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Abstract
The beneficial effects of regular physical activity and exercise training have been elucidated in many animal and human studies over the past 50 years. A majority of studies have demonstrated that regular sports activity and exercise training decrease cardiac mortality and all cause mortality, the recurrence of nonfatal myocardial infarction, and the necessity of revascularization procedures. It has also been shown to improve exercise capacity, psychological functioning, and risk factor management. Patients with cardiovascular disease can safely exercise observing a few instructions. For this, exercise tests need to be done to identify the risk of heart attack resulting from exercise, and high-risk patients need to be under a doctor's supervision while performing exercise training for a certain time. In contrast, low-risk patients can receive exercise prescriptions with basic instructions for exercise training to exercise in their homes. It is important that exercise becomes a regular part of patients pastime activity in order to continuously see the effects of cardio-protection from exercise. Finally, it is important to create an environment where all patients with cardiovascular disease can receive the benefits of cardiovascular rehabilitation. Medical staff should confidently promote cardiovascular rehabilitation and hospitals should be fully equipped with cardiovascular rehabilitation facilities to allow most, if not all, patients with cardiovascular disease to receive systematic treatment immediately after passing through the acute phase.
References
1. Franklin BA, Trivax JE, Vanhecke TE. New insights in preventive cardiology and cardiac rehabilitation. Curr Opin Cardiol. 2008. 23:477–486.
2. AHA. ACC. National Heart, Lung, and Blood Institute. Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pearson T, Pfeffer MA, Taubert KA. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006. 47:2130–2139.
3. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004. 116:682–692.
4. Wenger NK, Froelicher ES, Smith LK, Philip A, Ades PA, Berra K, Blumenthal JA, Certo CM, Dattilo AM, Davis D, DeBusk RF, Drozda JP Jr, Fletcher BJ, Franklin BA, Gaston H, Greenland P, McBride PE, McGregor CG, Oldridge NB, Piscatella JC, Rogers FJ. Clinical Practice Guidelines No. 17: cardiac rehabilitation as secondary prevention. 1995. Rockville: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, National Heart, Lung and Blood Institute.
5. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK. American Heart Association Council on Clinical Cardiology Subcommittee on Exercise, Rehabilitation, and Prevention. American Heart Association Council on Nutrition, Physical Activity, and Metabolism Subcommittee on Physical Activity. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003. 107:3109–3116.
6. Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS. American Heart Association. Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention). Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). American association of Cardiovascular and Pulmonary Rehabilitation. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005. 111:369–376.
7. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, Franklin B, Sanderson B, Southard D. American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology. American Heart Association Council on Cardiovascular Nursing. American Heart Association Council on Epidemiology and Prevention. American Heart Association Council on Nutrition, Physical Activity, and Metabolism. American Association of Cardiovascular and Pulmonary Rehabilitation. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007. 115:2675–2682.
8. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. American College of Sports Medicine. American Heart Association. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007. 116:1081–1093.
9. Wenger NK. Current status of cardiac rehabilitation. J Am Coll Cardiol. 2008. 51:1619–1631.
10. Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation. 2010. 121:63–70.
11. Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007. 116:1653–1662.
12. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F. American Heart Association Council on Nutrition, Physical Activity, and Metabolism. American Heart Association Council on Clinical Cardiology. American College of Sports Medicine. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007. 115:2358–2568.
13. Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc. 2009. 84:373–383.
14. Williams MA, Ades PA, Hamm LF, Keteyian SJ, LaFontaine TP, Roitman JL, Squires RW. Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J. 2006. 152:835–841.
15. Whiteson JH. Braddom RL, editor. Cardiac rehabilitation. Physical medicine and rehabilitation. 2007. 3rd ed. Philadelphia: WB Saunders;709–737.
16. Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011. 123:2344–2352.
17. Mora S, Cook N, Buring JE, Ridker PM, Lee IM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation. 2007. 116:2110–2118.
18. Swain DP, Franklin BA. Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol. 2006. 97:141–147.
19. Franklin BA. Fitness: the ultimate marker for risk stratification and health outcomes? Prev Cardiol. 2007. 10:42–45.
20. Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial infarction. Cardiol J. 2008. 15:481–487.
21. Kim C, Bang HJ, Kim JH, Sohn MK, Yang CY, Lee SG, Lee ES, Lee JH, Im SH, Jung TD, Lee KS. Recommendations for establishing cardiac rehabilitation programs; facility, equipment and staff: The Korean Society of Cardiac Rehabilitation (KSCR) Position Statement. J Korean Acad Rehabil Med. 2010. 34:491–497.
22. American Heart Association Nutrition Committee. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006. 114:82–96.
23. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001. 104:1694–1740.
24. Mezzani A, Agostoni P, Cohen-Solal A, Corrà U, Jegier A, Kouidi E, Mazic S, Meurin P, Piepoli M, Simon A, Laethem CV, Vanhees L. Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2009. 16:249–267.
25. Borg G. Physical performance and perceived exertion. 1962. Lund, Sweden: Gleerup.
26. Braith RW, Stewart KJ. Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. 2006. 113:2642–2650.
27. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ. American Heart Association Council on Clinical Cardiology. American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Resistance exercise in individuals with and without cardiovascular disease: 2007 update. A scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007. 116:572–584.
28. Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol. 2004. 43:1056–1061.
29. Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, Erbs S, Kluge R, Kendziorra K, Sabri O, Sick P, Schuler G. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004. 109:1371–1378.
30. Walther C, Mobius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R. Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2008. 15:107–112.
31. Dalal H, Evans PH, Campbell JL. Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction. BMJ. 2004. 328:693–697.
32. Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko HR, Williams PT, Johnstone IM, Champagne MA, Krauss RM. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation. 1994. 89:975–990.
33. Niebauer J, Hambrecht R, Velich T, Hauer K, Marburger C, Kalberer B, Weiss C, von Hodenberg E, Schlierf G, Schuler G, Zimmermann R, Kubler W. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. 1997. 96:2534–2541.
34. Kim C, Ahn JK, Bang IK. The beneficial effects of cardiac rehabilitation program after coronary angioplasty. Proceedings of the 3rd World Congress of International Society of Physical and Rehabilitation Medicine. 2005. Sao Palo, Brazil.
35. Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation. A randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J. 2009. 158:734–741.
36. Walther C, Gielen S, Hambrecht R. The effect of exercise training on endothelial function in cardiovascular disease in humans. Exerc Sport Sci Rev. 2004. 32:129–134.
37. Harrison DG. Cellular and molecular mechanisms of endothelial cell dysfunction. J Clin Invest. 1997. 100:2153–2157.
38. Posch K, Schmidt K, Graier WF. Selective stimulation of L-arginine uptake contributes to shear stress-induced formation of nitric oxide. Life Sci. 1999. 64:663–670.
39. Corson MA, James NL, Latta SE, Nerem RM, Berk BC, Harrison DG. Phosphorylation of endothelial nitric oxide synthase in response to fluid shear stress. Circ Res. 1996. 79:984–991.
40. Hambrecht R, Adams V, Erbs S, Linke A, Krankel N, Shu Y, Baither Y, Gielen S, Thiele H, Gummert JF, Mohr FW, Schuler G. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation. 2003. 107:3152–3158.
41. Adams V, Linke A, Krankel N, Erbs S, Gielen S, Mobius-Winkler S, Gummert JF, Mohr FW, Schuler G, Hambrecht R. Impact of regular physical activity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation. 2005. 111:555–562.
42. Gielen S, Hambrecht R. Effects of exercise training on vascular function and myocardial perfusion. Cardiol Clin. 2001. 19:357–368.
43. Hill JM, Zalos G, Halcox JP, Schenke WH, Waclawiw MA, Quyyumi AA, Finkel T. Circulating endothelial progenitor cells, vascular function, and cardiovascular risk. N Engl J Med. 2003. 348:593–600.
44. Adams V, Lenk K, Linke A, Lenz D, Erbs S, Sandri M, Tarnok A, Gielen S, Emmrich F, Schuler G, Hambrecht R. Increase of circulating endothelial progenitor cells in patients with coronary artery disease after exercise-induced ischemia. Arterioscler Thromb Vasc Biol. 2004. 24:684–690.
45. Laufs U, Werner N, Link A, Endres M, Wassmann S, Jurgens K, Miche E, Bohm M, Nickenig G. Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis. Circulation. 2004. 109:220–226.
46. Haskell WL. Cardiovascular Cardiovascular complications during exercise training of cardiac patients. Circulation. 1978. 57:920–924.
47. Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA. 1986. 256:1160–1163.
48. Vongvanich P, Paul-Labrador MJ, Merz CN. Safety of medically supervised exercise in a cardiac rehabilitation center. Am J Cardiol. 1996. 77:1383–1385.
49. Franklin BA, Bonzheim K, Gordon S, Timmis GC. Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: a 16-year follow-up. Chest. 1998. 114:902–906.
50. Scheinowitz M, Harpaz D. Safety of cardiac rehabilitation in a medically supervised, community-based program. Cardiology. 2005. 103:113–117.
51. Pavy B, Iliou MC, Meurin P, Tabet JY, Corone S. Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology. Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. Arch Intern Med. 2006. 166:2329–2334.
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