Angina and Silent Ischaemia

Range of Motion offers Exercise Physiologist designed one-on-one exercise sessions for individuals with this condition. Book a complimentary consultation or contact us to find out more.

The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Based on guidelines provided by the American College of Sports Medicine.

Condition Overview:

Myocardial ischaemia refers to the lack of oxygen supply to cardiac muscle caused by an obstruction of the coronary arteries (such as that caused by atherosclerosis) or a spasm of the coronary arteries.

Angina is a symptom of myocardial ischaemia (though angina may occur with no apparent symptoms) characterised by the following:

  • Discomfort and tightness in the chest.
  • May radiate to the jaw, neck, shoulders and arms.
  • Shortness of breath, nausea and sweating.
  • Symptoms lasting for ten to 20 seconds, or as long as 30 minutes.

There are three forms of angina, stable (associated with physical exertion), unstable (occurs unpredictably due to a clot or plaque blockage) and variant (occurs due to a spasm of the arterial wall).

Short Term Response to Exercise:

Stable angina is the most common exercise related form of the condition. Early cessation of exercise is effective in reducing symptoms from a single session. A sufficient warm-up is effective in preventing initial onset.

Long Term Response to Exercise:

Exercise is an effective method in the treatment of stable angina. It plays a role in reducing overall cardiac risk, and also in the prevention, halting or reversal of plaque accumulation. The underlying aim of exercise is to increase the threshold at which angina symptoms become apparent. Exercise is effective at increasing the capacity to perform activities of daily living without symptom expression.

Favourable responses occur primarily due to:

  • Reductions in myocardial oxygen demand.
  • Drop in arterial blood pressure.
  • Increase of blood supply to the heart and rest and during exercise.

Condition Management:

All forms of management revolve around the need to increase the supply and reduce the demand of myocardial blood supply. Exercise and medication are the primary methods of achieving a decrease in demand, while the removal of coronary artery disease risk factors (smoking, hypertension, overweight, stress) is effective in increasing supply.

Treatment Methodologies:

Range of Motion designs specific exercise programs unique to the individual based on The Range of Motion Model of Health. Modifications to this basic framework are made based on the specific recommendations outlined below.

Aerobic Exercise:

  • Heart rate 10-15 contractions below ischaemic threshold.
  • 3-7 days / week.
  • 20-30 minutes per session.
  • Prolonged warm-up and cool down.


  • Avoid excessive valsalva.
  • 2-3 days per week.
  • 15-20 minutes per session.


  • Not to discomfort.
  • 20 seconds per stretch.
  • Three days per week.

Visit The Heart Foundation website.

Book a complimentary consultation or contact us to find out more.

Gitkins, A. et. al., (2003). Angina and Silent Ischaemia. In: Durstine, J. L., Moore, G. E. (2003), ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities 2nd Ed. (pp 40-46) American College of Sports Medicine, Human Kinetics.