Cardiac Rehabilitation Update 2008 - Biological, Psychological, and Clinical Benefits

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Abstract

The potential benefits of formal, phase II cardiac rehabilitation and exercise training (CRET) programs have recently been reviewed in great detail.1–3 However, despite the substantial proven benefits of this therapy, which are outlined in part in this review, recent data have emphasized that many patients are not referred to formal CRET,4 and a minority of patients (14% of patients with acute myocardial infarction [MI] and 31% of those who have had bypass surgery) actually attend these programs5 due to numerous patient, provider, system, and community barriers.6 We hope that if clinicians understand the tremendous benefits of this therapy, which are at least equal to other proven therapies (aspirin, beta blockers, statins, etc.) with favorable cost–benefit ratios, this should enhance the utilization of CRET.

Citation
US Cardiology - Volume 5 Issue 1;2008:5(1):72-76

Pages

The potential benefits of formal, phase II cardiac rehabilitation and exercise training (CRET) programs have recently been reviewed in great detail.1–3 However, despite the substantial proven benefits of this therapy, which are outlined in part in this review, recent data have emphasized that many patients are not referred to formal CRET,4 and a minority of patients (14% of patients with acute myocardial infarction [MI] and 31% of those who have had bypass surgery) actually attend these programs5 due to numerous patient, provider, system, and community barriers.6 We hope that if clinicians understand the tremendous benefits of this therapy, which are at least equal to other proven therapies (aspirin, beta blockers, statins, etc.) with favorable cost–benefit ratios, this should enhance the utilization of CRET.

Biological Effects of Cardiac Rehabilitation and Exercise Training

The numerous benefits of formal CRET programs have been reviewed in detail elsewhere and are summarized in Table 1. Perhaps the most recognized effect of CRET is an improvement in functional status or overall exercise capacity.7,8 Since studies have demonstrated that overall fitness is a major predictor of clinical prognosis and survival, the marked improvements in exercise capacity following CRET are noteworthy. Even if other risk factors are present, high levels of fitness provide substantial cardiovascular protection.8 More marked improvements in exercise capacity occur in the more unfit patients at baseline, although we have described substantial benefits even in patients with relatively high baseline fitness.7
The overall effect of CRET on plasma lipids is modest, although its effect in patients with baseline hypertriglyceridemia9 and/or low levels of high-density lipoprotein cholesterol (HDL-C) is much more striking.10 Although the overall effect on HDL-C is only a 5–10% increase, this may still be extremely important since studies typically suggest a 3% reduction in clinical risk for every 1% increase in HDL-C. The effect of CRET on obesity indices is also usually modest, although much more marked benefits are seen in obese patients who lose more weight.11–13 We also reported substantial benefits of this therapy on parameters of blood rheology, improvements in function of the autonomic nervous system (relative increases in vagal/sympathetic ratio), and reductions in homocysteine and indices of ventricular repolarization dispersion, which may be a marker of malignant ventricular dysrhythmias.8

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References
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