Modern concepts o f coronary rehabilitation

pp 311-321

Abstract

Cardiac rehabilitation was in the past a high-structured, relatively-inflexible program received by the patients as a service not tailored to their individual needs. This caused some dismay among patients and physicians which considered the whole matter expensive in time and costs. Nowadays rehabilitation must be carefully adjusted to the individual need of preference of each patient. This includes the choice of physic activity in individual versus grupal sessions, adjustment to age, disease severity, morbility, prognosis and life style. Rehabilitation must encourage a progressive independence from the guided program and the adoption of a healthy lifestyle. The program must define the training goals and the reduction of coronary risk during rehabilitation. For instance, a post-AMI patient must be capable of an improvement in his performance during the next 8 to 12weeks. Risk reduction goals imply long term results and must be trade with the patient defining the best strategy to be applied in the improvement of his functional capacity. It is wise to stratify patients in groups of high or low risk, in order to define those who need close surveillance and ECG monitoring during training sessions. Regarding this point, pre-discharge stress-tests provide an excelent guide. Programs generally start with low-intensity dynamic exercising, and a subsequent add of isometric work. Isolated physical training is an incomplete rehabilitation tool. Always must be connected with a rational reduction in coronary risk factors.