At the end of the 10-year study period, peak VO2 had increased 21.8 percent in the exercise group, and there was a 28 percent difference in resting ejecting fraction between groups (p < 0.01 for both comparisons). Peak VO2 was maintained at more than 60 percent through the 10 years among patients in the exercise program, whereas it was less than 55 percent in the control group. Quality of life was significantly better in the exercise group (p < 0.05), and there were fewer hospital readmissions and cardiac deaths.

"Moderate supervised exercise training performed twice weekly for 10 years maintains functional capacity of more than 60 percent of maximum VO2 and confers a sustained improvement in quality of life," concluded the investigators.

In an accompanying editorial, David J. Whellan, MD, MHS, department of medicine, Jefferson Medical College, Philadelphia, commended the authors for the "remarkable" adherence achieved by the study (88 percent), something that has been difficult to achieve in other exercise-based studies. Whellan advised caution when interpreting the results because of the small sample size, and commented on the differences between exercise- and disease-management programs.

"When the additional interactions with the supervising cardiologist and exercise physiologists, and the educational focus of the coronary club are taken into account, one has to question if this study was a study of exercise training or a study evaluating a disease management strategy," he said. "Instead of shying away from the reality that training interventions are more than just exercise, investigators need to better define the totality of the intervention being provided."