Exercise training and cardiac rehabilitation in cardiovascular disease

ABSTRACT

Introduction: The aim of this review is to introduce the audience to exercise training (ET) as a therapeutic tool in coronary heart disease (CHD) and to discuss the role of and advances in cardiac rehabilitation (CR) as a means of effectively delivering ET.

Areas covered: The physiological mechanisms behind ET effects on the cardiovascular (CV) system as well as the implementation of ET in CR and the effects of CR on CV morbidity, risk factor modification, and mortality will be reviewed. Additionally, the clinical and financial impact of CR in today’s healthcare systems will be discussed.

Expert opinion: It is well-established that CR continues to be under-utilized despite significant benefits to patients and healthcare systems alike. Innovation in the structure of CR (such as the implementation of high-intensity protocols) and in accessibility (home and tele-health CR programs) is already helping improve efficacy and increase utilization of CR. However, the efficacy of home/remote delivery protocols is not well established and they comprise a minority of available CR services. More data and efforts are needed to improve such protocols and maximize the reach of remote delivery systems in order to effectively deliver CR services to more eligible individuals at lower costs.

KEYWORDS:

• Cardiac rehabilitation
• cardiovascular outcomes
• high intensity-intermittent training
• moderate intensity continuous training
• mobile health
• tele-rehabilitation

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights box

• ET has been a staple of prevention over millennia, despite this it remains an under-utilized resource our healthcare system.

• The benefits of ET are derived from improvements in lipid metabolism, increases in parasympathetic tone, reduction of endothelial dysfunction, and modulation of chronic inflammatory processes.

• These physiological changes drive improved clinical outcomes after CR including: mortality, HF severity, re-hospitalizations, and markers of CV health.

• Comprehensive CR is becoming the new standard of delivering ET therapy and is associated with better outcomes than ET-based protocols alone, as CR populations include higher numbers of elderly individuals and women (high-risk groups that have demonstrated less benefit from ET therapy alone).

• Efforts in improving CR are focusing on home, tele-medicine, and mobile delivery options; validation of HIIT protocols, and encouraging pre-procedure rehabilitation to improve outcomes among many others.

• The results of these efforts will hopefully increase CR accessibility, improve CV outcomes, and reduce per-patient costs associated with enrollment and completion of these programs.

Additional information

Funding

This paper was not funded.