Review Article. Cardiac rehabilitation

The definition of cardiac rehabilitation whether it be by the WHO or the European Society of Cardiology is very complex and includes not only the field of cardiology but also psychological and social interventions (Fig. 1). However, the practice of cardiac rehabilitation in Europe differs greatly from country to country. Cardiac rehabilitation in phase II varies from residential rehabilitation which includes cardiological management, stress management, exercise training, dietary instructions and intense risk factor modification as practiced in Germany, Austria and partially Switzerland and France in structured outpatient rehabilitation programmes with daily sessions, to once-a-week exercise training programmes without risk factor intervention in countries with less well-developed systems. Therefore, cardiac rehabilitation, as practiced in European countries, is difficult to define and to evaluate. Different components of cardiac rehabilitation, however, can be evaluated with respect to their effects on cardiac events or survival. Risk-factor intervention in patients with cardiac disease is of great importance because the event rate in patients with established coronary disease is five to seven times the event rate of patients with similar risk factors but with no evidence of cardiac disease. The following components of a multifactorial rehabilitation programme will be addressed: