Cardiac rehabilitation: where are we going?

Several components of cardiac rehabilitation can be considered to be of proven value: smoking cessation reduces cardiac events by 50% in observational studies, dietary modification such as the so-called Mediterranean diet--if rigorously applied--reduces cardiac events, decreases progression and has favourable effects on hypertension, osteoporosis and the risk of cancer. Cholesterol lowering by HMG-CoA reductase inhibitors is cost effective but not practiced widely enough. Exercise training programmes improve functional capacity and symptoms particularly in patients with compensated heart failure. The prognostic implications are unclear at present. Stress modification is useful and return to work may be enhanced by cardiac rehabilitation. Cardiac rehabilitation, as a multifactorial intervention prevents progression, improves well being and prognosis, and should be an integral part of the cardiological management after a cardiac event.