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BRIEF HISTORY OF CARDIAC REHABILITATION
The first record we have linking exercise with successful cardiac recovery came in 1772. An English physician noted that a patient who had had a heart attack was “nearly cured” after six months of sawing wood for a half hour a day. In 1799 another doctor wrote that physical activity benefited his patients who had chest pain. Those reports came long before the medical community knew what a heart attack was or what caused heart disease.
The original clinical description of a heart attack was written in 1912. The author of that paper stated his concern over physical exertion and the risk of aggravating the condition. He urged a conservative treatment of bed rest for six to eight weeks after the heart attack, medically termed a myocardial infarction (MI).
Needless to say, long periods of inactivity drained a person’s energy enormously. In the 1940s, Dr S.A. Levine stated that “long continued bed rest saps morale, provokes desperation, unleashes anxiety and ushers in hopelessness of the capacity of resuming a normal life”. In a move which seemed wildly progressive for the time, he recommended that patients be allowed to sit in a chair for one to two hours, beginning the first day after the MI.
There were no complications to Dr Levine’s approach, and his “chair treatment” rapidly caught on. This method, which improves circulation and lessens the risk of thrombosis, remains in use today. Remember how you were told to sit in the chair next to your bed in the hospital?
By 1950, medical authorities began to seriously question lengthy bed rest, pointing to the lack of evidence that it did any good and suggesting that it might do far more harm than good. Yet for many years more, well into the 1970s in various parts of the world, doctors continued to prescribe immobilisation of heart patients.
Inactivity is detrimental even for the healthiest individuals, much less for heart patients with compromised circulation. Put a healthy young man or woman in bed for any length of time, much less two to four weeks, and you will deplete energy, lead to easy fatigue and create dizziness. Of course those are exactly the symptoms that the heart patient finds so troublesome and depressing.
By the 1960s, a number of studies showed that early activity after an MI safely eliminates the adverse effects of prolonged bed rest. An appropriate time of training is needed to restore patients to pre-bed rest condition. One study demonstrated that functional capability of normal, healthy subjects dropped by one-third after three weeks of bed rest. It took the same amount of time to get back to normal. After three months of twice-daily rigorous exercise programs, all exceeded the level of functional capacity prior to bed rest.
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