Cardiac Rehabilitation and Fitness - What is the evidence ?

Medical Progress 

Progress in medication as well as treatment of cardiovascular disease in recent years has been impressive. As a consequence more men and women now survive acute events but with a considerably heavier burden of chronic conditions and clinical need. 

Recommendation

Cardiac rehabilitation (CR) has the highest level of recommendation (Class I) of all national and international cardiology and health societies.

- European Society of Cardiology (ESC).
- American Heart Association (AHA).
- American College of Cardiology (ACC).
- World Health Organisation (WHO).

And is endorsed by the Cardiac Society of Australia and New Zealand (CSANZ) and the New Zealand Heart Foundation. 

Aim

Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life, to maintain or improve functional capacity and to prevent subsequent coronary events, hospitalisations, and death from cardiac causes [ESC guideline].

Benefits

Cardiac Rehabilitation (CR) is associated with a 20% - 35% reduction in mortality in persons with coronary artery disease, particularly after myocardial infarction and after aortocoronary bypass surgery, but also after PCI for stable coronary disease. This benefit is thought to be mediated by several factors, including the benefits of exercise training, psychological benefits of group support and counseling, improved adherence to preventive therapies, and improved control of cardiovascular risk factors.
[EACPR]

For what condition is cardiac rehabilitation recommended ?

​The most sustainable benefit is achieved in conditions associated with coronary artery disease and heart failure:

Acute and stable Coronary Artery Disease
Stent Implantation
Coronary artery bypass surgery (CABG)
​Chronic Heart Failure
​Diabetes Mellitus
High Blood Pressure
​Atrial Fibrillation

How much Cardiac Rehabilitation do I need ?
​

This varies considerably between participants and requires individual assessment. 
​In a US study [Hammill et al.] participants of 36 sessions (12 weeks) had a 47% lower risk of death and a 31% lower risk of a heart attack compared to participants with only 1 session. 
​
Recently published data from 2016 showed that by continuous improvement of exercise capacity the risk of dying from a heart attack can be lowered.

Follow more news on Cardiology under Research Review:

Literature Resources:

1. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation 
Marwick TH, Hordern MD, Miller T, Chyun DA, Bertoni AG, Blumenthal RS, et al; 
Circulation 2009;119:3244-62.
2. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association.
Council on Clinical Cardiology, American Heart Associatin Exercise, Cardiac Rehabilitation, and Prevention Committee; Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; Council on Nutrition, Physical Activity, and Metabolism; Interdisciplinary Council on Quality of Care and Outcomes Research. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al; American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention of the Council on Clinical Cardiology, the Council on Nutrition, Physical Activity, and Metabolism, and the Council on Cardiovascular Nursing. 
Circulation 2009;119:3144-61. 
3. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al; 
Circulation 2007;116:329-43.
4. American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology;American Heart Association Council on Cardiovascular Nursing. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, et al; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Epidemiology and Prevention; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Association of Cardiovascular and Pulmonary Rehabilitation. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2007;115:2675-82. 
5. Current status of cardiac rehabilitation. Wenger NK.  
J Am Coll Cardiol 2008;51:1619-31. 
6. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al
Circulation. 2007; 116: 572-584