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[Complex cardiac rehabilitation in a strategy of secondary prevention of cardiovascular disease]

Dariusz Kałka, Małgorzata Sobieszczańska, Witold Pilecki, Jerzy Adamus
Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego 2009, 27 (157): 30-5
19650426
Due to the frequency of occurrence of cardiovascular disease and its course full of severe complications, patients with this condition make a special population. This group is the addressee of the preventive actions included in secondary prevention. The goal of these actions is a reduction of frequency of the occurrence of consecutive incidents connected with ischemic heart disease, ischemic stroke and peripheral artery disease. The actions put a special emphasis on the counteraction of significant and negative from the social-economic point of view phenomenon, such as disability and premature deaths. The key role within the frames of the integrated preventive procedure in the patients with cardiovascular disease plays the modification of physical activity, mainly realized as a part of a supervised physical training. The training is a basic element of a systematized cardiac rehabilitation. It was Hellerstain, who as a pioneer in using this kind of rehabilitation in the patients after acute coronary incidents, and in the 1950s began propagating a multi-disciplinary attitude to the cardiac rehabilitation programs. Since WHO's formulation of the first definition of cardiac rehabilitation in 1964, as a result of the achievements of modern invasive cardiology, cardiosurgery and pharmacotherapy, the procedures of treatment of the patients with acute coronary syndrome changed radically. Moreover, a time of their hospitalization has shortened significantly. This fact had an influence on created by many scientific associations the successive development of the standardized process of convalescence, which is cardiac rehabilitation. The Board of Polish Society of Cardiology (PTK), appreciating the rank of the issue, appointed a group of experts to work on the standards of the cardiac rehabilitation, which were published in 2004 in the journal "Folia Cardiologica". Based on the modified in 2003 requirements established by The Working Group of Rehabilitation and Effort Physiology of European Society of Cardiology and the authors' own experiences, they standardize the regulations of the cardiac rehabilitation. What is specially underlined in this document is keeping the regulation of cardiac rehabilitation effects optimization with maximum safety for the patients and recommending wide, not depending on age, access to complex rehabilitation programs, which contains multi-factor interventive actions. Promoting all aspects of the improvement of physical activity, the cardiac rehabilitation programs contribute to the large extent to the positive modification of arthrosclerosis risk factors, the improvement of physical performance and reducing the risk of occurrence of next acute cardiovascular incidences. All the above-mentioned aspects lead to a comeback to active participation in the social life, and consequently have a positive influence on the quality of life of the people with cardiovascular disease. The aim of this work is summing up the present knowledge of cardiac rehabilitation as a basic element of secondary prevention.

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