Rehabilitation of cardiac patients in the twenty-first century: changing paradigms and perceptions.

Rehabilitation of the coronary patient has changed dramatically over the past 40 years. The deleterious effects of prolonged bed rest have prompted the liberalization of activity soon after an acute cardiac event. Exercise-based cardiac rehabilitation has been shown to provide a 20-24% reduction in total and cardiovascular-related mortality. Adjunctive upper body aerobic exercise and mild to moderate resistance training can improve muscular strength and endurance in clinically stable coronary patients and attenuate the cardiovascular demands of occupational and leisure-time activities. Risk stratification has emerged as the centrepiece of strategies aimed at stabilizing or enhancing the clinical status of post-myocardial infarction patients, as well as vocational counselling. Moreover, randomized controlled trials have confirmed the hypothesis that lipid lowering is associated with, and possibly preceded by, plaque stabilization and a reduction in the risk of recurrent cardiac events.