Safety of exercise-based cardiac rehabilitation and exercise testing for cardiac patients in Japan: a nationwide survey.
BACKGROUND
The safety of exercise-based cardiac rehabilitation (CR) has not been investigated in Japan, so a nationwide survey was conducted to investigate the incidence of adverse events (AEs) associated with CR and exercise testing.


RESULTS
In total, 136 hospitals reported operating recovery-phase CR programs, amounting to 383,096 patient-hours of exercise training. The incidence rates of all AEs and life-threatening AEs (LAE: death, cardiac arrest, acute myocardial infarction, cardiac rupture) during exercise sessions were 12 and 1 event/383,096 patient-hours (3.13 and 0.26 events/100,000patient-hours), respectively. When CR programs were categorized as "Formal" in which an exercise prescription based on exercise testing was issued to individual patients or "Non-formal" without exercise prescription, the incidence of AEs during and within the 24 h after an exercise session was significantly lower in the Formal than the Non-formal CR programs (P<0.001), despite similar hospital size and coronary intervention volumes between the 2 category hospitals. Moreover, LAEs did not occur in 277,721 patient-hours in Formal CR, whereas 2 LAEs occurred in 105,375 patient-hours in Non-formal CR (P<0.05). During 469,215 exercise testing sessions, 3 LAEs (0.64 event/100,000tests) and 31 non-LAEs (6.61 events/100,000tests) occurred.


CONCLUSIONS
This first nationwide survey in Japan revealed that both exercise-based CR and exercise testing are generally safe, and that Formal CR, in which an individual exercise prescription is determined by exercise testing, is particularly safe.
Cardiology, Morioka Red Cross Hospital.
Masahiko
M
Saito
Kenji
K
Ueshima
Muneyasu
M
Saito
Toshiji
T
Iwasaka
Hiroyuki
H
Daida
Masahiro
M
Kohzuki
Shigeru
S
Makita
Hitoshi
H
Adachi
Hiroyoshi
H
Yokoi
Kazuto
K
Omiya
Hiroshi
H
Mikouchi
Hiroyuki
H
Yokoyama
Yoichi
Y
Goto
D044466:Asian People; D018572:Disease-Free Survival; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006331:Heart Diseases / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015996:Survival Rate