Cardiac rehabilitation 

Cardiac rehabilitation (CR) is defined by the world health organisation as "The sum of activity and interventions required to ensure the best possible physical, mental, and social conditions so that patients with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or resume their proper place in society and lead an active life". CR is a comprehensive model of care including established core components, including structured exercise, patient education, psychosocial counselling, risk factor reduction and behaviour modification, with a goal of optimizing patient's quality of life while helping to reduce the risk of future heart problems.

CR is delivered by a multi-disciplinary team, often headed by a physician such as a cardiologist. Nurses support patients in reducing medical risk factors such as high blood pressure, high cholesterol and diabetes. Physiotherapists or other exercise professionals develop an individualized and structured exercise plan, including resistance training. A dietitian helps create a healthy eating plan. A social worker or psychologist may help patients to alleviate stress and address any identified psychological conditions; for tobacco users, they can offer counseling or recommend other proven treatments to support patients in their efforts to quit. Support for return-to-work can also be provided. CR programs are very patient-centered.

Based on the benefits summarized below, CR programs are recommended by the  /and the European Society of Cardiology, among other associations. Patients typically enter CR in the weeks following an acute coronary event such as a (heart attack), with a diagnosis of  or following ,  a valve procedure, or insertion of a rhythm device . CR services can be provided in hospital, in an  setting such as a community center, or remotely at home using the phone and other technologies.

It is recommended patients begin outpatient CR within 2–7 days following a percutaneous intervention, or 4–6 weeks after cardiac surgery.In order to participate in an outpatient program, the patient generally must first obtain a physician's referral.

Participation typically begins with an intake evaluation that includes measurement of cardiac risk factors such as lipid measures, blood pressure, body composition, depression / anxiety, and tobacco use.[2] An exercise stress test is usually performed both to determine if exercise is safe and to allow for the development of a customized exercise program.

Risk factors are addressed and patients goals are established; a "case-manager" who may be a cardiac-trained Registered Nurse, Physiotherapist, or an exercise physiologist works to help patients achieve their targets. During exercise, the patient's heart rate and blood pressure may be monitored to check the intensity of activity.

The duration of CR varies from program to program, and can range from six weeks to several years. Globally, a median of 24 sessions are offered, and it is well-established that the more the better.

After CR is finished, there are long-term maintenance programs (phase III) available to interested patients, as benefits are optimized with long-term adherence; unfortunately however patients generally have to pay out-of-pocket for these services.

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Regards
Alex John
Managing Editor
Journal of Cardiac and Pulmonary Rehabilitation