Over time I have been continually amazed at what is learned each year about the positive aspects of regular exercise training. When I began my career as a clinical exercise physiologist in 1985, I worked with patients in the cardiac rehabilitation setting. Like today, this is where most of the jobs were located. But participants were limited primarily to those who had suffered a recent myocardial infarction or underwent coronary bypass graft surgery. Over time research has accumulated at a swiftening pace to allow for the insurance coverage of many other cardiac conditions to participate in cardiac rehabilitation. These include percutaneous coronary interventions, systolic heart failure, valve procedures, angina, and heart transplant. Recent papers published in excellent journals point to the benefit for those with an implantable cardiac defibrillator (1) and those who have undergone an ablation procedure to treat atrial fibrillation (2). So, we may see these patients in our programs in the future.

And during the SARS-CoV-2 COVID pandemic we have learned about the value of exercise as it relates to immune function and severity of COVID (3). It appears that higher exercise capacities, as expressed by peak VO2, are inversely related to the risk of hospitalization (4). Others have reported that regular physical activity is related to a reduced risk of SARS-CoV-2 infection, severe illness, and death (5).

With respect to general exercise the relationship between aerobic exercise and the risk of mortality in previously healthy individuals, and many of those with a chronic disease, has long been established. Recent data from the National Health Interview Survey (NHIS) found a unique association of reduced mortality (odds ratio = 0.90, 95% confidence interval = 0.83 – 0.97) in those who reported regular stretching routines (6). This is interesting and appears to be the first to report this association. The authors state that stretching may help individuals to keep exercising aerobically. This may also be related to the potential value of stretching to reduce injuries as reviewed in the September 2021 issue of this journal (7). But there may be other potential benefits related to vascular function (8).

I am excited to see what future research in exercise training will reveal to us. But I think it is safe to say that if someone with a chronic disease or condition can exercise safely, they should be encouraged as there is very likely a significant upside for them with little risk of a downside. And this is particularly true, I believe, when exercise is prescribed by a clinical (or accredited) exercise physiologist and when necessary, applied in a supervised setting.

1.
Atwater
BD,
Li
Z,
Pritchard
J,
Greiner
MA,
Nabutovsky
Y,
Hammill
BG.
Early increased physical activity, cardiac rehabilitation, and survival after implantable cardioverter-defibrillator implantation
.
Circ Cardiovasc Qual Outcomes
.
2021
Aug
;
14
(
8
):
e007580
.
Epub 2021 Jul 21. doi:10.1161/CIRCOUTCOMES.120.007580. PubMed PMID: 34284598
2.
Cai
C,
Bao
Z,
Wu
N,
Wu
F,
Sun
G,
Yang
G,
Chen
M.
A novel model of home-based, patient-tailored and mobile application-guided cardiac telerehabilitation in patients with atrial fibrillation: a randomised controlled trial
.
Clin Rehabil.
2021
Jul
16
:
2692155211032372. Epub July 16, 2021. doi:10.1177/02692155211032372. PubMed PMID: 34266323
3.
Nieman
DC.
Exercise is medicine for immune function: implication for COVID-19
.
Curr Sports Med Rep.
2021
Aug
1
;
20
(
8
):
395
401
.
doi:
.
PubMed PMID: 34357885
4.
Brawner
CA,
Ehrman
JK,
Bole
S,
Kerrigan
DJ,
Parikh
SS,
Lewis
BK,
Gindi
RM,
Keteyian
C,
Abdul-Nour
K,
Keteyian
SJ.
Inverse relationship of maximal exercise capacity to hospitalization secondary to coronavirus disease 2019
.
Mayo Clin Proc.
2021
Jan
;
96
(
1
):
32
9
.
Epub 2020 Oct 10. doi:10.1016/j.mayocp.2020.10.003. PubMed PMID: 33413833; PubMed Central PMCID: PMC7547590
5.
Lee
SW,
Lee
J,
Moon
SY,
Jin
HY,
Yang
JM,
Ogino
S,
Song
M,
Hong
SH,
Abou Ghayda
R,
Kronbichler
A,
Koyanagi
A,
Jacob
L,
Dragioti
E,
Smith
L,
Giovannucci
E,
Lee
IM,
Lee
DH,
Lee
KH,
Shin
YH,
Kim
SY,
Kim
MS,
Won
HH,
Ekelund
U,
Shin
JI,
Yon
DK.
Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study
.
Br J Sports Med.
2021
Jul
22
:
bjsports-2021-104203. Epub July 22, 2021. doi:10.1136/bjsports-2021-104203. PubMed PMID: 34301715; PubMed Central PMCID: PMC8300550
6.
Sheehan
CM,
Li
L.
Associations of exercise types with all-cause mortality among U.S. adults
.
Med Sci Sports Exerc.
2020
Dec
;
52
(
12
):
2554
62
.
doi:
10.1249/MSS.0000000000002406. PubMed PMID: 32520868
7.
Behm
DG,
Kay
AD,
Trajano
GS,
Alizadeh
S,
Blazevich
AJ.
Effects of stretching on injury risk reduction and balance
.
J Clin Exerc Physiol
.
2021
;
10
(
3
):
106
16
8.
Bisconti
AV,
E,
Longo
S,
Venturelli
M,
Coratella
G,
Limonta
E,
Doria
C,
Rampichini
S,
Esposito
F.
Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system
.
J Physiol.
2020
Sep
;
598
(
17
):
3645
66
.
Epub 2020 Jul 1. doi:10.1113/JP279866. PubMed PMID: 32613634