CARDIOLOGIST IN DODDABOMMASANDRA, BANGALORE
Although rehabilitation has been a part of the management of patients following a myocardial
infarction since the beginning of the last century, ideas have changed radically about
the form this should take. In the early 1900s Sir Thomas Lewis insisted his patients remain
in bed and be ‘guarded by day and night nursing and helped in every way to avoid voluntary
movement or effort’. These severe restrictions were continued for at least six to eight
weeks. The thinking was that complete rest would reduce the risk of aneurysm formation
and avoid hypoxia that might cause arrhythmias. Even after discharge mild exertion was
discouraged for up to a year and return to work was most unusual. In the 1970s periods of
bed rest of between one and four weeks were enforced and patients remained in hospital
for up to four weeks.
It is now clear that this de-conditioning has many adverse physical and psychological
effects. Patients with uncomplicated infarcts are now mobilised in hospital within a day or so
of admission and are often discharged on the third day if successful primary angioplasty has
Many hospitals provide a supervised rehabilitation program for patients who have had
an infarct or episode of unstable angina. The program begins in hospital as soon as possible
after admission. It includes a graded exercise regimen and advice about risk factor control.
Such programs have many benefits for patients to help them to return quickly to normal
life, including work and sexual activity. The supervised exercise regimen helps restore the
patient’s confidence. There is clear evidence of the benefits of exercise for patients with
ischaemic heart disease.54 Rehabilitation programs have been shown to be cost-effective.
Well-conducted programs are tailored to individual patients’ needs and are very popular
with many patients.55 There are often long-term exercise groups available for people who
have completed the formal classes.
Non-cardiac causes of chest pain