Awareness by the medical profession, public opinion and political power of the importance and need for a widespread multidimensional Cardiac Rehabilitation Programme (CRP), is still very recent, although the first guidelines were drawn up, and published by the American College of Sports Medicine in 1995.
Even though the benefits are widely known and evident (Recommendation Class 1 – Benefit clearly evident), the CRP (Cardiac Rehabilitation Programmes) continue to be underutilised worldwide. There are various causes for this scenario. Among others, there is a lack of medical referral, poor information for both health professionals and the community in general, on the importance and benefits of Cardiac Rehabilitation. Patient motivation and scarcity of resources are other important factors.
The most frequently referred patients to CRP include: myocardial infarction (heart attack), stable angina, after percutaneous revascularisation, after coronary artery bypass surgery, after the surgical repair or replacement of a heart valve, either while still in hospital during the recovery period, or as an out-patient.
More recently the importance of CRP, specifically supervised physical exercise, is recommended to patients with cardiac insufficiency and even to patients submitted to transplant surgery in the pre or post operative stages, be it heart transplant, lung or both.
Recognition and the subsequent evaluation of cardiovascular risk is a fundamental key factor in the initial medical assessment of the patient. It will determine a safe and feasible physical reconditioning programme, its intensity, the need for continuous electrocardio-graphic (ECG) monitoring and also the degree of medical supervision which will be necessary.
Starting early CRP as soon after a cardiovascular episode as possible, has been widely documented in reducing the mortality-risk associated with the disease.
The patient should be referred for CRP while he is still in hospital and whenever possible in the period immediately after hospital discharge. Usually CRP begins in the 1st to 3rd week after hospital discharge for a period of 3-6 months, including ECG monitoring, at least in the initial stages.
A Cardiac Rehabilitation Programme consists of:
> Exercise Training
> Nutritional Counselling
> Treatment of Diabetes,
Hypertension, Dyslipidemia
> Smoking Cessation
> Weight Control
> Psychosocial Treatment
> Counselling on Physical Activity

Physical activity should be continued after discharge from hospital on a long-term basis, without the need for direct medical supervision or monitoring, but should be prescribed and monitored systematically.
Although not all are objectively measurable, such as the physiological and psychological consequences on heart disease of, increased social participation or vocational rehabilitation, it is possible to conceptually divide the benefits of CRP into four sections:
MORTALITY: A reduction of between 12% to 28% on the total mortality rate and 22% to 30% on deaths due to cardiovascular disease.
FUNCTIONAL CAPACITY & PHYSIOLOGICAL ADAPTATIONS: Improvement on exercise tolerance; reduced heart rate and systolic blood pressure; more energy and increased muscle fibre, including many other physiological adaptations.
CARDIOVASCULAR RISK PROFILE: Reduction of weight in overweight patients or those with abdominal obesity, atherogenic dyslipidemia and peripheral resistance to insulin – glucose intolerance.
QUALITY OF LIFE AND PSYCHOSOCIAL PROFILE: Improved physical and mental health-related to quality of life; reduced periods of depression, anxiety and hostility.
With the expansion of the Alvor Hospital, conditions have now been created which make it possible to embrace this new challenge. This is especially due to the extensive gymnasium created specifically for therapeutic exercise and also due to the interdisciplinary team of professionals it counts on.