Current concepts in cardiac rehabilitation

This article has presented the historical basis for cardiac rehabilitation and the available data related to the four most important questions that remain: (1) Does exercise increase survival after myocardial infarction? Although it is generally thought that clinical trials have failed to demonstrate that cardiac rehabilitation prolongs life after a myocardial infarction, analysis of pooled data from all published studies shows that this conclusion is unjustified. (2) Can each individual patient's risk for a future cardiac event be determined? We have developed a method using serial application of Baye 's theorem to determine each patient's risk. By so doing, we can stratify patient groups by previous risk and then assess the effect of cardiac rehabilitation on altering risk without limiting the analysis to subsequent myocardial infarction and cardiac death. (3) Can regression of atherosclerosis be demonstrated? Regression of atherosclerosis has been clearly demonstrated in animal models, but new evidence suggests that it can also occur in human subjects. (4) Do all patients require monitored exercise after a myocardial infarction? Evidence documenting the safety of exercise in patients recovering from a myocardial infarction has resulted in inclusion of sick patients in cardiac rehabilitation programs and exercise of the healthier patients in unmonitored settings. Major changes in cardiac rehabilitation programs are now taking place, with the emphasis moving away from prolongation of life toward improvement in the quality of life. As a result, cardiac rehabilitation is no longer confined to exercise alone; equal emphasis is placed on dietary and psychologic aspects of patient recovery.