The development of cardiac rehabilitation: a historical critical approach.

Cardiac rehabilitation is an interdisciplinary and multidimensional process aimed at preventing and containing cardiovascular mortality, morbidity and disability, and promoting health in subjects with cardiocirculatory pathologies. A body of scientific evidence is today available with regard to the benefits of cardiac rehabilitation in terms of the containment of the progression of atherosclerosis, the increase in physical work ability, the reduction in symptomatology, the improvement in psychological well being and social re-adaptation, and the lowering in hospitalization rates and in recurrent clinical cardiac events. Cardiac rehabilitation derives its origin from the application of physical activity to the therapy of ischemic heart disease, and in this paper the historical evolution of the concept of angina pectoris and myocardial infarction as also the major progress in therapeutic exercise are discussed. Cardiac rehabilitation has become through time a multi-faceted process implemented in hospitals, in outpatient clinics and at home in a variety of models. However, recent data indicate that, in the USA, no more than 20% of eligible patients per year enter cardiac rehabilitation programs, and in Europe no more than 30% participate in them. The historical perception of cardiac rehabilitation provides knowledge of the fact that, through a long and articulated process, this health intervention has achieved relevant medical and social results and it also generates the awareness of the further advantages to be obtained in future cardiovascular patients.