Abstract

Coronary heart disease, heart failure, and cardiac transplantation are common cardiac problems of patients throughout the United States. The impact of these chronic conditions on patients, their families, and their communities represents both a major challenge and a major opportunity for providing optimal comprehensive management. Cardiac rehabilitation is defined by the World Health Organization as "the sum of activities required to ensure patients the best possible physical, mental and social conditions so that they may resume and maintain as normal a place as possible in the community." This guideline uses the U.S. Public Health Service definition of cardiac rehabilitation, namely "cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counseling. These programs are designed to limit the physiologic and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients." This guideline is designed for health professionals who provide care for cardiac patients, as well as for consumers, and is intended to optimize the quality, safety, effectiveness, and access to cardiac rehabilitation services.

The panel further defines cardiac rehabilitation as a multifactorial intervention process that follows a well-defined program structure. The process begins with assessments regarding all relevant aspects of the patient's status: medical, nutritional, psychosocial, educational, and vocational. The implementation of cardiac rehabilitation, based on these initial assessments, is designed to address the individual patient's needs as he or she works toward achieving optimal outcomes. This guideline addresses the relationship between identified patient needs and the provision of multifactorial services throughout the cardiac rehabilitation process to ensure optimal attention to these needs.

This guideline provides broad recommendations based on evaluation of the scientific evidence pertaining to the various components of cardiac rehabilitation. The key components of cardiac rehabilitation -- exercise, education, counseling (about cardiac risk factor modification, development of psychosocial and motivational skills), and behavioral interventions -- are each addressed.

Contents

• Guideline Development and Use
• Foreword
• Panel
• Dedication
• Acknowledgments
• Executive Summary
• 1. Overview
  • Incidence and Prevalence
  • Definitions and Goals
  • Background
  • Changes in the Contemporary Approach to Exercise Training
  • Increased Scope of Patients Eligible for Exercise Rehabilitation
  • Return to Work
  • Education, Counseling, and Behavioral Interventions
  • Psychosocial Aspects
  • Summary
  • Methodology
  • Strength-of-Evidence Ratings
• 2. Effects of Cardiac Rehabilitation Exercise Training
  • Exercise Tolerance
  • Strength Training
  • Exercise Habits
  • Symptoms
  • Smoking
  • Lipids
  • Body Weight
  • Blood Pressure
  • Psychological Well-Being
  • Social Adjustment and Functioning
  • Return to Work
  • Morbidity and Safety Issues
  • Mortality and Safety Issues
  • Pathophysiologic Measures
  • Patients With Heart Failure and Cardiac Transplantation
  • Elderly Patients
• 3. Effects of Cardiac Rehabilitation Education, Counseling, and Behavioral Interventions
  • Smoking
  • Lipids
  • Body Weight
  • Blood Pressure
  • Exercise Tolerance
  • Symptoms
  • Return to Work
  • Stress and Psychological Well-Being
  • Morbidity
  • Mortality
• 4. Organizational Issues
  • Intake Assessment and Risk Stratification for Exercise Surveillance
  • Alternate Approaches to the Delivery of Cardiac Rehabilitation Services
  • Adherence
  • Cost
  • Recommendations for Additional Research
• Acronyms
• Glossary
• Contributors
• References

Suggested citation:

Wenger NK, Froelicher ES, Smith LK, et al. Cardiac Rehabilitation. Clinical Practice Guideline No. 17. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute. AHCPR Publication No. 96-0672. October 1995.