History and ethos

Cardiac rehabilitation (CR) began in the 1960s. The rationale was that part of the heart muscle was no longer pumping but that a programme of exercise would strengthen the remaining muscle thereby restoring the patient's ability to lead a normal life. By the 1990s it was established that middle-aged, white males who had sustained a mild myocardial infarct (MI) could significantly increase their physical fitness, but that this had little impact on the poor psychosocial outcomes exhibited by approximately a third of patients. The term ‘comprehensive cardiac rehabilitation’ was introduced to redefine CR as an activity that also attended to the psychosocial needs of patients (World Health Organization, 1993) and this is now widely accepted.

Content

The main tool for behaviour change is usually education in the form of group talks. It is unusual for psychosocial needs to be formally assessed and the only ‘psychological’ treatment provided in most centres is group relaxation classes. There is some evidence suggesting benefit from adding breathing retraining, (van Dixhoorn & Duivenvoorden, 1999) and stress management (Trzcieniecka-Green & Steptoe, 1996) (see ‘Relaxation training’ and ‘Stress management’).

Most national clinical guidelines have called for CR to move away from group programmes to an individualized programme based on assessment of need (including medical, psychological and social) and offering a ‘menu’ of treatment choices (Department of Health, 2002).

Delivery of cardiac rehabilitation

Social class, gender, area of domicile, ethnicity and age are all associated with low levels of uptake.