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Cardiac Rehabilitation
Cardiac Rehabilitation Update 2008—
Biological, Psychological, and Clinical Benefits
a report by
Carl J Lavie, MD and Richard V Milani, MD
Ochsner Medical Center, New Orleans
The potential benefits of formal, phase II cardiac rehabilitation and still be extremely important since studies typically suggest a 3%
exercise training (CRET) programs have recently been reviewed in great reduction in clinical risk for every 1% increase in HDL-C. The effect of
detail.
1–3
However, despite the substantial proven benefits of this therapy, CRET on obesity indices is also usually modest, although much more
which are outlined in part in this review, recent data have emphasized that marked benefits are seen in obese patients who lose more weight.
11–13
We
many patients are not referred to formal CRET,
4
and a minority of patients also reported substantial benefits of this therapy on parameters of blood
(14% of patients with acute myocardial infarction [MI] and 31% of those rheology, improvements in function of the autonomic nervous system
who have had bypass surgery) actually attend these programs
5
due to (relative increases in vagal/sympathetic ratio), and reductions in
numerous patient, provider, system, and community barriers.
6
We hope homocysteine and indices of ventricular repolarization dispersion, which
that if clinicians understand the tremendous benefits of this therapy, may be a marker of malignant ventricular dysrhythmias.
8
which are at least equal to other proven therapies (aspirin, beta blockers,
statins, etc.) with favorable cost–benefit ratios, this should enhance the We recently demonstrated quite dramatic reductions in inflammation,
utilization of CRET. with nearly 40% reductions in levels of high-sensitivity C-reactive protein
(HSCRP) following formal CRET.
14
These reductions are noteworthy, since
Biological Effects of Cardiac Rehabilitation and studies have demonstrated that HSCRP is related to both atherosclerosis
Exercise Training and acute coronary heart disease (CHD) events. Importantly, we
The numerous benefits of formal CRET programs have been reviewed in demonstrated that these improvements were independent of statin
detail elsewhere and are summarized in Table 1. Perhaps the most use and weight loss (with equal reductions in the majority who lost
recognized effect of CRET is an improvement in functional status or weight and the minority who gained weight during CRET; see Figure 1).
14
overall exercise capacity.
7,8
Since studies have demonstrated that overall
fitness is a major predictor of clinical prognosis and survival, the marked Patients with metabolic syndrome (MS), which is associated with marked
improvements in exercise capacity following CRET are noteworthy. Even increases in CHD events and mortality, have considerably higher levels of
if other risk factors are present, high levels of fitness provide substantial HSCRP compared with patients without MS (see Figure 2).
15
Following
cardiovascular protection.
8
More marked improvements in exercise formal CRET, both groups have substantial improvements in HSCRP. In
capacity occur in the more unfit patients at baseline, although we have addition, the total number of metabolic risk factors fell from 3.3 to 2.8,
described substantial benefits even in patients with relatively high resulting in a 37% reduction in the overall prevalence of meeting criteria
baseline fitness.
7
for MS. Since studies show that overall CHD risk is highest in patients
with MS as well as those with higher levels of HSCRP (especially in those
The overall effect of CRET on plasma lipids is modest, although its effect with both MS and high HSCRP), the benefits of CRET, which results in
in patients with baseline hypertriglyceridemia
9
and/or low levels of reductions in both MS and HSCRP, are impressive.
high-density lipoprotein cholesterol (HDL-C) is much more striking.
10
Although the overall effect on HDL-C is only a 5–10% increase, this may Psychological Benefits of Cardiac Rehabilitation and
Exercise Training
“It is exercise alone that supports the spirit and keeps the mind in
Carl J Lavie, MD, is Medical Director of Cardiac Rehabilitation and
Preventive Cardiology and Director of Exercise Laboratories at
vigor”—Cicero.
Ochsner Medical Center, New Orleans. He joined Ochsner Medical
Center in 1989, and served as an Associate Director of the internal
Although greatly underemphasized, substantial evidence indicates that levels
medicine training program. He is the author of over 500 medical
publications, including nearly 30 textbook chapters. Dr Lavie serves
of psychological distress, including levels of depression, hostility, and anxiety,
on over 14 Editorial Boards, including the Mayo Clinic Proceedings, are related to the development and progression of CHD, CHD events, and
the Journal of American College of Cardiology, the American
recovery from these events.
16
We have published several manuscripts
Journal of Cardiology, and the Journal of Cardiopulmonary
Rehabilitation and Prevention. He serves on the Scientific Advisory Council for the American
demonstrating a high prevalence of psychological stress, evidence that
Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and previously served as psychological distress is associated with increased CHD risk factors
Chairman of Vascular Hypertension and Prevention for the American College of Cardiology (ACC).
(particularly hypertriglyceridemia, low levels of HDL-C, and hyperglycemia
E: clavie@ochsner.org [components of the MS]), and that patients with high psychological distress
benefit markedly from formal CRET programs.
17–25
72 © TOUCH BRIEFINGS 2008
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