Journal of Occupational Rehabilitation

, Volume 7, Issue 3, pp 173–183 | Cite as

Myocardial oxygen increases due to physical training in individuals with coronary heart disease (CHD): Rate pressure product (RPP) measurements

  • Majorkumar Govindaraju
  • Anil Mital


Endurance training is used to restore, as much as possible, the functional capabilities of individuals with coronary heart disease (CHD) during phase II of the cardiac rehabilitation program. The functional capabilities of individuals with CHD are a function of the capacity of their cardiovascular system which, in turn, is dependent upon the supply of oxygen to cardiac muscles. The greater the supply of oxygen to cardiac muscles (measured by peak myocardial oxygen consumption, MVO2max), the greater the ability of the circulatory system to meet the demands placed upon it. Rate pressure product (RPP; heart rate × systolic blood pressure) is an easy, reliable, and indirect measure of MVo2max. Therefore, contemporary cardiac rehabilitation programs should focus on enhancing RPPmax. Utilizing data from 210 individuals with CHD, a statistically significant pre-post conditioning effect in RPPmax was observed (p<0.01). In the absence of a control group, it was not possible to attribute increases in RPPmax to endurance training. This study also found no significant differences in RPPmax values among the three cardiac conditions investigated (bypass, angioplasty, and post-MI;p≥0.10). However, there were significant differences between the RPPmax values of men and women (p<0.01). The gender differences in RPPmax values disappeared when the data were normalized with respect to pretraining RPP values. Since a severe decline in MVo2max leads to most heart problems, it is suggested that future studies document the effect of endurance training on enhancing RPPmax. If such a relationship is established, then cardiac rehabilitation training programs should focus on enhancing MVo2max, by way of enhancing RPPmax. Such a focus is likely to result in a greater functional capability (ability to perform work). The discussion indicates how the design of jobs and assignment of individuals (both individuals with CHD and healthy people) to various jobs can be based on RPPmax rather than Vo2max, and how it can provide an objective basis for designing less stressful jobs from a psychological and physical demands perspective.

Key words

endurance training coronary heart disease (CHD) cardiac muscles rate presure product (RPP) 


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  1. 1.
    Mital A, Shrey DE, Broderick T, Kumar GM, Colon-Brown K, Gustin BW. Cardiac rehabilitaion: Current status and future trends. 1995; 7(1): 33–49.Google Scholar
  2. 2.
    Blumenthal JA, Jiang W, Waugh RA, Frid DJ, Morris JJ, Coleman RE, Hanson M, Babyak M, Thyrum ET, Krantz DS, O’Conner C. Mental stress-induced ichemia in laboratory and ambulatory ischemia during daily life.Circulation 1995; 92(8): 2102–2108.PubMedGoogle Scholar
  3. 3.
    Gobel FL, Nordstrom LA, Nelson RR,et al. The rate pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris.Circulation 1978; 57: 549–556.PubMedGoogle Scholar
  4. 4.
    Bruce RA, Fisher LD, Cooper NM. Separation of effects of effects cardiovascular disease and age on ventricular function with maximal exercise.Am J Cardiol 1974; 34: 757–762.PubMedCrossRefGoogle Scholar
  5. 5.
    May A, Nagle FJ. Changes in the rate-pressure product with physical training of individuals with coronary artery disease.Phys Ther 1984; 64(9): 1361–1366.PubMedGoogle Scholar
  6. 6.
    Lazarus B, Cullinane E, Thomson P. Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris.Am J Cardiol 1981; 47: 1075–1079.PubMedCrossRefGoogle Scholar
  7. 7.
    Starling MR, Michael MD, Crawford MH, O’Rourke RA. Superiority of selected treadmill exercise protocols predischarge and six weeks postinfarction for detecting ischemic abnormalities.Am Heart J 1982; 104: 1054–1060.PubMedCrossRefGoogle Scholar
  8. 8.
    Burek KA, Kirschet K, Topol EJ. Exercise capacity in victims 3 days after acute, uncomplicated myocardial infarction.Heart Lung 1989; 18: 575–582.PubMedGoogle Scholar
  9. 9.
    Specchia G, Falcone C, Traversi E, La Rovere MT, Guasti L, De Micheli G, Ardissino D, De Servi S. Mental stress as provocative test in victims with various clinical syndromes of coronary heart disease.Circulation 1991; 83(Suppl. II): II-108–II-114.Google Scholar
  10. 10.
    Hinderliter A, Miller P, Bragdon E, Ballenger M, Sheps D. Myocardial ischemia during daily activities: The importance of increased myocardial oxygen demand.J Am Coll Cardiol 1991; 18(2): 405–412.PubMedCrossRefGoogle Scholar
  11. 11.
    Detollenaere M, Duprez D, De Buyzere M, Vandekerchhove H, De Cock, N, De Backer G. Myocardial oxygen demands of job activities in post-myocardial infarct victims.Eur Heart J 1993; 14: 373–376.PubMedGoogle Scholar
  12. 12.
    Borg G. An introduction to Borg’s RPE-scale. Movement Publications: NY:Ithaca, 1985.Google Scholar
  13. 13.
    Legault SE, Freeman MR, Langer A, Armstrong PW. Pathophysiology and time course of silent myocardial ischemia during mental stress: clinical, anatomical, and physiological correlates.Brit Heart J 1995; 73: 242–249.PubMedCrossRefGoogle Scholar
  14. 14.
    Rozanski A, Bairey N, Krantz DS, Friedman J, Resser KJ, Morell M, Hilton-Chalfen S, Hestrin L, Bietendorf J, Berman D. Mental stress and the induction of silent myocardial ischemia in victims with coronary artery disease.New Engl J Med 1988; 318(16): 1005–1012.PubMedCrossRefGoogle Scholar
  15. 15.
    Mital A, Founooni-Fard H, Brown ML. Physical fatigue in high and very high frequency manual materials handling: Perceived exertion and physiological indicators.Hum Fact 1994; 36(2): 1994; 219–231.Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Majorkumar Govindaraju
    • 1
  • Anil Mital
    • 1
  1. 1.Industrial Engineering, Ergonomics and Engineering Controls LaboratoryUniversity of CincinnatiCincinnati

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