Stenting may not always be the answer to treating heart disease with stable angina.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event–free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event–free survival –– no stroke, heart attack, or death –– compared with 50% of stented patients after four years.

Exercise is an important part of any type of prevention, and it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home. Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate–intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.