Current role and future perspectives of cardiac rehabilitation in coronary heart disease

Abstract

Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…Although the present study derives from a pre-specified secondary analysis, this point should be further considered when interpreting the data, which should be viewed, at this point, as hypothesis generating. Albeit this, in view of the major hurdles related to both the implementation and adherence to exercise-based programs (encompassing CR) which have been previously reported in different clinical contexts, specifically addressing these secondary outcomes in detail could be of substantial importance, as to try to optimize and overcome some of these potential barriers [23,25,33]. In addition, given the specificities associated with the survivorship continuum (namely when considering different types of cancers, treatments, and comorbidities), assessing the safety of these approaches based on a framework reflective of clinical practice can also provide important ancillary data [16,33].…”

“…Moreover, there is still a need for more data on the feasibility, acceptability, and safety of this approach in specific subgroups of cancer survivors and in different settings. Indeed, when addressing the current paradigm concerning CR (as related specifically to CV patients, without a primary focus on cancer survivors), and even when considering the plethora of data attesting to its central role in different CVD, reports have nonetheless underscored several barriers to this intervention, leading to pitfalls such as low adherence rates [23][24][25]. As such, the question of whether cardio-oncology rehabilitation would be a feasible and acceptable model in different oncological settings is of pivotal importance.…”

The Effects of High-Intensity Interval Training on Exercise Capacity and Prognosis in Heart Failure and Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…Cardiac rehabilitation is an important component of secondary prevention of cardiovascular diseases. Some evidence suggests that cardiac rehabilitation can reduce the mortality risk and improve the prognosis among patients with cardiovascular diseases [ 3 , 4 ], and one of the most indispensable elements of such an intervention is participation in exercise training [ 5 ]. Although exercise training has positive effects on CAD and HF, such as increasing exercise capacity and improving left ventricular function [ 6 , 7 ], the most effective treatment options are likely dependent upon the type of exercise undertaken [ 8 ].…”

Adherence, safety and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…Moreover, there is still a need for more data on the feasibility, acceptability, and safety of this approach in speci c subgroups of cancer survivors and in different settings. Indeed, when addressing the current paradigm concerning CR (as related speci cally to CV patients, without a primary focus on cancer survivors), and even considering the plethora of data attesting to its central role in different CVD, several reports have nonetheless underscored the many barriers to this intervention, leading to pitfalls such as low adherence rates [23][24][25]. In view of this fact, the question of whether cardio-oncology rehabilitation would be a feasible and acceptable model in oncological setting is of pivotal importance.…”