Background

Coronary artery disease (CAD) is the most common type of heart disease. In CAD the blood vessels to the heart become narrowed from plaque buildup, and over time this limits the blood flow to the heart. When the heart does not receive enough blood supply to sustain the heart muscle tissue, a heart attack can occur. About 18.2 million adults in the United States have CAD. CAD is responsible for approximately 370,000 deaths per year in the United States.

Symptoms/Risks

Symptoms of CAD may occur with exercise or at rest and include chest pain or pressure, arm or jaw pain, difficulty breathing and light-headedness. CAD may also present with no symptoms until a person experiences a heart attack. Risk factors for CAD include high cholesterol, high blood pressure, diabetes, smoking, increased age and family history of CAD, heart attack or stroke.

Sports Medicine Evaluation and Treatment

For those with CAD, visiting a sports medicine physician can be an integral part of returning to or increasing exercise. In your visit, be prepared to discuss your cardiac history, answer questions about your current activity level and disclose any symptoms with physical exertion such as chest pain, palpitations, light-headedness or fainting. Tests that a sports medicine physician may order to help guide them with exercise prescription include an electrocardiogram (EKG), echocardiogram, cardiac stress test using a treadmill and lab work.

If you have recently had a heart attack, or if you have a low exercise tolerance, spending time in cardiac rehabilitation can be helpful to strengthen your heart, increase your exercise tolerance and help increase your activity in a safe environment. As part of your care, you could be given a specific exercise prescription, including the type, intensity, duration and frequency of exercise that would be most beneficial and safe for you.

Injury Prevention

It is very important for people with CAD, or at risk for CAD, to exercise regularly. Consistent exercise has been shown to prevent CAD, improve symptoms associated with CAD, and help control risk factors for CAD such as high blood pressure, diabetes, and high cholesterol. Regular exercise improves blood flow to the heart, thus allowing for more exertion without experiencing symptoms of CAD such as chest pain (angina). The more exercise you get, the less likely you are to develop CAD.

Return to Play

For individuals first diagnosed with CAD, new types or intensities of exercise should only occur after consultation with a cardiologist, sports medicine physician or primary care physician. They may initially set limits on what heart rate, perceived level of exertion, types or duration of exercise that should be performed. If you begin to feel chest pain, dizziness, an irregular heart rate, lightheadedness or nausea while exercising, it is important to stop your activity. If these symptoms are occurring more frequently, or for longer durations, talk to your healthcare provider before continuing with the exercise plan.

AMSSM Member Authors
Mark Sederberg, DO, and Amy Powell, MD, FAMSSM

References
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–528.
Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention of Coronary Artery Disease. Journal of the American Heart Association. 2018;7(4) e2047-9980