Rehabilitation of patients with cardiovascular disease: historical milestones, current approaches, clinical practice and challenges
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Abstract
In the treatment of patients with myocardial infarction, a special place belongs to cardiac rehabilitation (CR), which today is positioned as a multifaceted multidisciplinary science, combined with preventive cardiology. CR includes physical training, psychological rehabilitation, sessions with a social worker (motivation to return to work); consultations and training programs which embrace discussion of issues of secondary prevention, including modification of risk factors, stimulating adherence to physical activity and drug treatment. Its purpose is to maximize the recovery of the physical, psycho-emotional and social condition of patients with their return to work, to preserve the quality of life and provide long-term detention of the progression of atherosclerosis. The review presents the main historical aspects of the development of CR, provides statistical indicators of inclusion in the program of CR after a cardiac event – myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting, presents indications and contraindications for CR. The data are presented of registries and clinical examinations on the effectiveness of CR with physical training for reducing the rates of overall mortality, cardiovascular mortality, hospitalizations, improvement of quality of life, impact on lipid metabolism and processes of myocardial remodeling. Issues related to the time of the beginning of CR with exercise training after index event, duration and intensity of aerobic exercise, assignment of dynamic and static exercises were discussed. One of the main problems in assessing the effectiveness of CR is the existence of many programs in different countries and even in different centers, which limits the possibility of correct comparison of research results. We provide the results of our own study (n=91) in which 47 patients underwent training on a cycle ergometer 11–45 days after the infarction. No differences were found in load tolerance, depending on the start of training. The efficiency of CR with its physical component has been proved regarding the threshold power level and the hemodynamic value of the work performed. The results are presented of cycling ergometry after training in dynamics during 1 year of observation after myocardial infarction depending on the time of coronary circulation recovery in the infarct-determining coronary artery, the number of affected coronary arteries and the completeness of revascularization. Based on the data of leading associations of rehabilitation and preventive cardiology in Europe and America, the main perspective directions for further development of CR are outlined.
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