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Coronary heart disease: rehabilitation

from Medical topics

Published online by Cambridge University Press:  18 December 2014

By
Robert Lewin
Edited by
Susan Ayers ,
Andrew Baum ,
Chris McManus ,
Stanton Newman ,
Kenneth Wallston ,
John Weinman  and
Robert West
Robert Lewin
Affiliation:
University of York
Susan Ayers
Affiliation:
University of Sussex
Andrew Baum
Affiliation:
University of Pittsburgh
Chris McManus
Affiliation:
St Mary's Hospital Medical School
Stanton Newman
Affiliation:
University College and Middlesex School of Medicine
Kenneth Wallston
Affiliation:
Vanderbilt University School of Nursing
John Weinman
Affiliation:
United Medical and Dental Schools of Guy's and St Thomas's
Robert West
Affiliation:
St George's Hospital Medical School, University of London
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Summary

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.

Type
Chapter
Information
Cambridge Handbook of Psychology, Health and Medicine , pp. 656 - 659
Publisher: Cambridge University Press
Print publication year: 2007

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References

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