Cardiac Rehabilitation: New Emphasis on Metabolic Disease

  • Robert W. McGarrah
  • William E. KrausEmail author
Part of the Contemporary Cardiology book series (CONCARD)


Cardiac rehabilitation was developed in the mid-1970s as a mechanism to instruct and deliver exercise therapy to those having survived a recent acute coronary syndrome. Although the field of cardiac rehabilitation has a relatively short (40 years) history as evidence-based care for patients with cardiovascular disease, it continues to evolve. Changes in program scope have shifted the emphasis away from cardiac rehabilitation as a limited short-term intervention to one of a comprehensive secondary preventive strategy targeting the multiple medical, exercise, nutritional, and behavioral factors that place a patient at increased risk for a subsequent cardiac event.


Nutrition Graded exercise testing Metabolic disease Smoking Type A behavior Transtheoretical model of behavior change 


  1. 1.
    Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update. Circulation. 2011;124(22):2458–73.CrossRefGoogle Scholar
  2. 2.
    Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115:2675–82. Epub 007 May 18.CrossRefGoogle Scholar
  3. 3.
    King M, Bittner V, Josephson R, et al. Medical director responsibilities for outpatient cardiac rehabilitation/secondary prevention programs: 2012 update: a statement for health care professionals from the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Heart Association. Circulation. 2012;126(21):2535–43.CrossRefGoogle Scholar
  4. 4.
    Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Medical director responsibilities for outpatient cardiac rehabilitation/secondary prevention programs: a scientific statement from the American Heart Association/American Association for Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005;111:369–76.CrossRefGoogle Scholar
  5. 5.
    Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:1400–33.CrossRefGoogle Scholar
  6. 6.
    Kraus WE, Keteyian SJ. Cardiac rehabilitation. Totowa: Humana Press; 2007.CrossRefGoogle Scholar
  7. 7.
    American Asssociation of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs. 4th ed. Champaign: Human Kinetics Publishers; 2004.Google Scholar
  8. 8.
    Medicare Coverage Database. Centers for Medicare and Medicaid Services. Decision memo for cardiac rehabilitation programs (CAG-00089R). Available at: Accessed 10/8/07.
  9. 9.
    Medicare Coverage Database. Centers for Medicare and Medicaid Services. Decision memo for cardiac rehabilitation programs (CAG-00437N). Available at: Accessed 8/22/16.
  10. 10.
    James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefGoogle Scholar
  11. 11.
    Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014 Jun 24;129(25 Suppl 2):S1–45.CrossRefGoogle Scholar
  12. 12.
    AHA/ACC. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883–92.CrossRefGoogle Scholar
  13. 13.
    Ellestad MH, Selvester RH, Mishkin FS, James FW, Muzami K. Exercise electrocardiography. 4th ed. Philadelphia: F.A. Davis Company; 1996.Google Scholar
  14. 14.
    Blair SN, Kampert JB, Kohl HWI, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA. 1996;276:205–10.CrossRefGoogle Scholar
  15. 15.
    Blair SN, Kohl HWI, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989;262:2395–401.CrossRefGoogle Scholar
  16. 16.
    Kraus WE, Douglas PS. Where does fitness fit in? N Engl J Med. 2005;353:517–9.CrossRefGoogle Scholar
  17. 17.
    Lee S, Kuk JL, Katzmarzyk PT, Blair SN, Church TS, Ross R. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Diabet Care. 2005;28:895–901.CrossRefGoogle Scholar
  18. 18.
    Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106:793–800.CrossRefGoogle Scholar
  19. 19.
    Mark DB, Lauer MS. Exercise capacity: the prognostic variable that does not get enough respect. Circulation. 2003;108:1534–5.CrossRefGoogle Scholar
  20. 20.
    Morris CK, Myers J, Froelicher VF, Kawaguchi T, Ueshima K, Hideg A. Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men. J Am Coll Cardiol. 1993;22:175–82.CrossRefGoogle Scholar
  21. 21.
    American College of Sports Medicine. ACSM guidelines for exercise testing and prescription. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2014.Google Scholar
  22. 22.
    McNeer JF, Margolis JR, Lee KL, et al. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation. 1978;57:64–70.CrossRefGoogle Scholar
  23. 23.
    Abraham RD, Freedman SB, Dunn RF, et al. Prediction of multivessel coronary artery disease and prognosis early after acute myocardial infarction by exercise electrocardiography and thallium-201 myocardial perfusion scanning. Am J Cardiol. 1986;58:423–7.CrossRefGoogle Scholar
  24. 24.
    Marwick TH, Hordern MD, Miller T, et al. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119(25):3244–62.CrossRefGoogle Scholar
  25. 25.
    Wilmore JH, Green JS, Stanforth PR, Gagnon J, Rankinen T, Leon AS, Rao DC, Skinner JS, Bouchard C. Relationship of changes in maximal and submaximal aerobic fitness to changes in cardiovascular disease and non-insulin-dependent diabetes mellitus risk factors with endurance training: the HERITAGE Family Study. Metabolism. 2001;50:1255–63.CrossRefGoogle Scholar
  26. 26.
    Yeater RA, Ullrich IH, Maxwell LP, Goetsch VL. Coronary risk factors in type II diabetes: response to low-intensity aerobic exercise. W V Med J. 1990;86:287–90.PubMedGoogle Scholar
  27. 27.
    Grundy SM, Cleeman JI, Daniels SR. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–52.CrossRefGoogle Scholar
  28. 28.
    Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA. 2015;313(19):1973–4.CrossRefGoogle Scholar
  29. 29.
    Gami AS, Witt BJ, Howard DE, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403.CrossRefGoogle Scholar
  30. 30.
    Kraus WE, Slentz CA. Metabolic syndrome: recognition, etiology and physical fitness as a component. In: Opara E, editor. Nutrition and diabetes: pathophysiology and management. Hoboken: CRC Press; 2005.Google Scholar
  31. 31.
    Kwan G, Balady GJ. Cardiac rehabilitation 2012 advancing the field through emerging science. Circulation. 2012;125(7):e369–73.CrossRefGoogle Scholar
  32. 32.
    Prochaska J, DiClemente C. Stages and processes of self-change for smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Internal MedicineDuke University School of MedicineDurhamUSA

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