Cardiac rehabilitation programs.

Abstract

Cardiac rehabilitation programs are safe and effective in improving the functional activities of patients with cardiac disease, but they may be hazardous to those patients whose life might be in jeopardy if subjected to exercise. It is clear that not all cardiac patients require supervised rehabilitation programs to return to normal pre-cardiac-event activities. Many patients who have suffered cardiac events recover from the events without much functional debilitation, usually because they were normally active prior to the cardiac event. Patients who have had heart transplants, percutaneous transluminal coronary angioplasty, or heart valve surgery have no unique characteristics that differentiate them from cardiac patients who have had a myocardial infarction or coronary artery bypass graft or who have stable angina in terms of the necessity for participating in supervised rehabilitation programs. Therefore, patients who have had these surgical procedures might be selected for enrollment in cardiac rehabilitation programs on the basis of their physical and psychological conditions. Those patients who benefit from rehabilitation programs usually accomplish their goals within the 12-week sessions of the usual programs. Patients with stable cardiac conditions who are at high risk and have minimal functional capacities (3-5 METs) appear to benefit most, while patients who are of low risk and have functional capacities of 7-9 METs have minimal need for the program. High-risk patients have been described as including those who develop ventricular arrhythmias or marked ischemia with exercise. Low-risk patients have been described as including those who have functional capacities at 3 weeks postoperation of 8 METs or more, which allows them to resume most of their vocational and recreational activities. Patients with intermediate risk and functional capacities benefit from the programs, but they may not require the full 12 weeks of participation. The latter group may safely exit the programs when they attain the goals of the cardiac rehabilitation programs, e.g., the resumption of pre-cardiac-event activities and return to a relatively normal life. Accordingly, heart transplant patients and patients who have undergone percutaneous transluminal coronary angioplasty or heart valve surgery could benefit from prescribed cardiac rehabilitation programs if they have the need as described. The available information implies that many heart transplant, PTCA, or heart valve surgery patients are in excellent functional status after the surgical intervention and require minimal or no supervised exercise programs. However, a significant number of patients may lack confidence in their capabilities and may benefit from earlier exercise testing that would demonstrate to them their functional capabilities.(ABSTRACT TRUNCATED AT 400 WORDS)