculated the life expectancy of average 35- to 74-year-old Canadians found in the 1992 Canadian Heart Health Survey. The impacts of exercise training on cardiovascular risk factors were estimated as a 4% decrease in low-density lipoprotein (LDL) cholesterol, a 5% increase in high-density lipoprotein (HDL) cholesterol, and a 6 mm Hg decrease in both systolic and diastolic blood pressure. Exercise adherence was estimated at 50% for the first year and 30% for all additional years. Costs for a supervised exercise program determined from Canadian sources and converted to US dollars were estimated at $605 for the first year (medical evaluation, stress test, exercise prescription, and program costs) and $367 for all additional years (program costs). For an unsupervised program, the costs were estimated at $311 for the first year and $73 for all additional years.
  
  
  RESULTS
  The cost-effectiveness (CE) of an unsupervised exercise program (1996 U.S. dollars) was less than $12,000 per year of life saved (YOLS) for all individuals. The CE of a supervised exercise program was less than $15,000/YOLS for men with CVD, and between $12,000 and $43,000 for women with CVD and men without CVD.
  
  
  CONCLUSIONS
  Given the relatively few risks, substantial long-term benefits, and modest costs, an unsupervised exercise training program represents good value for all. A more expensive supervised exercise program is also cost-effective for most individuals with CVD.
authors.affiliation: Centre for the Analysis of Cost-Effective Care, Montreal General Hospital, Quebec.
authors.forename: I
authors.initials: I
authors.lastname: Lowensteyn
authors.forename: L
authors.initials: L
authors.lastname: Coupal
authors.forename: H
authors.initials: H
authors.lastname: Zowall
authors.forename: S A
authors.initials: SA
authors.lastname: Grover
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D015444:Exercise; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011322:Primary Prevention / Q000191:economics; D012307:Risk Factors