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(Circulation. 2000;102:1069.)
© 2000 American Heart Association, Inc.

AHA/AACVPR Scientific Statement

Core Components of Cardiac Rehabilitation/Secondary Prevention Programs

A Statement for Healthcare Professionals From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group

Gary J. Balady, MD (chair); Philip A. Ades, MD; Patricia Comoss, RN; Marian Limacher, MD; Ileana L. Pina, MD; Douglas Southard, PhD; Mark A. Williams, PhD; Terry Bazzarre, PhD

Key Words: AHA/AACVPR Scientific Statement • prevention • cardiovascular diseases • diet • exercise • risk factors

Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with cardiovascular disease.^{1 2} In 1994, the American Heart Association stated that cardiac rehabilitation programs should consist of a multifaceted and multidisciplinary approach to overall cardiovascular risk reduction, and that programs that consist of exercise training alone are not considered cardiac rehabilitation.¹ This concept has been further developed in the Agency for Health Care Policy and Research clinical practice guideline on cardiac rehabilitation,² which provides the most comprehensive review of the scientific literature and evidence-based recommendations regarding all aspects of the discipline. The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognize that all cardiac rehabilitation/secondary prevention programs should contain specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance to these behaviors, reduce disability, and promote an active lifestyle for patients with cardiovascular disease.

The purpose of this statement is to present specific information regarding evaluation, intervention, and expected outcomes in each of the core components of cardiac rehabilitation/secondary prevention programs: baseline patient assessment; nutritional counseling; risk factor management (lipids, hypertension, weight, diabetes, and smoking); psychosocial management; physical activity counseling; and exercise training. These recommendations are intended to assist cardiac rehabilitation staff in the design and development of their programs and to assist healthcare providers, insurers and policy makers, and consumers in the recognition of the comprehensive nature of such programs. It is not the intent of this statement to promote a rote approach or homogeneity among programs, but rather to foster a foundation of services upon which each program can establish its own specific strengths and identity and effectively attain outcome goals for its target population. Comprehensive and detailed guidelines regarding cardiac rehabilitation/secondary prevention programs have been published by the AACVPR³ and endorsed by the American Heart Association. Detailed guidelines on specific risk factor modifications are also available.^{4 5 6 7 8 9 10 11 12 13 14 15 16 17} Specific details regarding management of patients with heart failure, valvular disease, arrhythmias, and other cardiovascular diagnoses are beyond the scope of this document and can be found in the AACVPR guidelines.³

View this table: [in this window] [in a new window]   Table 1. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs

View this table: [in this window] [in a new window]   Table 1A. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs

View this table: [in this window] [in a new window]   Table 1B. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs

View this table: [in this window] [in a new window]   Table 1C. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs

Footnotes

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee in May 2000. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0186. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or e-mail pubauth@heart.org. To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400.

This statement is also being published in the September/October 2000 issue of the Journal of Cardiopulmonary Rehabilitation.

References

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2. Wenger NK, Froelicher ES, Smith LK, et al. Cardiac Rehabilitation: Clinical Practice Guideline No. 17. Rockville, Md: US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, National Heart, Lung, and Blood Institute; October 1995. AHCPR publication No. 96-0672.
   
3. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. Champaign, Ill: Human Kinetics Publishers; 1999.
   
4. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–407.[Abstract]
   
5. American College of Sports Medicine Position Stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:975–991.[Medline] [Order article via Infotrieve]
   
6. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
   
7. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2000.
   
8. Smith SC Jr, Blair SN, Criqui MH, et al. Preventing heart attack and death in patients with coronary artery disease. Circulation. 1995;92:2–4.
   
9. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP II). Bethesda, Md: National Institutes of Health, National Heart, Lung, and Blood Institute; 1993. NIH publication No. 93-3095.
   
10. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994;89:1333–1445.[Medline] [Order article via Infotrieve]
    
11. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [published erratum appears in Arch Intern Med. 1998;158:573]. Arch Intern Med. 1997;157:2413–2446.[Free Full Text]
    
12. Fiore MC, Bailey WC, Cohen SJ, et al. Smoking Cessation: Clinical Practice Guideline No. 18. Rockville, Md: US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; April 1996. AHCPR publication No. 96-0692.
    
13. Ruderman N, Devlin JT, eds. The Health Professional’s Guide to Diabetes and Exercise. Alexandria, Va: American Diabetes Association; 1995.
    
14. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;158:1855–1867.[Free Full Text]
    
15. Grundy SM, Pasternak R, Greenland P, et al. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 1999;100:1481–1492.[Free Full Text]
    
16. Rehabilitation After Cardiovascular Diseases, With Special Emphasis on Developing Countries: Report of a WHO Expert Committee. Geneva, Switzerland: World Health Organization; 1993. WHO Technical Report Series, No. 831.
    
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