Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future

Abstract

Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950’s; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary disease in light of societal changes as well as medical, digital and surgical advancements. Contemporary “cardiac rehabilitation” began when bed rest and physical inactivity was recommended and commonplace for MI survivors. Today, most patients who survive an MI, undergo reperfusion therapy, a short inpatient stay and are discharged with minimal physical morbidity. Despite this, the majority of modern day programs continue to be structured in the same way they have been for the past 50 years and this model has become incongruent with the contemporary context, especially in the COVID-19 era. This review aims to describe the historical foundations of cardiac rehabilitation to inform solutions and meet the demands of contemporary MI management. Delivering health systems reform to address modernization is current healthcare challenge where a united and interdisciplinary effort is needed.

Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)

“…The dominant mode of CR since its inception 50 years ago has been centre-based, typically supervised group classes delivered in a hospital outpatient setting, and focused on exercise training. 6,7 The coronavirus disease-19 (COVID-19) pandemic -and associated challenges of effectively delivering rehabilitation while following guidance on social distancing and shieldinghas foregrounded the need to reframe traditional CR delivery. Calls have particularly focused on inclusion of home-based programmes, as well as use of wearable technology, and interactive online or hybrid programmes that combine centre-and home-based modes.…”

“…COVID-19 restrictions also had implications for data collection: as participants completed questionnaires by post, or online via a secure web portal (rather than at clinic as initially planned). 7 It was also not possible to assess exercise capacity (incremental shuttle walk test), since lockdown measures meant participants were largely unable to attend, and services were unable to hold, research visits in a clinical setting.…”

The evolution of digital health technologies in cardiovascular disease research

“…The diversity and extensive communication between the central groups of scholars in this space highlight the collective efforts towards understanding how digital technologies can impact cardiovascular care. Many opportunities exist in the digital technology space for health system reform, and this requires a united and interdisciplinary effort 35 . Collaborative research networks, such as the American Heart Association's new Strategically Focused Research Network on Health Technologies and Innovation are moving towards 36 , SOLVE-CHD 37 and AF-Screen 38 , are other examples of advocacy groups who are promoting discussion and unification of research towards digital technology innovation and capacity building in the CVD care area.…”

Cardiac rehabilitation: Effective yet underutilized in patients with cardiovascular disease

“…Before the 1950s, the general approach to the management of myocardial infarction was bed rest and physical inactivity. A change in this method of management started with the recommendation of cardiac chair therapy, which involved patients sitting in a chair for a 1−2 h per day 10 . Over the following years, the recommendations included progressively more physical activity and in the 1970s a structured and supervised rehabilitation program was established 10 .…”

“… 10 Over the following years, the recommendations included progressively more physical activity and in the 1970s a structured and supervised rehabilitation program was established. 10 This program contained three phases. Phase I was initiated while the patient was still in the hospital after a cardiovascular event as low‐level supervised activity.…”