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.
- Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107:3109.
- Pescatello LS, Arena R, Riebe D, Thompson PD. ACSM’s Guidelines for Exercise Testing and Prescription, Wolters Kluwer/Lippincott Williams & Wilkins, 2014.
- 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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- DeBusk RF, Haskell WL, Miller NH, et al. Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care. Am J Cardiol 1985; 55:251.
- Ades PA, Pashkow FJ, Fletcher G, et al. A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. Am Heart J 2000; 139:543.
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- Colantonio LD, Huang L, Monda KL, et al. Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries. JAMA Cardiol 2017.
- Milani RV, Lavie CJ, Cassidy MM. Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. Am Heart J 1996; 132:726.
- Mallik S, Spertus JA, Reid KJ, et al. Depressive symptoms after acute myocardial infarction: evidence for highest rates in younger women. Arch Intern Med 2006; 166:876.
- Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation 2014; 129:1350.
- 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.
- Lear SA, Singer J, Banner-Lukaris D, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. Circ Cardiovasc Qual Outcomes 2014; 7:952.
- Taylor RS, Dalal H, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2015; :CD007130.
- Buckingham SA, Taylor RS, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis. Open Heart 2016; 3:e000463.
- Turk-Adawi K, Grace SL. Smartphone-based cardiac rehabilitation. Heart 2014; 100:1737.
- Varnfield M, Karunanithi M, Lee CK, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart 2014; 100:1770.
- Rawstorn JC, Gant N, Direito A, et al. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Heart 2016; 102:1183.
- 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
- INFORMATION FOR PATIENTS