CHAPTER 25 Cardiac Rehabilitation
While many of the sophisticated interventional techniques in cardiovascular medicine applied today are symptomatic therapies, cardiac rehabilitation (CR) offers a highly effective causative treatment of atherosclerotic coronary and peripheral disease. The lifestyle and risk factor modifications achieved by CR have been shown to halt disease progression, and to reduce cardiovascular mortality and the rate of non-fatal myocardial infarction in patients with stable coronary artery disease.This evolution from the traditional exercise training programme to facilitate return to work after a cardiovascular event into a comprehensive multidisciplinary intervention to improve patient prognosis is also reflected in the new definition of CR as coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality.
In addition to this preventive approach, exercise-based intervention programmes are effectively used as an adjuvant therapy in a number of cardiovascular diseases, most notably chronic heart failure (CHF). Since exercise intolerance in CHF is primarily related to the degree of peripheral changes (such as muscle atrophy, reduced peripheral perfusion due to endothelial dysfunction, abnormalities in ventilation, etc.), pharmacological treatment alone sometimes fails to significantly improve exercise capacity. Regular aerobic endurance training in stable CHF has been shown to improve peak oxygen uptake by 15–25%, to reduce peripheral vascular resistance, to retard or reverse muscle wasting, and to reduce morbidity.
Despite its documented clinical effectiveness, rehabilitation/prevention interventions are still widely underutilized in the clinical context. However, it becomes increasingly clear that the use of interventional and surgical procedures—for example, in stable coronary artery disease—is suboptimal therapy in the absence of simultaneous lifestyle modification, including regular physical exercise and aggressive treatment of cardiovascular risk factors.
Chapter 28)
