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How valuable is cardiac rehabilitation and who should get it?
  1. D P DE BONO
  1. Department of Health Studies, University of York
  2. York YO10 5DQ, UK
  3. Department of Medicine and Therapeutics, University of Leicester
  4. Leicester LE3 9QP, UK

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Modern cardiac rehabilitation is a multidisciplinary activity requiring a range of health skills to bring together medical treatment, education, counselling, exercise training, risk factor modification, and secondary prevention, to limit the harmful physical and psychological effects of heart disease, reduce the risk of death or recurrence of the cardiac event, and enhance the psychosocial and vocational state of patients.1 It has developed from older and more one dimensional concepts of exercise based rehabilitation, which had evolved in response to treatment regimens involving prolonged bed rest. The value of multidisciplinary rehabilitation rests on two questions: first, is the whole more than the sum of its parts, and second, is the environment of a cardiac rehabilitation programme a good way of ensuring patients receive and adhere to evidence based treatments? The first question can only be answered indirectly in that no trials of adequate size have randomised patients to single versus multidisciplinary intervention. Indeed, as will be argued below, it may not be realistic to do so. In general, intervention studies have shown better outcomes in terms of exercise tolerance, symptoms, plasma lipid levels, psychosocial wellbeing, smoking, and stress reduction.2 ,3 The interaction …

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