Advancing Scientific Cardiac Rehabilitation　― Retrospect and Prospect ―

Figures

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  Figure 1.. An example of a randomised controlled trial that reported no survival benefit with cardiac rehabilitation (CR) after acute myocardial infarction. In the rehabilitation after myocardial infarction trial (RAMIT) study, there was no difference in the survival rate between the CR group and the non-CR group after acute myocardial infarction. NS, not significant. Adapted from West et al.,5 with permission.

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  Figure 2.. An example of a cohort study that eliminated the healthy cohort bias in cardiac rehabilitation (CR) for heart failure patients. This cohort study successfully eliminated healthy cohort bias using the Frailty Index, showing that participation in outpatient CR was associated with better outcomes (all-cause death and heart failure hospitalization) in hospitalized patients with acute heart failure, regardless of the frailty category, except for severe frailty. CI, confidence interval; HR, hazard ratio. Adapted from Kamiya et al.,13 with permission.

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  Figure 3.. Multifaceted effects of exercise and the underlying biological mechanisms. ANP, atrial natriuretic peptide; ATP, adenosine triphosphate; BDNF, brain-derived neurotrophic factor; BNP, brain natriuretic peptide; CAnCs, circulating angiogenic cells; CO, cardiac output; CRF, cardiorespiratory fitness; eNOS, endothelial nitric oxide synthase; FGF, fibroblast growth factor; FSTL, follistatin-like; HIF, hypoxia inducible factor; HSP, heat shock protein; IL, interleukin; LV, left ventricular; METRNL, meteorin like protein; NO, nitric oxide; PGC, peroxisome proliferator-activated receptor gamma coactivator; RA, receptor antagonist; RNA, ribonucleic acid; ROS, reactive oxygen species; SERCA, sarco/endoplasmic reticulum calcium ATPase; SESN, sestrin; SV, stroke volume; TNF, tumor necrosis factor; VEGF, vascular endothelial growth factor. Adapted from Sanchis-Gomar et al.,14 with permission.

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  Figure 4.. Annual trends in participation rates in inpatient (A) and outpatient (B) cardiac rehabilitation (CR) in Japan derived from the nationwide DPC data are shown. AMI, acute myocardial infarction; AP, angina pectoris; HF, heart failure; PAD, peripheral artery disease. Adapted from Kanazawa et al.,16 with permission.

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  Figure 5.. A perspective on advancing scientific cardiac rehabilitation (CR). CR has advanced based on scientific evidence derived from clinical research including randomized controlled trials (RCTs) and meta-analyses on the support of advancement in basic fields such as molecular biology and information technology. Moving forward, we must take on new challenges and actively pursue scientific CR.