Exercise and Brain in Coronary Heart Disease

Prior treatment

• Presence of metal implants (e.g., pacemaker or implantable cardioverter-defibrillator-ICD) not compatible with MRI (reported during the phone screening)
• Any surgery or medical intervention planned during the study period.

Other illness

• Acute coronary syndrome in the last year, coronary surgery, or percutaneous intervention in the last 6 months.
• Treatment for any type of cancer in the last 2 years.
• Current psychiatric diagnosis (visit to psychiatrist and drug treatment prescription in the last year), including major depression and history of psychiatric illness (schizophrenia, bipolar disorder, hallucinations).
• Diagnosis of neurological or cerebrovascular disorder (e.g. stroke).
• Diabetes with uncontrolled glycemia.
• Obstructive left main artery disease (significant disease \> 50%)
• Unstable angina
• Uncontrolled cardiac arrhythmia
• Moderate to severe pulmonary hypertension.
• Moderate to severe valve disease (grade 3-4)
• Acute pulmonary embolism, or deep vein thrombosis.
• High-grade heart block or complete left bundle branch block or altered basal electrocardiogram with difficulties to interpret in exercise testing.
• Acute systemic illness or fever.
• Acute or chronic renal failure (estimated glomerular filtration rate \< 30 mL/min)
• Pulmonary fibrosis or interstitial disease (respiratory failure or severe COPD confirmed by pneumological study).

Other

• Used of assisted walking devices.
• Severe hospitalization in the intensive care unit in the last 6 months.
• Grade III obesity.
• Medical contraindication for inclusion in an exercise program.
• Resting blood pressure \> 180/110.
• Chest pain with exertion or changes in the ST segment suggestive of severe ischemia during ergometry.
• Severe inducible ischemia
• Functional capacity in ergometry (\<5 METS).
• Paroxysmal or persistent atrial fibrillation with episodes in the last 6 months.
• Acute endocarditis, myocarditis, or pericarditis.
• Aortic dissection
• Hypertrophic obstructive cardiomyopathy.
• Retinopathy.
• Severe autonomic or peripheral neuropathy.
• Recent treatment for alcohol or substance abuse.
• Claustrophobia.
• Plans to participate or current participation in other studies that might interferes with this study.
• Current pregnancy or intention to get pregnant during the study period

• Men and women aged between 50 and 75 years old, both inclusive (\*Contingency plan: increase the range to 40-75 if we have difficulties to get the study sample)
• Must have stable coronary heart disease (phase III), proven by invasive coronary angiography or CT with at least one coronary lesion \> 50%.
• Able to speak and read fluent Spanish.
• Live in Granada city or surrounding areas (able to come to evaluations and exercise program)
• Living in community during the study (i.e. independent home, non-assisted living facilities)
• Ejection fraction ≥ 45%.
• Functional grade I-II according to the New York Heart Association (NYHA) scale.
• Sinus rhythm.
• Stable optimal medical treatment (3 or more drugs at the determined by a cardiologist).
• Physically inactive, considering: 1) not meeting the WHO recommendations in both the aerobic and strength part, and 2) not to be participating in a planned and structured exercise program at least 3 days per week and for more than 3 months. Both conditions must be met to be included. Note: going for a walk will not be considered an exclusion reason.
• Classified as cognitively normal according to Stics-m