Cardiac rehabilitation (CR) is a multidisciplinary, medically supervised, outpatient program that aims to optimize physical, mental, and social functioning of people with cardiovascular disease. These programs are designed with the goal of halting or reversing the progression of cardiovascular disease and improving outcomes. Aerobic exercise training in a classic gym is generally considered the cornerstone of CR and is of minimal risk in patients with cardiovascular disease. Other key components of CR include nutrition counseling, psychological support, stress management, tobacco cessation, and education on topics relevant to cardiovascular disease such as blood pressure, diabetes, and cholesterol management. Cardiac rehabilitation is usually based at a hospital or physicians’ office and traditionally consists of 2 to 3 one-hour sessions per week for 12 to 18 weeks for a total of at least 36 hours. Intensive CR programs provide a more rigorous experience in nutrition counselling, stress management practice, and group support in addition to exercise training and may require up to 72 hours of participation.
Should I Participate in Cardiac Rehabilitation?
The American Heart Association and American College of Cardiology highly recommend enrolling and participating in a CR program if you have 1 or more of the following conditions: any type of myocardial infarction (heart attack) or acute coronary syndrome over the past year, angina (chest pain or pressure), heart failure, and recent coronary artery stent placement, coronary artery bypass graft surgery, cardiac valve surgery, or heart transplant. Medicare and most commercial health insurers provide CR coverage for patients with these conditions. Peripheral artery disease, often characterized by leg pain with walking, also improves with CR.
Why Should I Participate in Cardiac Rehabilitation?
Even if you already had a cardiovascular procedure and/or are already taking the recommended medications for your condition, completing a CR program reduces your risk of hospital readmission and cardiovascular death by 25% to 50%. Your exercise capacity is likely to increase and you may lose weight and body fat after undertaking CR. Cardiac rehabilitation can also lower cholesterol, blood pressure, and blood glucose levels, complementing your medical therapy and reducing your risk of recurrent cardiac events such as myocardial infarction and stroke. Implementing healthy lifestyle behaviors via CR also promotes improvements in your quality of life and reduces feelings of depression and anxiety.
How Does Cardiac Rehabilitation Work to Treat My Cardiovascular Disease?
The comprehensive lifestyle changes promoted in CR work by treating underlying causes of heart disease, such as high blood pressure, cholesterol, and blood glucose levels. Additionally, aerobic exercise, stress management, and healthy nutrition all have potential positive effects on the physiology of your cardiovascular system, which includes lowering inflammation, relaxing blood vessels, and reducing the risk of blood clots.
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Published Online: October 10, 2018. doi:10.1001/jamacardio.2018.3252
Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Horwich reports grants from Samsung and the National Institutes of Health outside the submitted work. Dr Fonarow reports grants from the National Institutes of Health and personal fees from Amgen, Bayer, Janssen, and Novartis outside the submitted work.
Disclaimer: Dr Fonarow is associate editor for health care quality and guidelines of JAMA Cardiology, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Sources:Thomas RJ, Balady G, Banka G, et al. 2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2018;71(16):1814-1837. doi:10.1016/j.jacc.2018.01.004
Sandesara PB, Lambert CT, Gordon NF, et al. Cardiac rehabilitation and risk reduction: time to “rebrand and reinvigorate.” J Am Coll Cardiol. 2015;65(4):389-395. doi:10.1016/j.jacc.2014.10.059