The American Heart Association (AHA) recommends in a statement issued Monday that doctors strongly encourage their cardiac patients to participate in rehabilitation programs aimed at preventing a recurrence of heart problems.

In 1994, the AHA declared that cardiac rehabilitation should include not only exercise training but also multifaceted programs aimed at reducing risk factors for coronary heart disease.

In today’s revised statement, the association reviews the recommended components for an effective cardiac rehabilitation/prevention program, with an emphasis on exercise training.

Studies have shown that exercise-based cardiac rehab lowers heart-related mortality rates by 26 percent, and total mortality rates by 20 percent, compared with usual medical care.

Heart patients who undertake exercise training also have fewer non-fatal heart attacks, and require bypass surgery and angioplasty less often, than patients who do not participate in exercise training.

Despite this, the AHA says, cardiac rehab programs “remain underused in the United States, with an estimated participation rate of only 10 percent to 20 percent of the greater than 2 million eligible patients per year” - that is, people who’ve had a heart attack or have undergone procedures to clear blocked coronary arteries.

The main reason for low participation rates - particularly among women, older individuals, and ethnic minorities - is that doctors are not referring patients to rehab programs, say Dr. Arthur S. Leon from the University of Minnesota in Minneapolis and colleagues in the American Heart Association’s journal Circulation.

Also, inadequate third-party reimbursement for cardiac rehabilitation, and limited access to these programs, play a role in certain areas of the country.

The statement also discusses alternative models to the traditional hospital- or community center-based settings for cardiac rehabilitation, such as home and Internet-based approaches.

SOURCE: Circulation, January 25, 2005.