Cardiac Rehabilitation as Therapeutic Strategy After Coronary Artery Bypass Grafting

based cardiac rehabilitation.13 Although there are many reports that show the short-term effects of exercise-based cardiac rehabilitation in patients after CABG, such as the reports above,12,13 the existing evidence of the efficacy of cardiac rehabilitation on the long-term prognosis in patients after CABG is limited. To date, no studies have aimed at assessing the effect of active cardiac rehabilitation participation on exercise capacity and long-term prognosis in patients after CABG. CABG is generally selected for patients with advanced arteriosclerosis, such as those with severe calcification in the coronary arteries or severe multivessel lesions, compared with percutaneous coronary intervention. Therefore, it remains a major challenge to determine whether cardiac rehabilitation can avoid cardiac accidents and improve the long-term prognosis of patients after CABG. In this issue of the Journal, Origuchi et al14 examine the effect of outpatient cardiac rehabilitation on exercise capacity and long-term prognosis in patients after CABG in a multicenter cohort. Their study consisted of 240 patients who actively participated in outpatient cardiac rehabilitation and 106 patients who did not. The primary endpoint C ardiac rehabilitation effectively improves exercise tolerance, reduces readmission rates and improves long-term prognosis in patients with cardiovascular disease (CVD).1,2 Several studies have shown that exercise training effectively suppresses neurohumoral factors and inflammatory cytokines, and also improves vascular endothelial function and musculoskeletal metabolism.3–5 In addition, a disease management program implemented by a multidisciplinary team as part of a comprehensive cardiac rehabilitation program has been recognized as useful for secondary prevention in patients with CVD.6 Currently, a comprehensive cardiac rehabilitation program is internationally recommended in guidelines for coronary artery disease as well as for heart failure.7–9 Recently, “The Standard Rehabilitation Program for Heart Failure” has been released to promote appropriate cardiac rehabilitation for heart failure throughout Japan.10 In the 1970 s, coronary artery bypass grafting (CABG) was introduced in Japan, and there are currently more than 10,000 procedures performed in this country.11 Adachi et al reported that after CABG patients improved exercise tolerance of peak oxygen uptake (peak V̇O2) with 2 weeks of exercise-based cardiac rehabilitation.12 Takeyama et al showed that the index of parasympathetic activity and exercise tolerance was improved by 3 weeks of exerciseArticle p ????