Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease
- Nanette K Wenger, MD
Nanette K Wenger, MD
- Professor of Medicine (Cardiology)
- Emory University School of Medicine
- Robert S Rosenson, MD
Robert S Rosenson, MD
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
- Lynne T Braun, PhD, RN, CNP
Lynne T Braun, PhD, RN, CNP
- UpToDate NP Advisory Board Member
- Professor of Nursing
- Rush University College of Nursing
Lack of physical activity is among the risk factors that have adverse effects on the progression of coronary atherosclerosis. Numerous observational studies in both men and women have demonstrated that regular exercise and physical fitness are both associated with a reduced risk of coronary events and coronary death. (See "Exercise and fitness in the prevention of cardiovascular disease".)
Many patients who are eligible for and require exercise training as part of their recovery do not receive such therapy, often because of lack of awareness by healthcare professionals, by patients and their families, and by healthcare insurers of the appropriateness and effectiveness of an exercise intervention .
Based upon these observations and the demonstrated benefit of risk factor reduction, cardiac rehabilitation programs were developed to provide exercise training and counseling on risk factor modification for the secondary prevention of coronary heart disease [2-6]. (See "Prevention of cardiovascular disease events in those with established disease or at high risk".)
Cardiac rehabilitation programs are comprehensive, long-term services involving medical evaluation, supervised exercise, cardiac risk factor modification, education, and counseling. They limit the physiologic and psychologic effects of cardiac illness, reduce the risk of sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients. Cardiac rehabilitation improves risk factors, exercise capacity, and survival after percutaneous coronary intervention and coronary artery bypass graft surgery.
The efficacy and safety of cardiac rehabilitation programs will be reviewed here. The details of these programs are discussed separately. (See "Cardiac rehabilitation programs".)
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- EVIDENCE OF BENEFIT
- Exercise training
- - Mechanisms of benefit
- Psychosocial intervention
- Role of program completion
- Long-term impact
- COMPREHENSIVE RISK FACTOR INTERVENTION
- Magnitude of benefit
- Short-term comprehensive intervention
- Long-term comprehensive intervention
- RECOMMENDATIONS OF OTHERS
- UTILIZATION RATES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS