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Intensive Cardiac Rehabilitation: an Underutilized Resource

  • Public Health Policy (E Klodas, Section Editor)
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Abstract

Purpose of Review

To review evidence-based lifestyle modification strategies for secondary prevention and explore how they are incorporated in traditional cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) programs.

Recent Findings

While physical activity is an important element of cardiac rehabilitation, more recent studies support a variety of methods, including stress management and plant-based diets, to reduce cardiovascular risk factors. Patients who participate in traditional CR programs demonstrate clinical improvement, which are significantly greater in intensive CR (ICR). Yet, there is still a disparity in numbers between those who are eligible and those who ultimately enroll.

Summary

Research into non-surgical and non-pharmacological health management approaches continues to validate the effectiveness of multidisciplinary intensive CR programs, but there is an increasing need to connect patients with these opportunities.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388–98.

    CAS  PubMed  Google Scholar 

  2. Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58(23):2432–46.

    PubMed  Google Scholar 

  3. Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr, Hayman LL, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124(8):967–90.

    CAS  PubMed  Google Scholar 

  4. Maruthur NM, Wang N-Y, Appel LJ. Lifestyle interventions reduce coronary heart disease risk: results from the PREMIER trial. Circulation. 2009;119(15):2026–31.

    PubMed  PubMed Central  Google Scholar 

  5. • Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12. This meta-analysis compares outcomes between people enrolled in exercise-based CR with no-exercise controls and supports that the CR group has a better cardiovascular mortality rate than the control group.

    PubMed  Google Scholar 

  6. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey de Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    PubMed  Google Scholar 

  7. Rao SV, Hess CN, Dai D, Green CL, Peterson ED, Douglas PS. Temporal trends in percutaneous coronary intervention outcomes among older patients in the United States. Am Heart J. 2013;166(2):273–81.e4.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Venkitachalam L, Kip KE, Selzer F, Wilensky RL, Slater J, Mulukutla SR, et al. Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985-1986 PTCA and 1997-2006 Dynamic Registries. Circ Cardiovasc Interv. 2009;2(1):6–13.

    PubMed  Google Scholar 

  9. Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA. Outcomes with intravascular ultrasound-guided stent implantation: a meta-analysis of randomized trials in the era of drug-eluting stents. Circulation: Cardiovascular Interventions. 2016;9(4):e003700.

    CAS  Google Scholar 

  10. Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115(5):e69–171.

    PubMed  Google Scholar 

  11. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–16.

    CAS  PubMed  Google Scholar 

  12. Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503–15.

    CAS  PubMed  Google Scholar 

  13. Fang J, Ayala C, Luncheon C, Ritchey M, Loustalot F. Use of outpatient cardiac rehabilitation among heart attack survivors — 20 States and the District of Columbia, 2013 and four states, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:869–73.

    PubMed  PubMed Central  Google Scholar 

  14. Mazzini MJ, Stevens GR, Whalen D, Ozonoff A, Balady GJ. Effect of an American Heart Association Get With the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. Am J Cardiol. 2008;101(8):1084–7.

    PubMed  Google Scholar 

  15. Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation. 2018;137(20):2166–78.

    PubMed  Google Scholar 

  16. Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011;124(25):2951–60.

    PubMed  Google Scholar 

  17. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.

    PubMed  PubMed Central  Google Scholar 

  18. Williams KA, Martin GR. New American College of Cardiology population health agenda to focus on primary prevention. JACC. 2015;66(14):1625–6.

    PubMed  Google Scholar 

  19. Keyes A, Anderson JT, Grande F. Serum cholesterol response to changes in the diet: I. Iodine value of dietary fat versus 2S-P. Metabolism. 1965;14(7):747–58.

    PubMed  Google Scholar 

  20. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):1519.

    PubMed  PubMed Central  Google Scholar 

  21. Keys A, Menotti A, Aravanis C, Blackburn H, Djordevic BS, Buzina R, et al. The seven countries study: 2,289 deaths in 15 years. Prev Med. 1984;13(2):141–54.

    CAS  PubMed  Google Scholar 

  22. Keys A, Anderson JT, Grande F. Serum cholesterol response to changes in the diet: II. The effect of cholesterol in the diet. Metabolism. 1965;14(7):759–65.

    CAS  PubMed  Google Scholar 

  23. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease--six year follow-up experience. Framingham Study Ann Intern Med. 1961;55:33–50.

    CAS  PubMed  Google Scholar 

  24. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008;168(7):713–20.

    PubMed  Google Scholar 

  25. Ockene JK, Kuller LH, Svendsen KH, Meilahn E. The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). Am J Public Health. 1990;80(8):954–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Mensink RP. Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. Geneva: World Health Organization; 2016.

    Google Scholar 

  27. Siscovick DS, Barringer TA, Fretts AM, Wu JH, Lichtenstein AH, Costello RB, et al. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2017;135(15):e867–84.

    CAS  PubMed  Google Scholar 

  28. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343(8911):1454–9.

    PubMed  Google Scholar 

  29. American Heart Association. Cardiovascular disease: a costly burden for America–projections though 2035. https://healthmetrics.heart.org/wp-content/uploads/2017/10/Cardiovascular-Disease-A-Costly-Burden.pdf. Published February 14, 2017. Accessed September 14, 2018.

  30. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85.

    PubMed  Google Scholar 

  31. Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet. 2002;360(9344):1455–61.

    PubMed  Google Scholar 

  32. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133(2):187–225.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Willett WC. Dietary fats and coronary heart disease. J Intern Med. 2012;272(1):13–24.

    CAS  PubMed  Google Scholar 

  34. Aune D, Keum N, Giovannucci E, et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2016;353:i2716.

    PubMed  PubMed Central  Google Scholar 

  35. Esselstyn CB, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63(7):356–64b.

    PubMed  Google Scholar 

  36. Massera D, Zaman T, Farren GE, Ostfeld RJ. A whole-food plant-based diet reversed angina without medications or procedures. Case Rep Cardiol. 2015;2015:978906.

    PubMed  PubMed Central  Google Scholar 

  37. Van Horn L, Carson JA, Appel LJ, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016;134(22):e505–29.

    PubMed  Google Scholar 

  38. Schwingshackl L, Bogensberger B, Hoffmann G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2018;118(1):74–100.e11.

    PubMed  Google Scholar 

  39. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet (London, England). 2014;383(9933):1999–2007.

    CAS  Google Scholar 

  40. Wang Y, Chun OK, Song WO. Plasma and dietary antioxidant status as cardiovascular disease risk factors: a review of human studies. Nutrients. 2013;5(8):2969–3004.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC, et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med. 2013;369(21):2001–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Hshieh TT, Petrone AB, Gaziano JM, Djoussé L. Nut consumption and risk of mortality in the physicians’ health study. Am J Clin Nutr. 2015;101(2):407–12.

    CAS  PubMed  Google Scholar 

  43. Papandreou C, Becerra-Tomás N, Bulló M, et al. Legume consumption and risk of all-cause, cardiovascular, and cancer mortality in the PREDIMED study. Clin Nutr. 2018

  44. Li H, Li J, Shen Y, Wang J, Zhou D. Legume consumption and all-cause and cardiovascular disease mortality. Biomed Res Int. 2017;2017:6.

    Google Scholar 

  45. Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JE, Willett W, et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol. 2017;70(4):411–22.

    PubMed  PubMed Central  Google Scholar 

  46. Mirrahimi A, de Souza RJ, Chiavaroli L, et al. Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts. J Am Heart Assoc. 2012;1(5):e000752.

    PubMed  PubMed Central  Google Scholar 

  47. Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014;19(3):407–17.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014;174(4):577–87.

    PubMed  Google Scholar 

  49. Navarro JCA, Antoniazzi L, Oki AM, Bonfim MC, Hong V, Bortolotto LA, et al. Prevalence of metabolic syndrome and Framingham risk score in apparently healthy vegetarian and omnivorous men. Arq Bras Cardiol. 2018;110(5):430–7.

    PubMed  PubMed Central  Google Scholar 

  50. Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovascular Diagnosis Ther. 2014;4(5):373–82.

    Google Scholar 

  51. Dod HS, Bhardwaj R, Sajja V, Weidner G, Hobbs GR, Konat GW, et al. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am J Cardiol. 2010;105(3):362–7.

    CAS  PubMed  Google Scholar 

  52. Wang F, Zheng J, Yang B, Jiang J, Fu Y, Li D. Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4(10):e002408.

    PubMed  PubMed Central  Google Scholar 

  53. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S76–99.

    PubMed  Google Scholar 

  54. Kent L, Morton D, Rankin P, Ward E, Grant R, Gobble J, et al. The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status: a cohort study. Nutr Metab. 2013;10:58.

    Google Scholar 

  55. Smidowicz A, Regula J. Effect of nutritional status and dietary patterns on human serum C-reactive protein and interleukin-6 concentrations. Adv Nutr. 2015;6(6):738–47.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Macknin M, Kong T, Weier A, et al. Plant-based no added fat or American Heart Association diets, impact on cardiovascular risk in obese hypercholesterolemic children and their parents. J Pediatr. 2015;166(4):953–959.e3.

    PubMed  PubMed Central  Google Scholar 

  57. Tuso P, Stoll SR, Li WW. A plant-based diet, atherogenesis, and coronary artery disease prevention. Permanente J. 2015;19(1):62–7.

    Google Scholar 

  58. Kahleova H, Levin S, Barnard N. Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients. 2017;9(8):E848.

    PubMed  Google Scholar 

  59. USDA. Scientific Report of the 2015 Dietary guidelines advisory committee. February 2015.

  60. Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med. 2000;160(11):1621–8.

    CAS  PubMed  Google Scholar 

  61. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244–53.

    PubMed  Google Scholar 

  62. Wannamethee SG, Shaper AG, Walker M. Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation. 2000;102(12):1358–63.

    CAS  PubMed  Google Scholar 

  63. Stewart RAH, Held C, Hadziosmanovic N, Armstrong PW, Cannon CP, Granger CB, et al. Physical activity and mortality in patients with stable coronary heart disease. J Am Coll Cardiol. 2017;70(14):1689–700.

    PubMed  Google Scholar 

  64. Arnson Y, Rozanski A, Gransar H, Hayes SW, Friedman JD, Thomson LEJ, et al. Impact of exercise on the relationship between CAC scores and all-cause mortality. JACC Cardiovasc Imaging. 2017;10(12):1461–8.

    PubMed  Google Scholar 

  65. Lahtinen M, Toukola T, Junttila MJ, Piira OP, Lepojärvi S, Kääriäinen M, et al. Effect of changes in physical activity on risk for cardiac death in patients with coronary artery disease. Am J Cardiol. 2018;121(2):143–8.

    PubMed  Google Scholar 

  66. Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob Health. 2015;3(3):e132–42.

    PubMed  PubMed Central  Google Scholar 

  67. Moholdt T, Lavie CJ, Nauman J. Sustained physical activity, not weight loss, associated with improved survival in coronary heart disease. J Am Coll Cardiol. 2018;71(10):1094–101.

    PubMed  Google Scholar 

  68. Varghese T, Schultz WM, McCue AA, Lambert CT, Sandesara PB, Eapen DJ, et al. Physical activity in the prevention of coronary heart disease: implications for the clinician. Heart. 2016;102(12):904–9.

    CAS  PubMed  Google Scholar 

  69. Ornish D. Love and survival: the scientific basis for the healing power of intimacy. New York: HarperPerennial; 1998.

    Google Scholar 

  70. Tawakol A, Ishai A, Takx RA, Figueroa AL, Ali A, Kaiser Y, et al. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. Lancet. 2017;389(10071):834–45.

    PubMed  Google Scholar 

  71. Frasure-Smith N, Lespérance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993;270(15):1819–25.

    CAS  PubMed  Google Scholar 

  72. Boyle SH, Samad Z, Becker RC, Williams R, Kuhn C, Ortel TL, et al. Depressive symptoms and mental stress-induced myocardial ischemia in patients with coronary heart disease. Psychosom Med. 2013;75(9):822–31.

    PubMed  PubMed Central  Google Scholar 

  73. Seeman TE, Syme SL. Social networks and coronary artery disease: a comparison of the structure and function of social relations as predictors of disease. Psychosom Med. 1987;49(4):341–54.

    CAS  PubMed  Google Scholar 

  74. Tyagi A, Cohen M. Yoga and heart rate variability: a comprehensive review of the literature. Int J Yoga. 2016;9(2):97–113.

    PubMed  PubMed Central  Google Scholar 

  75. Manchanda S, Narang R, Reddy K, Sachdeva U, Prabhakaran D, Dharmanand S, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India. 2000;48(7):687–94.

    CAS  PubMed  Google Scholar 

  76. Manchanda S, Mehrotra U, Makhija A, Mohanty A, Dhawan S, Sawhney J. Reversal of early atherosclerosis in metabolic syndrome by yoga-a randomized controlled trial. J Yoga Physic Ther. 2013;3(1):1.

    Google Scholar 

  77. Krishna BH, Pal P, Pal G, Balachander J, Jayasettiaseelon E, Sreekanth Y, et al. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res. 2014;8(1):14.

    PubMed  PubMed Central  Google Scholar 

  78. Field T. Yoga clinical research review. Complement Ther Clin Pract. 2011;17(1):1–8.

    PubMed  Google Scholar 

  79. Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14(5):407–13.

    PubMed  Google Scholar 

  80. Pal A, Srivastava N, Narain V, Agrawal G, Rani M. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial. East Mediterr Health J. 2013;19(5):452–8.

    CAS  PubMed  Google Scholar 

  81. Cramer H, Lauche R, Haller H, Dobos G, Michalsen A. A systematic review of yoga for heart disease. Eur J Prev Cardiol. 2015;22(3):284–95.

    PubMed  Google Scholar 

  82. Lakkireddy D, Atkins D, Pillarisetti J, Ryschon K, Bommana S, Drisko J, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: the YOGA my heart study. J Am Coll Cardiol. 2013;61(11):1177–82.

    PubMed  Google Scholar 

  83. Toise SC, Sears SF, Schoenfeld MH, Blitzer ML, Marieb MA, Drury JH, et al. Psychosocial and cardiac outcomes of yoga for ICD patients: a randomized clinical control trial. Pacing Clin Electrophysiol. 2014;37(1):48–62.

    PubMed  Google Scholar 

  84. Olex S, Newberg A, Figueredo VM. Meditation: should a cardiologist care? Int J Cardiol. 2013;168(3):1805–10.

    PubMed  Google Scholar 

  85. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks. Circulation: Cardiovascular Quality and Outcomes. 2012;5(6):750–8.

    Google Scholar 

  86. Gupta SK, Sawhney RC, Rai L, et al. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients-Mount Abu open heart trial. Indian Heart J. 2011;63:461–9.

    PubMed  Google Scholar 

  87. Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: a randomized control trial. International Journal of Yoga. 2013;6(2):111–7.

    PubMed  PubMed Central  Google Scholar 

  88. Newman LB, Andrews MF, Koblish MO, Baker LA. Physical medicine and rehabilitation in acute myocardial infarction. AMA Arch Intern Med. 1952;89(4):552–61.

    CAS  PubMed  Google Scholar 

  89. Benton JG, Rusk HA. The patient with cardiovascular disease and rehabilitation: the third phase of medical care. Circulation. 1953;8(3):417–26.

    CAS  PubMed  Google Scholar 

  90. Wenger N, Gilbert C, Skorapa M. Cardiac conditioning after myocardial infarction. An early intervention program. J Cardiac Reabil. 1971;2:17–22.

    Google Scholar 

  91. Erb BD, Fletcher GF, Sheffield TL. Standards for cardiovascular exercise treatment programs. Am Heart Assoc Subcommittee Rehab Target Activity Group Circulation. 1979;59:1084A–90A.

    Google Scholar 

  92. Pashkow FJ. Issues in contemporary cardiac rehabilitation: a historical perspective. J Am Coll Cardiol. 1993;21(3):822–34.

    CAS  PubMed  Google Scholar 

  93. Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274(11):894–901.

    CAS  PubMed  Google Scholar 

  94. Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko HR, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation. 1994;89(3):975–90.

    CAS  PubMed  Google Scholar 

  95. Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115(20):2675–82.

    PubMed  Google Scholar 

  96. Heran BS et al. Cochrane database of systematic reviews 2011, Issue 7.

  97. Ornish D, Scherwitz L, Billings J, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease five-year follow-up of the lifestyle heart trial. JAMA. 1998;280:2001–7.

    CAS  PubMed  Google Scholar 

  98. Aldana SG et al. Heart lung. 2003;32:374–82.Ornish Lifestyle Medicine. www.Ornish.com. Accessed September 15, 2018.

  99. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001–7.

    CAS  PubMed  Google Scholar 

  100. Barnard RJ, Ugianskis EJ, Martin DA, Inkeles SB. Role of diet and exercise in the management of hyperinsulinemia and associated atherosclerotic risk factors. Am J Cardiol. 1992;69:440–4.

    CAS  PubMed  Google Scholar 

  101. Pritikin Longevity Center. www.Pritikin.com. Accessed September 15, 2018.

  102. Ornish DM, Scherwitz LW, Doody RS, Kesten D, McLanahan SM, Brown SE, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54–9.

    CAS  PubMed  Google Scholar 

  103. Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The lifestyle heart trial. Lancet. 1990;336:129–33 (Reprinted in Yearbook of Medicine and Yearbook of Cardiology (New York: C.V. Mosby, 1991).

    CAS  PubMed  Google Scholar 

  104. Gould KL, Ornish D, Kirkeeide R, Brown S, Stuart Y, Buchi M, et al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol. 1992;69:845–53.

    CAS  PubMed  Google Scholar 

  105. Silberman A, Banthia R, Estay IS, Kemp C, Studley J, Hareras D, et al. The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. Am J Health Promot. 2010;24(4):260–6.

    PubMed  Google Scholar 

  106. Ornish D. Avoiding revascularization with lifestyle changes: the multicenter lifestyle demonstration project. Am J Cardiol. 1998;82:72T–6T.

    CAS  PubMed  Google Scholar 

  107. Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep. 2013;15(1):291.

    PubMed  PubMed Central  Google Scholar 

  108. Viswanathan M. Interventions to improve adherence to self-administered medications for chronic diseases in the United States. Ann Intern Med. 2012;157(11):785–95.

    PubMed  Google Scholar 

  109. Ornish D. The spectrum. New York: Ballantine Books; 2008.

    Google Scholar 

  110. Daubenmier JJ, Weidner G, Sumner MD, Mendell N, Merritt-Worden T, Studley J, et al. The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Ann Behav Med. 2007;33(1):57–68.

    PubMed  Google Scholar 

  111. Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2017;4:CD002902.

    PubMed  Google Scholar 

  112. • Blumenthal JA, Sherwood A, Smith PJ, et al. Enhancing cardiac rehabilitation with stress management training: a randomized clinical efficacy trial. Circulation. 2016;133(14):1341–50. This randomized clinic trial not only confirmed that people participating in CR have lower event rates than those who choose not to enroll, but also demonstrated that adding an additional element of stress management training to CR reduces clinical event rates even more.

    PubMed  PubMed Central  Google Scholar 

  113. Beatty AL, Li S, Thomas L, Amsterdam EA, Alexander KP, Whooley MA. Trends in referral to cardiac rehabilitation after myocardial infarction: data from the National Cardiovascular Data Registry 2007 to 2012. J Am Coll Cardiol. 2014;63(23):2582–3.

    PubMed  PubMed Central  Google Scholar 

  114. Aragam KG, Dai D, Neely ML, Bhatt DL, Roe MT, Rumsfeld JS, et al. Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States. J Am Coll Cardiol. 2015;65(19):2079–88.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, National Jewish Health, Main Campus, 1400 Jackson St., Denver, CO, 80206, USA

    Andrew M. Freeman

  2. Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA

    Pam R. Taub & Hannah C. Lo

  3. Preventive Medicine Research Institute and Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Dean Ornish

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  1. Andrew M. Freeman
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  2. Pam R. Taub
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  3. Hannah C. Lo
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  4. Dean Ornish
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Correspondence to Andrew M. Freeman.

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Conflict of Interest

Pam R. Taub has no disclosures related to this paper. However, she is a consultant and speaker for Sanofi/Regeneron, Novo-Nordisk, Boehringer-Ingleheim, Janssen, Pfizer, Amarin, and Amgen. She is a stock holder of Cardero Therapeutics. She is also medical director of the Ornish/ICR program at UC San Diego Health System.

Hannah C. Lo declares no conflict of interest.

Andrew M. Freeman does non-promotional speaking for Boehringer-Ingleheim. He is also medical director of the Ornish/ICR program at National Jewish Health.

Dean Ornish receives royalties from books, fees from Sharecare, and sometimes honoraria from lecturing.

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This article does not contain any studies with human or animal subjects performed by any of the authors. It is a review article summarizing previously published human studies.

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Freeman, A.M., Taub, P.R., Lo, H.C. et al. Intensive Cardiac Rehabilitation: an Underutilized Resource. Curr Cardiol Rep 21, 19 (2019). https://doi.org/10.1007/s11886-019-1104-1

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