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Part IX Cardiac rehabilitation 

Part IX Cardiac rehabilitation
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date: 25 July 2021

The development of cardiac rehabilitation (CR) over the past 60 years is a fascinating story that is marked by a number of landmark research studies, some evolutionary and others revolutionary. It would be impossible to include all research studies that left a significant mark on the course of CR over the years, but this chapter is an attempt to provide readers with a description of several published papers that are representative of the key advances in the science of CR during its 60-year history.

To identify such landmark studies is no easy feat. While assessment of the impact of a given paper could be attempted by measuring the number of times it is referenced or cited in other articles, this method is not entirely satisfactory since the number of times a paper is cited may vary due to a number of factors, not just the article's soundness and scientific significance. On the other hand, the impact of a given research study could be assessed by asking the opinion of ‘experts’, but this method is also prone to shortcomings, since those opinions are simply opinions and may be based on non-scientific factors. In the end, we used a combination of the two approaches, combining the subjectivity of expert opinion with the objectivity of the citation index of a given paper.

We first identified the hundred most cited research papers on the topic of ‘cardiac rehabilitation’ using Scopus. Once those studies were identified, two of the authors (RJT and RWS) each identified from that list (and from other published research studies with which they were familiar) the ten articles that they felt had the biggest impact on the field of CR. This process resulted in 15 articles that were felt to represent landmark papers, either because they introduced important new concepts to CR (i.e. they were ‘revolutionary’), or because they expanded previous scientific knowledge that had a lasting impact on the clinical practice of CR (i.e. they were ‘evolutionary’). The authors attempted to be as unbiased as possible in this selection process, a fact that may be overlooked by some readers since the authors included (reluctantly) a small number of published papers on which we, ourselves, were contributing authors.

The 15 articles referenced in this chapter, and dozens of others not included, have had a clear impact on the science and practice of CR since its inception in the 1950s. Particular recognition is warranted for the large number of studies on the physiologic effects of exercise training on cardiovascular health, studies that have helped to establish and explain many of the benefits of CR services. Other studies have identified the important impact of interventional strategies for nutrition, smoking cessation, weight loss, psychological well-being, and long-term treatment adherence. The size limitations of the current article prohibit further descriptions of these important works, but the authors nonetheless pay tribute to the scores of investigators who have collectively contributed to the scientific advancement of CR. While much is already known about CR thanks to these studies, the authors firmly believe that many more important studies are yet to be published, studies that will move the field of CR to even greater heights of impact and will need to be added to a new list of landmark papers in due course.

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