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The WHO definition of cardiac rehabilitation from 1968 refers to a “process by which a person is restored to an optimal physical, medical, psychological, social, emotional, sexual, vocational and economic status.” Over the ensuing years this statement of intent has remained remarkably similar. The World Health Organization’s current definition addresses the cardiovascular status of the patient before, during, and after the event:

Cardiovascular diseases constitute the leading cause of morbidity and premature mortality in industrialized parts of the world, and now pose a growing public health problem in developing countries. Where rehabilitation and secondary prevention were once seen as valuable only to patients recovering from uncomplicated acute myocardial infarction, they are now regarded as essential to all cardiac patients. Rehabilitation in appropriate exercise programs, education, and counseling are emerging as the most effective means of restoring patients’ quality of life and independence and promoting their social integration.,

Guidelines on prevention of coronary heart disease (CHD) in clinical practice have been issued by Joint Task Forces of European and other Societies1-3 and the latest update was released in 2003 by the Third Joint Task Force.

Cardiac rehabilitation (CR) has been defined as the sum of interventions required to ensure the best possible physical, psychological, and social conditions so that patients with subacute or chronic disease may, by their own efforts, preserve or resume as normal a place as possible in the life of the community.–

The Clinical Practice Guideline , prepared for and promulgated by the US Department of Health and Human Services, characterizes cardiac rehabilitation as the provision of comprehensive long-term services involving medical evaluation; prescribed exercise; cardiac risk factor modification; and education, counseling, and behavioral interventions. The goal of this multifactorial process is to limit the adverse physiologic and psychologic effects of cardiac illness, to reduce the risk of sudden death or reinfarction, to control cardiac symptoms, to stabilize or reverse progression of the atherosclerotic process, and to enhance the patient’s psychosocial and vocational status. The guideline defines that provision of cardiac rehabilitation services is directed by a physician, but can be implemented by a variety of healthcare professionals.

Cardiac rehabilitation had its beginnings in Canada in the late 1960s; since then it has gained in strength and stature until today there are 130 comprehensive multidisciplinary programs across the country. The province of Ontario, with 11 million inhabitants, most of whom live within 200 km of the United States border, is the most populated and has the largest number of full-service and partial-service programs. Of the remainder, the majority are in western Canada (the provinces of British Columbia, Alberta, and Manitoba), with fewer in Quebec and the Maritime Provinces.

The concept of cardiac rehabilitation (CR) was introduced into Australia by the National Heart Foundation (NHF) in 1961 when it began establishing CR clinics in each of the major cities. Medical Directors of the four pioneer CR clinics were Dr Alan Goble, Melbourne, Dr Tony Seldon, Sydney, Dr Graeme Neilson, Brisbane, and Dr Robert Cutforth, Hobart. By 1964 over 1000 patients were attending these clinics.

The population of South Africa totals approximately 46 million people and is ethnically and economically diverse. The diversity is reflected in the patterns of urbanization with nearly 50% of the black population residing primarily in rural or peri-urban areas compared to fewer than 20% of white South Africans or those of mixed ancestral or Asian origin (South African National Census 2001). However, urbanization of the black population has been increasing rapidly, particularly since 1994. Furthermore, this rapid urbanization combined with globalization has been accompanied by large shifts in the health patterns of South Africans, increasing the prevalence of non-communicable disease. The South African National Burden of Disease study for the year 2000 estimated that 17% of all deaths were due to cardiovascular diseases.

The concept of cardiac rehabilitation is comparatively new in mainland China and has received scant attention until recently. Indeed, in most parts of the country it is underdeveloped. This is not surprising when one considers the enormity of the country (9 million km) and its population (1.3 billion), and the fact that heart disease has only recently, although rapidly, become a major cause of death and disability. This is partly a reflection of the rapid increases in urbanization, population mobility and aging, environment deterioration and economic growth and, as a consequence, growing income disparities and rising unemployment. The population of China with coronary heart disease is now estimated to be at least 20 million and there are major challenges, such as hypertension and tobacco smoking. For instance, at least 350 million people smoke, of which 50 million are teenagers. Thus, there is a growing recognition that cardiac rehabilitation services should be established and developed.