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© Borgis - Postępy Nauk Medycznych 10/2008, s. 700
Tomasz Jaxa-Chamiec
Comment
Cardiovascular diseases (CVD) in developed countries are the main cause of increased mortality. They represent a major clinical, epidemiological and social problem.
Their diffusion is also a great economic problem of the modern world. Significant progress in diagnosis and treatment of CVD observed over the past decades has given as a result a very significant positive outcome in CVD patients.
It is difficult to imagine the possibility of halting the epidemic of CVD without dissemination of prevention and use of non-pharmacological methods of treatment.
In patients with CVD, a key way of proceeding should be a properly implemented modern comprehensive cardiac rehabilitation. Its conduct is not only the use of modern methods of pharmacology, but above all, the wider impact of education leading to changes in patients´ lifestyles.
This review seeks to raise all the key issues in this regard. One of the most effective methods in both primary and secondary prevention is increased physical activity. The particular role of physical training in patients with CVD made it become the leading topic in this monograph.
The first chapter of the monograph includes comprehensive information concerning definition, purpose, meaning and benefits of cardiac rehabilitation. Developing refers to the standards expressed by both American and European scientific societies and is based on broad and, in our opinion, representative papers of the field. In this section it could be found some interesting historical information, e.g. how the ancient societies apreciated the role of physical exercise.
In another part of this review Dr Krzysztof Smarż presents data on rehabilitation in various clinical settings.Standards in this field are shown in this chapter, considering also patients with heart failure. This knowledge is especially important because, until recently, patients were dienied of this form of therapy.
Another chapter of the monograph developed by Dr Michał Ambroziak presents in an accessible way the physiological aspects of the effort, with particular emphasis on the modern perspective of the role of physical activity in terms of genetics.
The fourth part of this review, addressed to medical practitioners, seems to be particularly important. Its subject is the new perspective on ECG stress test - method available and commonly used in clinical practice since several decades. As a result of a rapid development of new imaging techniques it has been in a setback. I am convinced that it is time to look again at the role of the stress test, particularly in the evaluation of prognosis. The justification could be formed in the recent publications of experts of the field P. Kligfield and MS Lauer. These authors recommend the use of special scores for the interpretation of the results of exercise test. The application of this extended interpretation of exercise should be, in my opinion, implemented as soon as possible. The wider use of the scores should result in the creation of new software for the stress test. Such software can not only effectively rebuild the position of test in the diagnosis of coronary heart disease, but more importantly, should become an important tool in health prevention programs.
Another part of the present work covers the practical aspects related to the exercise tests in different groups of cardiac patients. In addition to the discussion on the role of classical stress test ECG, Dr Krzysztof Smarż presents contemporary clinical importance of ergospirometry and, not fully appreciated and rarely used, the 6-minute walk test, particularly useful in both rehabilitation and treatment of patients with heart failure.
The last part of the monograph is focused on the secondary prevention – pharmacological prevention and a change in patients´ lifestyle. Our goal was to draw the attention of medical practitioners mainly to the second part of preventive action.
Based on the latest guidelines of American and European cardiac societies, it is clear that the key action to improve the prognosis of patients with CVD is the modification of risk factors such as obesity, smoking, poor dietary habits, as well as little physical activity. Recently, it has been shown that psychological, economical and social factors determine patients´ lifestyles. The improvement of psychological well-being, as well as of the socio-economic situation gives much more tangible benefits than we thought before.
In conclusion, this monograph presents some important issues. Bearing in mind the educational role of this monograph we tried to present its complexity based on the comprehensive literature.
The overarching goal was to convince our readers of the leading role of physical training in the contemporary sense of cardiac rehabilitation. We would like this monograph to convince about the appropriateness of the motto, by Dr. Darren ER Warburton of the University of British Columbia: „. Routine physical activity is associated with improved psychological well-being. (.) Psychological well-being is particularly important for the prevention and management of cardiovascular diseases”.
Postępy Nauk Medycznych 10/2008
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