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In a coronary club, physical trainings (30-60 lessons) by using bicycle ergometry were performed in 242 patients with various types of coronary heart disease, two thirds having a history of myocardial infarction. In 58% of the patients, the interval between the onset of myocardial infarction and the initiation of the trainings ranged 1 to 3 months. The trainings were found to be beneficial in 99.4% of the patients who had sustained myocardial infarction. After 30 training lessons, the threshold exercise capacity showed a 36.3% increase. Beneficial trainings depended on the number of trainings and, to a lesser degree, on patients' age. The trainings were followed by favorable changes in plasma lipid levels and hemorheology.

In experimental conditions, exercise increased electrical stability of the heart in trained rats, promoted an improvement of heart electrical stability in hypoxic hypoxia and under the effect of dextran, which is known to worsen blood rheologic properties, and had no effect on heart electrical stability in curantyl-treated rats. In 50 postmyocardial-infarction coronary patients, exercise was conductive to a drop in erythrocyte cholesterol/phospholipid ratio and total plasma cholesterol, and a rise in alpha-cholesterol level. In 10 untrained control coronary patients, erythrocyte cholesterol/phospholipid ratio remained unchanged.

Two months after myocardial infarction, 30 patients were subjected to a 10-week physical training course. Following the training, their threshold capacity grew by 46%. The effect of training (increased threshold capacity, reduced double product at submaximum effort) persisted for 1 year after myocardial infarction. In 28 control-group patients, changes of threshold capacity and double product at submaximum effort were not significant over the first post-infarction year. A relatively early post-infarction physical training is not associated with complications and largely speeds up physical rehabilitation.

The psychological effect of short exercise on a bicycle trainer (30 sessions over 10 weeks) was assessed in 20 postmyocardial infarction patients, while spontaneous mental changes were assessed in 21 untrained controls. Exercise was started 2 to 2.5 months after the attack. Mental states were assessed by the brief multifactorial personality assessment questionary (the BMPAQ test) and the neuroticism scale (NS). Physical exercise contributed to a more rapid psychological rehabilitation, as evidenced by the BMPAQ and NS testing. The mentality of the control patients improved less rapidly as shown by the BMPAQ test, while their NS parameters remained unchanged. Mental parameters of trained and untrained patients were basically similar within 12 months, after myocardial infarction as evidenced by the BMPAQ test.

This is a report on the results of physical training in 52 patients who had myocardial infarction and in 8 patients with angina pectoris of effort who had not suffered infarction. The training lasted 10 weeks, 3 times a week using a bicycle ergometer. 75% of the patients have accomplished the entire program of training. Patients who had myocardial infarction showed threshold capacity increased by 22%, which is considerably higher than in the group with no training. The work equivalent to the exercise was performed after training with lower pulse rate and systolic arterial pressure. In the majority of patients the volume of the heart decreased, as determined by X-ray and the amplitude coefficient of apex cardiogram diminished which justifies the assumption of improvement in the state of the myocardium in these patients. In patients with angina pectoris of effort there was an increase of threshold capacity which is explained by decreased pulse rate and systolic arterial pressure after physical loading.

The substantiation and the indications and contraindications for the physical training of patients who have had myocardial infarction are discussed on the basis of the experience gained at the Clinic of Internal Diseases of the Medical Department of K. Marx University in Leipzig (DDR) and the First Chair of Hospital Therapy of the N.I. Pirogov Second Moscow Medical Institute. On the strength of their own findings and the information in the current literature, the authors name, among other precoditions for training, diminution of capacity for muscular work, psychologic instability and the persisting threat of the progression of ischemic heart disease. The methods of functional diagnosis, which is also a necessary precondition for the physical rehabilitation of the patients are bicycle ergometry, auxiliary tests for the gaseous composition of blood and exhaled air, determination of the heart volume by means of X-ray, catheterization of the pulmonary artery with a floating catheter, ventriculography, and coronarography.

Results of physical training in 37 patients with the ischaemic heart disease with angina of effort are given, 31 one them had had myocardial infarction. Training on bicycle ergometer lasted 2 1/2 to 10 months. After exercise 75% of patients showed enhanced threshold capability, the "double product" (the heart rate x systolic AP) decreased at the expense of the pulse deceleration and decrease of the systolic AP with the standard exercise of 50 W. The maximum size of the "double product" under exercise and also with the appearance of angina remained unchanged. The heart volume after exercises did not change. Changes in haemodynamics depended on the initial functional state of the myocardium, which was evaluated by the degree of rise of the diastolic pressure in the pulmonary artery (DPPA) with 50 W exercise and according to the functional curves of the left ventricle traced by comparing DPPA and the minute volume. In patients with "good" myocardial function (DPPA not lower than 30 mm Hg) after exercises the stroke and minute volumes increased with the threshold exercise, DPPA decreased with 50 W, functional curve of the left ventricle approached the functional curve of healthy individuals. Patients with "bad" function (DPPA over 30 mm Hg and higher did not show) changes in haemodynamics and in the functional curve of the left ventricle.