Cardiac rehabilitation: not just exercise anymore

SUMMARY: The treatment of older and sicker patients and decreasing length of stays are forcing a rethinking of approaches to cardiac rehabilitation. As a result, cardiac rehabilitation programs are becoming more flexible, emphasizing life-style changes and psychosocial support to meet patient needs. KEY POINTS: Today's rehabilitation patients are likely to be older and to stay in the hospital fewer days than patients in the past, and they may have congestive heart failure or be candidates for cardiac transplantation. Newer therapies, such as angioplasty, result in some patients being diagnosed, treated, and discharged quickly. These patients often do not stay in the hospital long enough to undergo the first phase of cardiac rehabilitation. With the decreasing length of stays for most cardiac events, it is not reasonable to expect that inpatient rehabilitation will produce tangible improvement in physical capacity or significant retention of information and instructions. Rehabilitation programs need to be changed accordingly. Low-risk patients undergoing angioplasty may still need cardiac rehabilitation to decrease the risk of restenosis and to reduce cardiac risk factors. Programs that include aggressive risk-factor modification may produce regression in stenosis of coronary arteries, but compliance is difficult to elicit and maintain.