Rehabilitation of coronary patients

Kellermann, Jan J.; Lévy, M; Feldman, Salomon; Kariv, I

doi:10.1016/0021-9681(67)90094-x

Cited by 23 publications

(5 citation statements)

References 6 publications

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“…Physical rehabilitation owes its origins to “armchair” treatment 3. While post-discharge exercise based rehabilitation developed in some countries4 Britain lagged behind5: until recently most survivors in Britain were discharged with no more than one page of written advice. Patients who have experienced myocardial infarction may also suffer anxiety or depression,6 7 8 and some rehabilitation initiatives developed round psychological therapy 9…”

Section: Introductionmentioning

confidence: 99%

Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial

Jones

West

1996

BMJ

246

123

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Objective-To evaluate rehabilitation after myocardial infarction.Design-Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months.

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Section: Introductionmentioning

confidence: 99%

Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial

Jones

West

1996

BMJ

246

123

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“…In Germany, Beckmann 3 (1908-1991) advocated a similar approach, training cardiac patients to a fitness level where they could participate in a mountain walking tour. Other early Israeli initiatives included a triweekly gymnasium-based weightlifting and calisthenics program 4 and a 4-month long biweekly cycle ergometer program. 5 In North America, Herman Hellerstein of the Cleveland Clinic became interested in exercise rehabilitation during the late 1950s, and at the International Conference on Physical Activity and Cardiovascular Health (Toronto, October 1966), 6 his group reported on 189 middle-aged men with coronary heart disease, followed for an average of 2.2 years.…”

Section: Resultsmentioning

confidence: 99%

A Half-Century of Evidence-Based Cardiac Rehabilitation: A Historical Review

Shephard¹

2020

Clinical Journal of Sport Medicine

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Objective: To review the achievements of cardiac exercise rehabilitation programs retrospectively and to identify continuing challenges to their success. Methods: A review of files accumulated while working with the Toronto Rehabilitation Center, updated by articles identified by PUB-MED, OVID, and Google Scholar through February 2019. Results: After the early lead of Israeli physicians, cardiac rehabilitation began in Ontario during the 1960s and quickly attracted a large case load. Recurrence rates of the patients recruited were low relative to those receiving standard medical treatment, even after allowing for differences in risk factors at entry to programs. Controlled trials began but were individually of insufficient in size to show a significant reduction in recurrences or mortality. Subsequently, multiple meta-analyses demonstrated a 20% to 25% reduction of all-cause and cardiac mortality over the first few years of follow-up in patients who persisted with their rehabilitation. Compliance continued a problem at many centers, but special features of the Toronto cardiac rehabilitation program sustained a compliance of 82.8% over 3 years. Although vigorous exercise increased the immediate risks of a recurrence 5-to 10-fold, this was more than offset by the long-term benefits of enhanced physical condition, and cardiac deaths were a rarity during either supervised or home-based exercise sessions. About a half of patients developed a depression immediately after infarction, but if encouraged to persist with prescribed exercise, their quality of life progressively improved. Among the wide variety of mechanisms underlying the benefits of exercise, gains of aerobic power seemed particularly important. With sustained training, the physical condition of some younger patients progressed to the point of participating successfully in marathon events. Older patients also benefited from sustained training, but for them, optimal results were likely associated with less rigorous physical demands. Conclusions: Research conducted in Toronto and elsewhere has established the benefits of exercise-centered cardiac rehabilitation. However, there remains a need to define the optimum timing of program onset, and the frequency, intensity, and duration of supervised training sessions. Return to blue-collar occupations also needs to be boosted, and the limited participation of eligible patients in available programs remains a continuing challenge.

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“…They were tested according to a modified Astrand protocol [2,16] using the graded multistage submaximal test (85% of maximum predicted heart rate) on a mechanically braked bicycle. During the effort period, heart rate, blood pressure and ECG (lead V5) were recorded while in the recovery period leads II, III and AVF were added.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the Exercise Test in Patients with Angiographically Documented Coronary Artery Disease

et al. 1977

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100 male patients with at least 75% obstruction of one or more coronary arteries were subjected to submaximal exercise tests. Among the 73 subjects who had positive tests, 92% of those with one-vessel obstruction had an ST depression of 1 mm, none having more than 2 mm; by contrast, 44% of those with three-vessel disease had an ST depression of more than 2 mm and only 27% an ST depression of 1 mm. Left-ventricular end-diastolic pressure exceeded 15 mm Hg in 86% of the patients who had an ST depression of more than 2 mm but only in 33% of those with a depression of 1mm; impaired contractility was found in 81% of the former and in 36% of the latter. 92% of those with one-vessel obstruction were able to perform work of 75 and 100 W/min while only 25% of those with three-vessel disease were able to perform the same amount of work. The peak exercise heart rate and systolic blood pressure also decreased with the increase in the number of affected vessels.

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Rehabilitation of coronary patients

Cited by 23 publications

References 6 publications

Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial

Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial

A Half-Century of Evidence-Based Cardiac Rehabilitation: A Historical Review

Evaluation of the Exercise Test in Patients with Angiographically Documented Coronary Artery Disease

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