Guidelines for Cardiac Rehabilitation

Changes in cardiac rehabilitation in the 1990s involved the development of different patterns of the delivery of rehabilitative care. Patients were offered with a choice of individual versus group and center-based versus home-based physical activity programs. The recent application of risk-stratification procedures for coronary patients has brought major changes in the delivery of cardiac rehabilitation exercise training. Patients considered at low risk are able to undertake less supervised rehabilitation in a safe manner. Contemporary cardiac rehabilitation programs provide several important core components, including baseline patient assessment, nutrition counseling, risk factor management, psychosocial management, and activity counseling. However, appropriately prescribed exercise therapy remains the cornerstone of these programs. Cardiac rehabilitation programs have been categorized as phase I (inpatient), phase II(up to 12 weeks of ECG monitoring), phase II(no ECG monitoring under clinical supervision), and phase IV(no ECG monitoring, professional supervision). Cardiac patients who have specific needs to consider when formulating the exercise prescription include those with a history of myocardial infarction and angina, congestive heart failure, mitral valve stenosis and cardiac transplantation. Finally, the goals of rehabilitative care should include improvement of the functional capacity to achieve functional independence with an emphasis on quality of life.