Modern coronary rehabilitation. New concepts in care

Contemporary rehabilitative care for coronary patients involves individualized recommendations and applications. The challenge to the physician is to select those services that are appropriate for a given patient, on the basis of both medical recommendations and patient preferences, so as to encourage progressive independence in rehabilitative care. The physician, patient, and rehabilitation professional can then define the desired outcome of each intervention, in both a quantitative and a time-based format. Physical activity goals can often be rapidly met, whereas risk reduction addresses longer-term outcomes. Exercise test-based risk stratification can identify the high-risk subset of coronary patients, who require supervision of exercise testing, often with ECG monitoring. Low-risk patients can exercise independently. Modest-intensity dynamic exercise is beneficial and has greater adherence and safety than high-intensity exercise. Isometric exercise is recommended once patients attain a reasonable dynamic (aerobic) exercise capacity. Education and counseling are necessary to implement reduction of coronary risk factors. Technological advances that may help in delivery of educational services include videocassettes and computer interactive programs for home use. Information shared with family members has added benefit, because they may also have coronary risk attributes. Innovative approaches may improve the effectiveness and efficiency of long-term rehabilitative care.