Exercise training resulted in a 20% reduction in all-cause mortality and a 26% reduction in total cardiac mortality; favorable but nonsignificant trends were noted in nonfatal MI, CABG, and percutaneous coro- nary revascularization procedures. There was no difference between the mortality rate effects of exercise-only and more comprehensive cardiac rehabilitation interventions, and the benefits were independent of actual amount and intensity of exercise. Many of the studies demonstrating the efficacy of exercise- based cardiac rehabilitation enrolled patients after an AMI or coronary revascularization procedure. Clear benefits of exer- cise training also have been shown in patients with stable angina. Controlled trials consistently have demonstrated an improvement in functional capacity and a delay in the onset of ischemia in anginal patients who complete an exercise training program.444,615 620 Exercise-based cardiac rehabilita- tion could also reduce subjective evidence of ischemia and could ameliorate symptoms.615,619,621,622 The reduction in mortality rate associated with exercise interventions might be explained partially by modification of traditional cardiovascular risk factors. Controlled trials have demonstrated reductions in total cholesterol, triglycerides, and BP, although these findings have not been uniform. Exercise also can enhance smoking quit rates. Other potential mechanisms include decreased fibrinogen and coagulabil- ity,623 moderation of inflammation,624 improved endothelial function,625 627 and improved autonomic regulation.628,629 Several studies have documented the safety of exercise- based cardiac rehabilitation in patients with documented SIHD.630 633 The 2007 AHA Scientific Statement on Exer- cise and Acute Cardiovascular Events estimates the risk of a major adverse cardiac event (MACE) at 1 in 80 000 patient- hours.447 This low event rate applies to medically supervised programs that evaluate patients before participation, provide serial surveillance, and are equipped to handle emergencies. Specific strategies for reducing exercise-related cardiovascu- lar events have not been evaluated. 