The April edition of the on-line The Journal of Exercise Physiology featured
an interesting and controversial article on the entire concept of exercise
prescription for cardiac rehabilitation at the following website:
http://www.css.edu/users/tboone2/asep/jan4.htm
This article concluded:
"There is a negative side to implementing exercise rehabilitative sessions
without medical supervision. If coronary artery disease is not cured by
exercise, which it is not, then exercise with this disease can certainly
predispose the patient to a
life-threatening crisis. This logic, although not agreed upon by many
contemporary specialists in the field, extends across the spectrum of cardiac
patients (whether low, moderate, or high risk for cardiovascular
complications).
There is also a negative side to paying the high charges for exercise sessions
(either with or without ECG monitoring). These rising costs represent the most
logical means by which program directors waste little time in increasing their
revenue. However, if the charges continue to rise without serious
documentation of need or the likelihood of meeting the program outcomes, one
could expect these services to be gradually reduced in the years to come.
In summary, we are convinced that it is not right to put the cardiac patient
at risk (however slight, such as during unsupervised exercise) just because
insurance carriers will pay for the sessions. We also disagree with the notion
that any health professional is adequately educated to provide care during the
design and implementation of the exercise prescription (as exercise
physiologists are trained).
Clearly, while some gains in cardiac rehabilitation are obvious, the subtle
but definite changes from proven standards and protocols appear to put the
welfare of the patients at risk. In light of these remarks, it seems apparent
that cardiac rehabilitation specialists should re-evaluate the concept of
"quality care."
These specialists should also collect and analyze data of all unsupervised
patients and correlate risks against costs. Above all, new developments in
cardiac rehabilitation, particularly exercise rehabilitation, must be
adequately and scientifically researched before financial incentives takes
precedent over patients' safety".
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Comments from anyone about this article?
Dr Mel C Siff
Littleton, Colorado, USA
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