Page 882 - Cardiac Nursing

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858 PA R T V / Health Promotion and Disease Prevention
intake, reductions in systolic blood pressure, body mass index Lastly, there has been a change in the public health care mes-
and blood lipids, an improvement in glucose tolerance, and a sage toward physical activity as inherently beneficial regardless of
27% reduction in Framingham Risk Score. These changes were objective measurements of fitness. This has led to a shift in focus
associated with reductions in hospitalizations and coronary from morbidity, mortality, and exercise capacity to issues related
events. Angiographic results included less progression of coro- to maintaining an active lifestyle and optimizing the patient’s ca-
nary artery disease and greater stabilization of plaque in the in- pacity to perform the physical challenges offered by occupational
tervention group. The home-based model of rehabilitation, vali- or recreational activities. Further studies on costs, benefits, and
dated at Stanford University in the 1980s, 88 has been used in other outcomes should solidify the role of cardiac rehabilitation in
many centers over the past 20 years. This approach uses home ex- the clinical management of patients with cardiovascular disease.
ercise that is either unmonitored or monitored via telephone or
microprocessor. Some programs feature regular feedback via tele-
phone or home visits, and recent approaches have used exercise R EFERENCES
monitoring devices such as pedometers, accelerometers, and HR 1. Centers for Disease Control and Prevention, U.S. Department of Health
recording devices to encourage and document compliance with and Human Services. (1999). Promoting physical activity: A guide for com-
prescribed exercise. Safety and efficacy of these home programs munity action. Champaign, IL: Human Kinetics.
have been shown to be similar to those of more conventional 2. Pate, R. R., Pratt, M. P., Blair, S. N., et al. (1995). Physical activity and
public health: A recommendation from the Centers for Disease Control
programs. 88,89 and Prevention and the American College of Sports Medicine. JAMA, 273,
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3. Institute of Medicine. (2002). Dietary reference intakes for energy, carbohy-
drate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washing-
CLOSING COMMENT ton, DC: National Academy Press.
4. Fletcher, G. F., Balady, G., Blair, S. N., et al. (1996). Statement on exer-
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considered routine care. Despite the advent of new therapies in ercise and Cardiac Rehabilitation of the Council on Clinical Cardiology,
cardiovascular medicine, cardiac rehabilitation maintains an im- American Heart Association. Circulation, 94(4), 857–862.
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portant place in reducing morbidity and mortality. The controlled 5. U.S. Public Health Service, Office of the Surgeon General. (1996). Physi-
exercise trials, when combined, demonstrate that the efficacy of cal activity and health: A report of the Surgeon General. Atlanta, GA: U.S.
Department of Health and Human Services, Centers for Disease Control
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rected interest to humanistic concerns, providing a balance for the 6. Paffenbarger, R. S., Hyde, R. T., Wing, A.L., et al. (1986). Physical activ-
emphasis on complex technology. It also provides an ideal envi- ity, all-cause mortality, and longevity of college alumni. New England Jour-
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nal of Medicine, 314, 605–613.
ronment for supervision of patients and for ensuring stability af- 7. Haskell, W. L., Lee. I., Pate, R.., et al. (2007). Physical activity and pub-
ter an interventional procedure. Available data suggest that cardiac lic health: Updated recommendation for adults from the American Col-
rehabilitation is economically sound. lege of Sports Medicine and the American Heart Association. Medicine &
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Medicine is experiencing an evolution toward technologic effi- Science in Sports & Exercise, 39, 1423–1434.
cacy and outcomes assessment. Health economists and legislators 8. Squires, R. W., & Hamm, L. F. (2006). Exercise and the coronary heart
disease connection. In L. F. Hamm, K. Berra, & T. Kavanagh (Eds.),
are reexamining the value placed on all forms of medical care. Al- AACVPR cardiac rehabilitation resource manual (pp. 53–62). Champaign,
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Some of the ways in which the current economic environment has domized trials of rehabilitation with exercise after myocardial infarction.
Circulation, 80, 234–244.
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changed cardiac rehabilitation include lessening of direct ECG 10. Oldridge, N. B., Guyatt, G. H., Fischer, M. E., et al. (1988). Cardiac re-
monitoring, shorter hospital stays, and more rapid progression to habilitation with exercise after myocardial infarction. JAMA, 260,
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rehabilitation is implemented have encouraged greater referral to diac rehabilitation: Clinical practice guideline No. 17 (AHCOR Publication
No. 96-0672). Rockville, MD: U.S. Department of Health and Human
and participation in cardiac rehabilitation, and newer models of Services, Public Health Service, Agency for Health Care Policy and Re-
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risk reduction, case management, and cost efficacy. 12. Taylor, R. S., Brown, A., Ebrahim, S., et al. (2004). Exercise-based reha-
Data on efficacy, safety, and technologic advances in the treat- bilitation for patients with coronary heart disease: Systematic review and
ment of cardiovascular disease have changed cardiac rehabilitation meta-analysis of randomized controlled trials. American Journal of Medi-
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cine, 116, 682–692.
in such a way that a wider range of patients can benefit from these 13. Thomas, R. J., King, M., Liu, L., et al. (2007). AACVPR/ACC/AHA
services than in the past. For example, patients with stable CHF, 2007 performance measures on cardiac rehabilitation for referral to and
once excluded from cardiac rehabilitation programs, are now delivery of cardiac rehabilitation/secondary prevention services. Journal of
Cardiopulmonary Rehabilitation and Prevention, 27, 260–290.
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thought to be among those who benefit the most. 96 Patients who 14. Wee, C. C., McCarthy, E. P., Davis, R. B., et al. (1999). Physician coun-
have had pacemakers, transplantation, bypass or valvular surgery, seling about exercise. JAMA, 282, 1583–1588.
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and claudication now comprise a significant fraction of those in 15. Sherman, S. E., & Hershman, W. Y. (1993). Exercise counseling: How do
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many programs. Despite this fact, most eligible patients (approx- general internists do? Journal of General Internal Medicine, 8, 243–248.
imately 80%) do not receive these services. It is clear that not all 16. Damush, T. M., Stewart, A. L., Mills, K. M., et al. (1999). Prevalence and
patients need all components of cardiac rehabilitation, but direct- correlates of physician recommendations to exercise among older adults.
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Journal of Gerontology A Biology Science Medicine Science, 54, M423–M427.
ing these services to patients who need them most remains one of 17. Ribisl, P. M. (2001). Exercise: The unfilled prescription. American Journal
the important challenges for the field. of Medicine and Sports, 3, 13–21.