Many patients with asymp- tomatic VHD feel better with regular aerobic exercise to improve cardiovascular fitness.1 3 Although heavy iso- metric repetitive training might increase LV afterload, resistive training with small free weights or repetitive Table 4. Stages of VHD Stage Definition Description A At risk Patients with risk factors for development of VHD B Progressive Patients with progressive VHD (mild to moderate severity and asymptomatic) C Asymptomatic severe Asymptomatic patients who have the criteria for severe VHD: C1: Asymptomatic patients with severe VHD in whom the LV or RV remains compensated C2: Asymptomatic patients with severe VHD with decompensation of the LV or RV D Symptomatic severe Patients who have developed symptoms as a result of VHD LV indicates left ventricle; RV, right ventricle; and VHD, valvular heart disease. Table 5. Frequency of Echocardiograms in Asymptomatic Patients With VHD and Normal LV Function Stage Type of Valve Lesion Aortic Stenosis* Aortic Regurgitation Mitral Stenosis Mitral Regurgitation Progressive (Stage B) Every 3 5 y (mild severity; Vmax Every 3 5 y (mild severity) Every 3 5 y (MV area >1.5 ) Every 3 5 y (mild severity) Every 1 2 y moderate severity; Vmax Every 1 2 y (moderate severity) Every 1 2 y (moderate severity) Severe asymptomatic Every 6 12 mo (Vmax 4 m/s) Every 6 12 mo Every 1 2 y (MV area 1.0 ) Every 6 12 mo Dilating LV: More frequently Every year (MV area <1.0 cm2 ) Dilating LV: More frequently Patients with mixed valve disease may require serial evaluations at intervals earlier than recommended for single-valve lesions. These intervals apply to most patients with each valve lesion and do not take into consideration the etiology of the valve disease. *With normal stroke volume. 