Use of Readiness for Change in Cardiac Rehabilitation Programs

Abstract

The era of cardiac rehabilitation in the United States dates back at least thirty years, when Herman Hellerstein at Case Western Reserve, Andy Wallace at Duke and Ken Cooper in Dallas envisioned that a comprehensive lifestyle approach to the rehabi- tation and prevention of patients having had a cardiac event would potentially yield great benefits for the individual patient and the health care system. Until that time, the thought of vigorous exercise in the cardiac patient soon after an event was close to anathema. One of us (WEK) was introduced to Herman Hellerstein in Cleveland in the late 1960’s, when his father sought medical opinion from him for a cardiac condition. WEK was introduced to Andy Wallace in 1979 by which time the latter had started a multidisciplinary, geographically regional cardiac rehabilitation program at Duke based upon consultations with Hellerstein and Cooper. By then, cardiac rehab- itation was progressing beyond the vision of exercise only, and since then the concept of cardiac rehabilitation has grown into the comprehensive multidisciplinary program that we know today and that we attempt to describe in this volume. The practice of cardiac rehabilitation has grown and metamorphosed in the last thirty years in parallel with the growth and metamorphosis of the practice of card- vascular medicine. During the formative stages of cardiac rehabilitation, the use of coronary care units was in its infancy. The coronary artery bypass operation was less than ten years old. The LIMA bypass had not been invented.