Cardiac rehabilitation (CR) represents an important component of cardiovascular (CV) risk reduction and promotion of CV health. A key component of integrated care, CR provides implementation of exercise training, CV risk reduction, specifically in relation to nutrition and weight, diabetes management, lipid management, hypertension control, and stress reduction. The goal of CR services is to stabilize or reverse progression of atherosclerosis, reduce the risk of myocardial infarction and sudden death, control cardiac symptoms, and enhance the patient’s psychosocial and vocational status.
The beneficial effects of exercise have been investigated for centuries. In 1768, Herbeden observed that a patient with angina improved after chopping wood for 30 minutes a day. This finding is one of the first publications noting the CV benefit of exercise in patients with coronary disease.1 William Stokes advocated walking for patients with heart disease in the mid-1800s, but this was in contradiction to the popular opinion stressing the importance of bed rest for weeks after a CV event. In the 1950s, Samuel Levine and Bernard Lown noted both physical and psychological benefits of early mobilization following acute coronary symptoms.2 Concurrent with gradual changes from sedentary convalescence to early mobilization after acute coronary events, the importance of risk factors and lifestyles in the genesis of coronary disease was realized, and the concept of CR was born. The first structured rehabilitation program was pioneered in Israel in 1955.3
Furthermore, the differentiation between primary and secondary prevention of CHD was challenged. Pathologic studies confirmed that atherosclerosis may develop insidiously over decades and may be advanced at time of presentation with symptoms or an acute event. Newer diagnostic tests for acute coronary syndromes have shown that myocardial infarction represents a continuum of damage. The presentation of a person with angina, an acute coronary syndrome, or coincidental asymptomatic disease should now trigger the initiation of a lifelong program of risk factor modification including physical exercise.
In parallel with this philosophy, CR has evolved and is considered a class I indication in most clinical practice guidelines for patients with stable angina, acute myocardial infarction within the last 12 months, percutaneous coronary intervention (PCI) with or without stenting, or coronary artery bypass graft (CABG) surgery. In addition, CR is recommended for patients with peripheral arterial disease,4 valvular disease,5 congestive heart failure,6 and heart transplant. Additional candidates for CR include those with pulmonary hypertension and congenital heart disease.7
CR has developed worldwide but differs widely among countries, from highly structured inpatient programs to informal home-based programs. Although there may be no ideal rehabilitation program, the majority consist of regular outpatient exercise and educational programs. Comprehensive rehabilitation involves a multidisciplinary team comprising a physician, program manager, CV nurse, exercise physiologist or physical therapist, and access to a registered dietician and clinical psychologist.
This chapter, in addition to defining the essential components of CR programs, will provide ...