Australian Preventive Cardiologist Dr Tony Neaverson has invented a novel form of exercise, which he has termed “Neocardial Exercise”. At the Noosa Heart Prevention Clinic in Australia’s South Queensland he continues his work of over thirty years in the prevention of, and reduction in, atherosclerosis- the scourge of cardiac patients.

Working in conjunction with Margaret Bermingham from the Department of Bio-science University of Sydney, they have demonstrated the fact that the “Bad Cholesterol” LDL comes in various particle sizes – from very small dense type B, to relatively speaking larger molecules Type A.

It is these Type B Dense particles which are particularly dangerous and atherogenic.

Their work has shown that the ratio of serum triglyceride to HDL-cholesterol (the good one) correlates with the small dense type B particle in that, if your ratio is greater than two, then all your LDL particles are small dense type B and you are a red hot candidate for a heart attack.

Work in the Heart Disease Prevention centre has shown that by using “Neocardial Exercise” for periods of less than thirty minutes three times a week increases the HDL and reduced the triglyceride caused a highly significant reduction in the ratio in both 145 Primary (p=0.008) and 143 Secondary Prevention (p= 0.0007) patients.

This reduction was sufficient to reduce the ratio to Less then 2 in vast majority of patients within six weeks of commencing the exercise. They further showed that patients with the smallest particles had significantly greater increase in particle size than those who had the largest particles.

This work was initially presented at an American Heart Association Meeting in Honolulu in 1993 in which other significant benefits after six weeks of this form of exercise were discussed.

• Improved physical fitness – men improved by 22%. Women by 33%

Increasing physical fitness lowers the risk of death by 23%

There is a lower risk of developing cardiovascular disease

Fitter people are also 3-6 times less likely to develop diabetes, high blood pressure and metabolic syndrome than those who are unfit

• Lowering Blood Pressure - Both men and women significantly lower blood pressure. (P= Less then 0.0001). On average systolic fell 9mmHg, Diastolic 5mmHg

This effect is greater in patients with hypertension (BP Greater then 140/80mmHg)

Mean fall from 164mmHg systolic to 144mmHg p = Less then 0.0001

Mean fall from 94mmHg diastolic to 80mmHg p = Less then 0.0001

• Beginning Weight Loss - Significant reduction in Body Mass Index

Without dietary restriction in obese or overweight p = Less then 0.0001

Changes in Traditional Biochemical Risk Factors:

Total Cholesterol

Primary Prevention High Risk - 10%*

Low Risk - 4%

Secondary Prevention High Risk -16%*

Low Risk - 4%

LDL cholesterol

Primary Prevention High Risk -11%*

Low Risk - 3%

Secondary Prevention High Risk -9%*

Low Risk - 3%

HDL cholesterol

Primary Prevention High Risk + 7%*

Low Risk + 1%

Secondary Prevention High Risk +10%*

Low Risk + 4%*

Triglycerides

Primary Prevention High Risk - 11%*

Low Risk - 12%*

Secondary Prevention High Risk - 27%*

Low Risk - 15%*

Total cholesterol/HDL

Primary Prevention High Risk –15%*

Low Risk - 5%

Secondary Prevention High Risk – 28%*

Low Risk - 8%*

Non HDL cholesterol

Primary Prevention High Risk -8%

Low Risk - 5%

Secondary Prevention High Risk – 19%*

Low Risk - 5%

• Indicates significant finding

These results after eighteen sessions of exercise over six week’s show a very significant reduction in risk of a cardiac event or second cardiac event.

However, recently newer risk factors have come into contention and the more traditional, whilst still of importance are less relevant.

Many of the older studies excluded a significant number of patients who as they did not have Total cholesterol or LDL-cholesterol abnormalities were excluded by the design of the studies.

These particularly relate to those with low HDL (Less than 1mmol/L) and moderately high triglycerides (Greater then 2mmol/L) and estimates as high as 60% of patients with significant risk factors for coronary artery disease are claimed to have been excluded by inclusion criteria.

Furthermore, whilst in the tightly controlled clinical trial situation patients are cajoled into attending for follow up and clinical investigators plagued by the Clinical Study Nurse to ensure that all records are completed – where at each visit tablet counts are made to ensure patient compliance – pristine results are ensured.

In the clinical practice arena a very different scenario is taking place. Patients who fail to re-attend for an appointment may be black listed and excluded. Where reliance is placed on the patient’s honesty to ensure that all medication is taken appropriately. Where the physician has no idea whether or not the patient has even had the prescription dispensed by a chemist.

In this scenario we find that, in the case of lipid lowering therapy, over 50% of the patients in all countries around the world have not reached their target levels for cholesterol or LDL lowering.

Even when the target may be a modest reduction (eg to attain a cholesterol level Less then 5mmol/L) over 50% of patients cannot make it for whatever reason be it non compliance, too low a dose, drug interaction, non reported side effects or ineffectiveness.

In this situation we find the “experts” or a select committee of effete professors and academics, divorced from the real world of medicine, advocating making the bar even higher (paradoxically by lowering the target level of cholesterol or LDL cholesterol).

These recommendations made simply on the results of tightly controlled pharmaceutically supported multicentre clinical trials; which have no basis in reality.

In one such study if the results were applied to the total population the cost of the particular drug would be over half of the total health budget of that country!

What is the answer?

With the advent of newer risk factors together with the final recognition of the importance of increasing HDL in the prevention of coronary artery disease (even when LDL cholesterol is normal) perhaps some sanity into preventive cardiology may come.

Unfortunately there is no financial gain in life-style change for the Multinational Pharmaceutical Houses – indeed there is the very real possibility of a reduced market for lipid lowering agents.

Governments whilst mouthing platitudes about the importance of exercise, diet, responsible alcohol consumption, smoking and the like are reluctant to dedicate financial support to these ventures.

The health improvement which will be obtained and the consequent savings in medical costs particularly in chronic diseases and hospitalisation are not instantaneous and in all probability in Western Society the government concerned may not be in power.

Recently the Queensland Government introduced a series of television commercials with the object of advancing the cause of eating more fruit and vegetables to the tune of two fruits and five vegetables per day.

Scant respect, if any, was paid to the financial cost of a family of four initiating such a change in eating habits.

My Cardiac Nurse took a visit to a supermarket and fruit store and averaged the price of conforming to the recommendations at a cost of $3.72/day/.person which equals for the family a weekly cost of $104. Hardly a proposition in today’s economic climate!

In fact physical inactivity has been shown to be a greater cause of morbidity and mortality than low fruit and vegetable diet . The cost of three Neocardial Walks/ week is simply cost of the patient’s time.

Whilst the single most beneficial action is to move the sedentary patient into the mild activity Group, if we wish to improve lifestyle and subsequently reduce the financial burden of chronic disease it is necessary to increase the level of activity further.

What Level of Exercise?

Exercising at or above the anaerobic threshold has been shown to be the most appropriate level to improve cardio-respiratory function.

Major problems with exercising at this level for protracted periods are the development of a metabolic acidosis.

Under a state of metabolic acidosis the myocardium does not respond to endogenous or exogenous catecholamines.

Hypokalaemia by the transfer of potassium into the cells promotes dysrhythmia.

Patients with acute myocardial ischaemia develop a metabolic acidosis commensurate with the severity of the ischaemia .

Neocardial Exercise by providing a specific individual exercise prescription allows the patient to exercise at sufficient level to ensure cardiac training effect without developing any significant metabolic acidosis.

This form of exercise can be undertaken irrespective of the patient’s physical condition or level of obesity with improvements in all parameters with results comparable with those fitter and lighter. A Paper submitted for Website Publication September 2006