Benefits of the First Pritikin Outpatient Intensive Cardiac Rehabilitation Program

Abstract

Pritikin Intensive Cardiac Rehab 449C ardiac rehabilitation (CR) is a medically supervised treatment program designed to promote optimal recovery after a cardiac event or procedure and to reduce the risk for future cardiac events in patients with cardiovascular disease (CVD). 1,2 Exercise is the central focus of CR, with additional instruction on healthy dietary patterns and lifestyle behaviors that impact cardiovascular risk. Cardiac diagnoses that are approved by the Centers for Medicare & Medicaid Services (CMS) for referral to CR include myocardial infarction, coronary artery bypass surgery, stable angina pectoris, heart valve repair or replacement, coronary angioplasty or coronary stenting, heart transplant, and heart failure with reduced ejection fraction. 3 Cardiac rehabilitation has proven to be beneficial for reducing hospitalizations, reinfarction, cardiac mortality, all-cause mortality, and improving daily function, depressive symptoms, and quality of life among patients with CVD. 1,[4][5][6][7][8][9][10][11][12][13] Traditional CR typically includes up to 36 1-hr, supervised, monitored exercise sessions over 12-18 wk. In August 2010, the CMS expanded coverage for CR to include intensive cardiac rehabilitation (ICR) programs, 14 based on demonstrated improvements in specific endpoints, including less progression of coronary heart disease, reduced need for coronary bypass surgery, and reduced need for percutaneous coronary interventions. Intensive cardiac rehabilitation includes all the components of traditional CR plus up to 36 additional 1-hr sessions, for a total of 72 sessions during a period of up to 18 wk.Three ICR programs have been approved by the CMS 15 : the Ornish Reversal Program, the Pritikin Program, and the Benson-Henry Institute Cardiac Wellness Program at Massachusetts General Hospital. The Pritikin-certified ICR program is a comprehensive lifestyle change program based on three pillars: safe and effective exercise, a healthy eating plan, and a healthy mindset. 16 The Pritikin diet was designed by Nathan Pritikin in 1955 to mimic the diet of the Tarahumara Indians of Mexico, which was high in unprocessed, complex carbohydrates, fiber, and plant sterols and low in fat, cholesterol, and simple sugars. The original Pritikin program began in 1976 as a residential lifestyle change program to reduce the risk of recurrent cardiovascular events. 17 Favorable outcomes of the Pritikin Longevity Center 3-wk residential program included clinically meaningful reductions in CVD risk factors (eg, 23% decrease in total and low-density lipoprotein cholesterol, 18 33%

Intensive Versus Traditional Cardiac Rehabilitation: Mortality and Cardiovascular Outcomes in a 2016–2020 Retrospective Medicare Cohort

“…9 More recent studies have demonstrated that patients in ICR had better postrehabilitation scores on fitness, physical function, diet quality, and greater decreases in body mass index compared with those in CR. 17,18 Although these benefits could explain, at least in part, the improved survival seen with ICR over CR, future studies are needed to explore these effects.…”

“…Smaller, nonrandomized, retrospective, and prospective studies have shown differences between ICR and CR. 9,17 For example, a small observational study conducted before CMS’s approval of outpatient ICR demonstrated reduced hospitalization rates and trends towards reduced Medicare costs and reduced all-cause mortality with intensive lifestyle modification programs that were the forebears of current ICR programs. 9 More recent studies have demonstrated that patients in ICR had better postrehabilitation scores on fitness, physical function, diet quality, and greater decreases in body mass index compared with those in CR.…”

Efficacy of Intensive Lifestyle Education and Forest-Based Exercise for the Primary Prevention of the Risk of Coronary Artery Disease

“…Lifestyle modification to prevent coronary artery disease (CAD) includes enhancing exercise and physical activity, improving dietary habits and emotional stability, smoking cessation, etc., to manage CAD risks [1,2] The secondary prevention named as cardiac rehabilitation has traditionally been hospital-based with conventional regimens, but it has some barriers that make it difficult for patients to enroll and adhere to the program, despite its benefits and effectiveness [3]. For these reasons, emerging approaches, such as home-based rehabilitation and intensive cardiac rehabilitation, have been introduced to complement the weaknesses of conventional methodologies [2][3][4][5][6]. Those approaches could be applied to primary prevention, too.…”