The evolution of cardiac rehabilitation

Angina pectoris is a type of chest pain caused by reduced blood flow to the heart. The original medical description of this condition was noted in the late 1700’s. Soon after, an angina patient was found to have improved symptoms by walking in the woods 30 minutes daily. Unfortunately, this finding was ignored, and inactivity became the standard of treatment for all acute coronary events for the next 200 years, only changing in the 1940s. This immobility caused deconditioning, decreased functional capacity, prolonged hospital stays, and increased morbidity and mortality.

We now know that a 30-minute walk in the woods is not only a physical activity that decreases the risk of future events, but also something that helps with stress management and relaxation. If you suffered a myocardial infarction (heart attack) in the 1930s, standards of care placed you on 6 weeks of bedrest. In the 1940s, you were allowed to sit up in a chair sooner, and in the 1950s, the nurses took you on a 3-5-minute walk four weeks after your event. It was then realized that the earlier ambulation reduced some complications. Research continued to corroborate the benefits of physical activity to improved outcomes.

Cardiac rehab as we know it today is a multidisciplinary approach to risk factor modification. It continues to evolve as research dictates. Phase II cardiac rehab is usually a 12-week outpatient program. Patients exercise while being monitored and risk factor modification is taught, including tobacco cessation, diet counseling, blood pressure monitoring and stress management.

The World Health Organizations defines cardiac rehab with accuracy: It is the sum of activities required to influence favorably the underlying cause of the disease, as well as to ensure the patient the best possible physical, mental and social conditions, so that they may, by their own efforts, preserve or resume when lost, as normal a place as possible in the life of the community (World Health Organization, 1993).

The outlook of cardiac rehab is exciting as we explore non-traditional protocols of delivery. High-intensity interval training and high-calorie-expenditure exercise programs are gaining momentum. Work- and home-based cardiac rehab are options to move away from the traditional outpatient setting. Integrating modern technology, such as internet, apps, phones and other monitoring devices with cardiac rehab will change delivery of the services.

These future possibilities offer a much-needed expansion of the program into a variety of demographics and will remove many barriers to current participation. Innovation will bring cardiac rehab into the next generation, and we will see a decrease in mortality and morbidity from our country’s number one killer as more participants access and use this proven, evidence-based program.

Lisa McNally, BSN, RN, is HeartLife Oconee Coordinator for Prisma Health. HeartLife is Prisma Health’s comprehensive heart disease rehabilitation program. For more information about the HeartLife program, click here.

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