Exercise in post infarct rehabilitation

In 1957, Hellerstein and Ford defined rehabilitation as 'the process by which a patient is returned realistically to his greatest physical, mental, social, vocational and economic usefulness and, if employable, is provided an opportunity for gainful employment in a competitive industrial world'. They stressed the importance of starting the rehabilitation process 'at the moment the patient is first stricken with his disease', of mobilising the patient as soon as is practical and of paying close attention to the emotional as well as physical consequences of the attack. They believed that 80% of the aftercare of cardiac patients could be managed by the 'private physician' and only a minority required the attention of a specialist team. The time scale used in 1957 (three to four weeks in hospital) was rather different to the one we use today, but otherwise most of what he suggested then has scarcely been improved upon since. In 1968 Hellerstein went on to describe the physical training programme he had devised to improve the fitness of 'habitually lazy, hypokinetic, sloppy, endomesomorphic over-weight males' who were the usual victims of myocardial infarction. He wished to 'add life to years and perhaps add years to life'. The conclusions from his original study were that 'an active intervention programme of conditioning including exercise, weight reduction, diet therapy, and cessation of smoking is feasible, reasonably acceptable and appears to be of benefit in the treatment of coronary heart disease'.