‘Cardiac rehabilitation works’: but it should be tailored individually, started early, and followed for a lifetime

Extract

This editorial refers to ‘Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study’^†, by S. Doimo et al., on page 678.

Regular exercise and cardiovascular lifestyle adaption have become a major issue in cardiovascular treatment in a primary as well as in a secondary preventive setting.^1–3 Still, in secondary prevention, evidence has mainly been gained from meta-analyses, where relevant clinical endpoints, such as cardiovascular mortality and overall mortality, as well as recurrent cardiovascular events and hospitalizations were shown to be significantly lower in patients following cardiac rehabilitation after a cardiovascular event.^4–7

As such, cardiac rehabilitation can no longer be seen as a possible addition to standard (e.g. pharmacological) therapies—it has to be established as the crucial fundamentum in multimodal cardiovascular treatment.^{1  ,  3} In primary prevention, a substudy of the PURE trial recently demonstrated that regular exercise is able to reduce cardiovascular events in individuals that follow a regular training independently from further cardiovascular risk factors.⁸ Moreover, these benefits follow a ‘dose–effect relationship’, particularly regarding exercise (‘the more the better’).⁸ On the other hand, more than a decade ago, the ‘INTERHEART’ study group outlined the importance of multimodal lifestyle changes as it is the combination of risk factor reduction that strikingly decreases cardiovascular risk.⁹