However, according to a survey of cardiac rehabilitation in Italy, the ISYDE project, although the benefits of an active lifestyle have been clearly demonstrated by scientific data, only a few Italians and Europeans take up regular physical exercise, especially after a cardiac event.
One of the ISYDE investigators, Professor Romualdo Belardinelli, has examined the little investigated role of dancing in the exercise programme of rehabilitation patients. Some evidence suggests that dancing, as an example of aerobic interval training, may prove superior to moderate endurance training because of its effect on oxidative stress. A study reported last year showed that high-intensity interval training reduced left ventricular remodeling and improved aerobic capacity and quality of life in a group of elderly post-infarction patients when applied in addition to their standard medications.
Even if dancing doesn't come naturally, most rehabilitation patients will see sexual satisfaction as a quality-of-life measure and will be keen to resume activities. But, says presenter Dr Elaine Steinke from Wichita, USA, that may not be as simple as they hope; cardiac patients have multiple worries. "They may have concerns about resuming sexual activity, feelings of sexual inadequacy, changes in sexual interest or changes in patterns of sexual activity," she says. In addition, anxiety, depression, co-morbid conditions and medications may all have an effect on the restoration of a satisfying sex life.
"Prior research has largely focused on sexual frequency," adds Steinke, "and certainly a cardiac event may well cause a reduction in sexual activity. Patients are worried about chest symptoms during intercourse or even an acute ischemic event during sex. Many lack information about returning to sexual activity."
One 2007 study of sexual satisfaction in 35 women with either non-STEMI or unstable angina found that 49% had resumed sexual activity within 12 weeks of discharge, 35% were not sexually satisfied, 41% were "mostly dissatisfied", and 24% "somewhat dissatisfied". For those not resuming sexual activity, 83% reported described their desire as much lower than prior to illness.
A further study cited by Steinke found that both women and men reported significantly less sexual activity and less satisfaction after an event than before. Age negatively, and education and perceived health positively, were all associated with frequency and satisfaction.
And if not dancing or sex, what about prayer? While the evidence from randomised controlled trials is sparce, one RCT reported by the Lancet in 2005 found that neither prayer nor "music, imagery and touch" therapy significantly improved clinical outcome after catheterisation or PCI. Similarly, a sub-analysis of 503 patients in the ENRICHD trial who completed a Daily Spiritual Experiences questionnaire within 28 days of their AMI (with 18 month follow-up) found little evidence that spirituality, church attendance or frequency of prayer was associated with cardiac morbidity or all-cause mortality post-infarction. However, while grade A evidence of any benefit is slim, findings from anecdotal reports cannot yet rule out the importance of spirituality as a coping tool.