title: [Leisure-time sport activities and cardiac outpatient therapy in coronary patients].
abstract: BACKGROUND
  Exercise intensity in coronary patients is controlled by heart rate measurements. Very few investigations have compared the maximum heart rate in cardiac outpatient groups, in leisure-time sport activities, and especially in swimming.
  
  
  METHODS
  Within different exercise conditions 21 coronary patients, nine in well-compensated cardiac condition joining a training group and twelve joining the exercise group with lower intensity, without signs of heart failure, engaged in an incremental bicycle ergometry. A six-lead ECG was derived at the same time with a 24-h ECG. The performance tolerance was measured by the pulse limit derived in 20 patients; one patient failed to show signs of subjective or objective ischemia. During a 24-h ECG monitoring, the patients took part in a 1-h standardized cardiac outpatient program, a standardized swimming program 4 x 25 m, and a typical self-selected leisure-time activity.
  
  
  RESULTS
  The patients showed a peak work capacity of 2.2 W/kg and a symptom-free work capacity of 1.3 W/kg. The derived upper heart rate limit was passed during swimming by 19, during leisure-time activity by 16, and during cardiac outpatient program by two patients. The maximum of the mean overriding the limit occurred in leisure-time activity. Signs of ischemia occurred during ergometry in 15, during swimming training in ten patients, during leisure-time activity in eight, and during cardiac outpatient therapy in one. Arrhythmia < Lown IVa was documented on the ergometer in 15, during leisure-time sport activity in 15, during cardiac outpatient therapy in 17, and during swimming in eight patients. Arrhythmia Lown IVa occurred in one patient each during ergometry, leisure sports, and during the night.
  
  
  CONCLUSIONS
  Coronary patients are in danger to exercise beyond the pulse limit during swimming and other leisure-time sports and not during cardiac outpatient therapy. The upper heart rate limit should be observed during swimming and other endurance leisure-time activities, and is of little importance during cardiac outpatient therapy.
authors.affiliation: Abteilung Sportmedizin, Medizinische Klinik, Universität Tübingen, Silcherstrasse 5, 72074 Tübingen. hans-christian.heitkamp@med.uni-tuebingen.de
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Heitkamp
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schimpf
authors.forename: Arno
authors.initials: A
authors.lastname: Hipp
authors.forename: Andreas
authors.initials: A
authors.lastname: Niess
mesh_terms: D000553:Ambulatory Care; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013177:Sports; D013550:Swimming