This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
AHCPR releases cardiac rehabilitation
Cardiac rehabilitation services—medically supervised
interventions aimed at limiting physical and other damage from
heart disease that reduce the risk of death and help patients
resume a normal life—are widely under-used in spite of their
proven benefits, according to a newly released Agency for Health
Care Policy and Research-supported clinical practice guideline.
Indeed, less than a third of heart patients participate in
cardiac rehabilitation programs even though potentially all of
them could benefit from the services, notes Douglas B. Kamerow,
M.D., M.P.H., AHCPR's director of Clinical Practice Guideline
The clinical practice guideline recommends a comprehensive
approach to cardiac rehabilitation that includes exercise
training to improve exercise tolerance and stamina and education,
counseling, and behavioral interventions to assist patients in
achieving and maintaining optimal health. The guideline also
recommends considering home-based cardiac rehabilitation, guided
by a health care professional, as an alternate approach for low-
or moderate-risk patients who cannot participate in traditional,
structured group cardiac rehabilitation, which is generally
conducted in hospitals or other health or community
An estimated 13.5 million Americans have coronary heart disease,
including almost 1 million who survive heart attacks each year,
more than 600,000 annually who undergo coronary artery bypass
surgery or balloon angioplasty—an invasive procedure used to
open blocked coronary arteries—and the approximately 2,000
patients who have heart transplants each year. About half of all
these patients are elderly. Heart disease patients also include
about 7 million persons with angina—recurring chest
4.7 million who have stable heart failure.
According to Nanette K. Wenger, M.D., Co-Chair of the 19-member
private-sector panel that developed the guideline, and Professor
of Medicine at the Emory University School of Medicine in
Atlanta, GA, physicians know about cardiac rehabilitation, but
not enough refer their patients for services. She points out that
cardiac rehabilitation should be part of the discharge plans for
all heart disease patients, and even though some doctors
prescribe individual components of cardiac rehabilitation, such
as exercise training or education, individual activities by
themselves are less effective. Dr. Wenger is a cardiologist and
consultant to the Emory Heart Center and Director of the Cardiac
Clinics at Grady Memorial Hospital.
The goals of a well-designed cardiac rehabilitation program are
- Increase exercise tolerance: The most consistent benefits
occur when patients exercise three times a week, 20 to 40
minutes at a time, at 70 to 85 percent of the baseline
exercise test heart rate. Exercise training should last 12
weeks or more. The guideline recommends that patients
continue exercising to maintain the benefits of exercise
- Improve symptoms: Cardiac rehabilitation decreases anginal
pain and improves heart failure symptoms, such as shortness
of breath and fatigue.
- Improve blood fat levels: Nutritional education and
counseling, behavioral interventions, and exercise training
improve cholesterol levels. Some patients also may need
- Decrease smoking: As many as 25 percent of patients who
smoke cigarettes will quit after participating in a smoking
cessation program as part of cardiac rehabilitation.
- Improve psychosocial well-being and reduce stress:
Education, counseling, and psychosocial interventions, as
well as exercise training, improve these outcomes.
- Reduce mortality: Comprehensive cardiac rehabilitation has
been shown to reduce death rates in patients after heart
attack by 25 percent.
Erika Sivarajan Froelicher, R.N., Ph.D., Co-Chair of the panel,
said heart disease patients should ask for cardiac rehabilitation
if it is not offered, and they should look for flexibility in a
program so that they can stick with it. Dr. Froelicher is a
Professor of Nursing and Adjunct Professor of Medicine at the
University of California, San Francisco.
The guideline was cosponsored by the National Heart, Lung, and
Blood Institute and AHCPR and developed under an AHCPR contract
awarded to the American Association of Cardiovascular and
Pulmonary Rehabilitation. The panel convened by the association
included physicians, nurses, exercise physiologists, behavioral
specialists, dieticians, physical and occupational therapists,
Return to Contents
Proceed to Next Section