Exercise in cardiac rehabilitation

There is a saying that “what goes around comes around”, and exercise training as a treatment for patients suffering from coronary heart disease is no exception to the rule. The eighteenth century English physician, William Heberden, recorded the case of a patient suffering from angina “who set himself the task of sawing wood every day and was nearly cured”.1 Almost a century later in 1854, the Irish doctor, William Stokes wrote “the symptoms of debility of the heart are often removable by a regulated course of gymnastics, or by pedestrian exercise”.2 His “pedestrian cure” consisted of comfortable walking initially on level ground, the distance and gradient being increased as tolerance improved—always, however, cautioning against excessive fatigue, breathlessness, or chest pain. Have we progressed that far since then? Over the ensuing years, Stokes' exercise training regime was largely forgotten, obscured by the teaching of the London surgeon John Hilton, who stressed the value of strict bed rest.3 Unfortunately Hilton's precept was carried to extremes. Prolonged immobilisation in bed became the cornerstone …