Cardiac rehabilitation programs
- 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
- 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
- Section Editor — Lipids
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
Outpatient cardiac rehabilitation programs provide supervised exercise training in conjunction with other secondary prevention interventions. They are designed to speed recovery from acute cardiovascular events such as myocardial infarction, myocardial revascularization, or hospitalization for heart failure and to improve quality of life. In addition, patients with stable coronary heart disease derive benefits. (See "Prevention of cardiovascular disease events in those with established disease or at high risk".)
This topic will discuss the organization and content of these programs. The indications for and the efficacy and safety of cardiac rehabilitation are discussed separately. (See "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)
The components of cardiac rehabilitation programs are delivered by a dedicated team including a medical director, nurses, exercise specialists, nutritionists, and counselors. These programs include provision of comprehensive long-term services involving the following core components (table 1A-B) [1-4]:
●Medical evaluation/baseline patient assessment
●Exercise training and physical activity counseling
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- Tang LH, Zwisler AD, Berg SK, et al. Is the Cardiovascular Response Equivalent Between a Supervised Center-Based Setting and a Self-care Home-Based Setting When Rating of Perceived Exertion Is Used to Guide Aerobic Exercise Intensity During a Cardiac Rehabilitation Program? Am J Phys Med Rehabil 2016.
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- Brawner CA, Abdul-Nour K, Lewis B, et al. Relationship Between Exercise Workload During Cardiac Rehabilitation and Outcomes in Patients With Coronary Heart Disease. Am J Cardiol 2016; 117:1236.
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- Blumenthal JA, Sherwood A, Smith PJ, et al. Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial. Circulation 2016; 133:1341.
- Lamberti M, Ratti G, Gerardi D, et al. Work-related outcome after acute coronary syndrome: Implications of complex cardiac rehabilitation in occupational medicine. Int J Occup Med Environ Health 2016; 29:649.
- King M, Bittner V, Josephson R, et al. Medical director responsibilities for outpatient cardiac rehabilitation/secondary prevention programs: 2012 update: a statement for health care professionals from the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Heart Association. Circulation 2012; 126:2535.
- Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation 2011; 124:2951.
- Taylor RS, Dalal H, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2010; :CD007130.
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- INITIATION OF REHABILITATION
- EXERCISE TRAINING
- Risk stratification for exercise
- Frequency and duration
- Rating of perceived exertion (Borg scale)
- Exercise progression
- Resistance training
- Long-term exercise
- HEART FAILURE AND CARDIAC TRANSPLANTATION PATIENTS
- Nutritional counseling and weight management
- Cessation of smoking
- Diabetes management
- Management of hypertension and hyperlipidemia
- PSYCHOSOCIAL SUPPORT
- MEDICAL DIRECTOR RESPONSIBILITIES
- ALTERNATE APPROACHES
- SUPPLEMENTAL APPROACHES
- INFORMATION FOR PATIENTS