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• W1997018661 abstract "We and others1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar3Ades PA Huang D Weaver SO Cardiac rehabilitation participation predicts lower rehospitalization cost.Am Heart J. 1992; 123: 916-921Abstract Full Text PDF PubMed Scopus (153) Google Scholar, 4O'Connor GT Buring JE Yusuf S et al.An overview of randomized trials of rehabilitation with exercise after myocardial infarction.Circulation. 1989; 80: 234-244Crossref PubMed Scopus (1137) Google Scholar have demonstrated the benefits of cardiac rehabilitation and exercise training programs on coronary risk factors, including lipids, obesity indices, exercise capacity, and adverse psychological factors (especially depression and hostility), as well as significant reductions in hospitalization costs and overall cardiac morbidity and mortality. These benefits have been noted in several subgroups of patients, including elderly, female, and obese patients, those with high or low baseline exercise capacity, as well as diabetic patients.1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar5Lavie CJ Milani RV Littman AB Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly.J Am Coll Cardiol. 1993; 22: 678-683Abstract Full Text PDF PubMed Scopus (236) Google Scholar, 6Lavie CJ Milani RV Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort.Am J Cardiol. 1995; 76: 177-179Abstract Full Text PDF PubMed Scopus (193) Google Scholar7Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women.Am J Cardiol. 1995; 75: 340-343Abstract Full Text PDF PubMed Scopus (167) Google Scholar, 8Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.Chest. 1996; 109: 52-56Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar, 10Lavie CJ Milani RV Patients with high baseline exercise capacity benefit from cardiac rehabilitation and exercise training programs.Am Heart J. 1994; 128: 1105-1109Abstract Full Text PDF PubMed Scopus (45) Google Scholar, 11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar The report in this issue of CHEST by Dylewicz et al (see page 47) extends these benefits to glucose metabolism and insulin resistance following exercise training in patients after bypass. Although the program used by Dylewicz et al was very short (only 3 weeks, compared to the usual 12-week phase II cardiac rehabilitation and exercise training programs), they still demonstrate significant improvements in work capacity. Numerous studies indicate that parameters of exercise capacity and fitness predict the risk of major cardiac events and mortality, and changes in fitness over time are also very predictive of subsequent risk.1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar12Blair SN Kohl III, HW Paffenbarger RS et al.Physical fitness and all-cause mortality: a prospective study of healthy men and women.JAMA. 1989; 263: 2395-2401Crossref Scopus (3156) Google Scholar, 13Blair SN Kohl III, HW Barlow CE et al.Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men.JAMA. 1995; 273: 1093-1098Crossref PubMed Scopus (1683) Google Scholar, 14Vanhees L Fagard R Thijs L et al.Prognostic value of training-induced change in peak exercise capacity in patients with myocardial infarcts and patients with coronary bypass surgery.Am J Cardiol. 1995; 76: 1014-1019Abstract Full Text PDF PubMed Scopus (122) Google Scholar These data may be particularly applicable to groups with lower baseline exercise capacity, such as elderly,5Lavie CJ Milani RV Littman AB Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly.J Am Coll Cardiol. 1993; 22: 678-683Abstract Full Text PDF PubMed Scopus (236) Google Scholar, 6Lavie CJ Milani RV Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort.Am J Cardiol. 1995; 76: 177-179Abstract Full Text PDF PubMed Scopus (193) Google Scholar female,7Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women.Am J Cardiol. 1995; 75: 340-343Abstract Full Text PDF PubMed Scopus (167) Google Scholar and diabetic patients,11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar as well as those with adverse psychological profiles.11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar, 15Milani RV Lavie CJ Cassidy MM Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J. 1996; 132: 726-732Abstract Full Text PDF PubMed Scopus (201) Google Scholar16Milani RV Lavie CJ Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol. 1998; 81: 1233-1236Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar, 17Lavie CJ Milani RV Cassidy MM et al.Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol. 1999; 83: 1480-1483Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 18Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs in coronary patients with hostility symptoms. Mayo Clin Proc. (In press)Google Scholar Substantial data indicate that a large majority of coronary patients have an insulin resistance syndrome, characterized by impaired glucose metabolism, hypertension, abdominal obesity, hypertriglyceridemia, and low levels of high-density lipoprotein (HDL) cholesterol.2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar We have previously demonstrated that diabetic coronary patients not only have lower exercise capacity than nondiabetics, they also have more hypertension, obesity, and higher triglycerides and lower levels of HDL cholesterol.11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar The improvements in glucose metabolism and insulin resistance, as noted in the present report with only 3 weeks of exercise training, further support data that exercise training improves insulin sensitivity in a broad range of coronary patients, with or without definite diabetes. Cardiac rehabilitation and exercise training usually result in small but statistically significant improvements in lipids.1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar5Lavie CJ Milani RV Littman AB Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly.J Am Coll Cardiol. 1993; 22: 678-683Abstract Full Text PDF PubMed Scopus (236) Google Scholar, 6Lavie CJ Milani RV Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort.Am J Cardiol. 1995; 76: 177-179Abstract Full Text PDF PubMed Scopus (193) Google Scholar7Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women.Am J Cardiol. 1995; 75: 340-343Abstract Full Text PDF PubMed Scopus (167) Google Scholar, 8Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.Chest. 1996; 109: 52-56Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar, 10Lavie CJ Milani RV Patients with high baseline exercise capacity benefit from cardiac rehabilitation and exercise training programs.Am Heart J. 1994; 128: 1105-1109Abstract Full Text PDF PubMed Scopus (45) Google Scholar11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar, 15Milani RV Lavie CJ Cassidy MM Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J. 1996; 132: 726-732Abstract Full Text PDF PubMed Scopus (201) Google Scholar16Milani RV Lavie CJ Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol. 1998; 81: 1233-1236Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar, 17Lavie CJ Milani RV Cassidy MM et al.Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol. 1999; 83: 1480-1483Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar18Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs in coronary patients with hostility symptoms. Mayo Clin Proc. (In press)Google Scholar, 19Lavie CJ Milani RV Effects of nonpharmacologic therapy with cardiac rehabilitation and exercise training in patients with low levels of high-density lipoprotein cholesterol.Am J Cardiol. 1996; 78: 1286-1289Abstract Full Text PDF PubMed Scopus (44) Google Scholar20Milani RV Lavie CJ Prevalence and effect of non-pharmacologic treatment of “isolated” low-HDL cholesterol in patients with coronary artery disease.J Cardiopulm Rehabil. 1995; 15: 439-444Crossref PubMed Scopus (28) Google Scholar, 21Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease.Am J Cardiol. 1994; 74: 1192-1195Abstract Full Text PDF PubMed Scopus (60) Google Scholar Although only total cholesterol significantly fell in the short-term study by Dylewicz et al, most of our studies show more significant improvements during the 12-week programs, especially in reducing triglycerides and increasing levels of HDL cholesterol.1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar5Lavie CJ Milani RV Littman AB Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly.J Am Coll Cardiol. 1993; 22: 678-683Abstract Full Text PDF PubMed Scopus (236) Google Scholar, 6Lavie CJ Milani RV Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort.Am J Cardiol. 1995; 76: 177-179Abstract Full Text PDF PubMed Scopus (193) Google Scholar7Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women.Am J Cardiol. 1995; 75: 340-343Abstract Full Text PDF PubMed Scopus (167) Google Scholar, 8Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.Chest. 1996; 109: 52-56Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar, 10Lavie CJ Milani RV Patients with high baseline exercise capacity benefit from cardiac rehabilitation and exercise training programs.Am Heart J. 1994; 128: 1105-1109Abstract Full Text PDF PubMed Scopus (45) Google Scholar11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar, 15Milani RV Lavie CJ Cassidy MM Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J. 1996; 132: 726-732Abstract Full Text PDF PubMed Scopus (201) Google Scholar16Milani RV Lavie CJ Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol. 1998; 81: 1233-1236Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar, 17Lavie CJ Milani RV Cassidy MM et al.Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol. 1999; 83: 1480-1483Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar18Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs in coronary patients with hostility symptoms. Mayo Clin Proc. (In press)Google Scholar, 19Lavie CJ Milani RV Effects of nonpharmacologic therapy with cardiac rehabilitation and exercise training in patients with low levels of high-density lipoprotein cholesterol.Am J Cardiol. 1996; 78: 1286-1289Abstract Full Text PDF PubMed Scopus (44) Google Scholar20Milani RV Lavie CJ Prevalence and effect of non-pharmacologic treatment of “isolated” low-HDL cholesterol in patients with coronary artery disease.J Cardiopulm Rehabil. 1995; 15: 439-444Crossref PubMed Scopus (28) Google Scholar, 21Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease.Am J Cardiol. 1994; 74: 1192-1195Abstract Full Text PDF PubMed Scopus (60) Google Scholar Although most studies show only small reductions in low-density lipoprotein (LDL) cholesterol, LDL heterogeneity may improve with exercise training, which may transform the LDL particle from a small, dense (pattern B), and more easily oxidized and atherogenic LDL into a larger and more fluffy (pattern A) LDL, which is less atherogenic.21Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease.Am J Cardiol. 1994; 74: 1192-1195Abstract Full Text PDF PubMed Scopus (60) Google Scholar, 22Lavie CJ Lipid and lipoprotein fractions and coronary heart disease.Mayo Clin Proc. 1993; 68: 618-619Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The impact of obesity in cardiovascular disease is now being appropriately and increasingly recognized by many major societies, including the American Heart Association.23Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on peak aerobic capacity and work efficiency in obese patients with coronary artery disease.Am J Cardiol. 1999; 83: 1477-1480Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar The prevalence of obesity in patients with coronary artery disease approaches 40%, and obesity has adverse effects on many coronary risk factors, including adverse effects on plasma lipids (especially increasing levels of triglycerides and reducing levels of HDL cholesterol), raising arterial pressure and left ventricular hypertrophy (even independent of arterial pressure), possibly reducing exercise capacity, and worsening insulin sensitivity.2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 8Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.Chest. 1996; 109: 52-56Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar, 23Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on peak aerobic capacity and work efficiency in obese patients with coronary artery disease.Am J Cardiol. 1999; 83: 1477-1480Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar In addition to all of these effects, data indicate that obesity is an independent coronary risk factor.24Lavie CJ Milani RV Exercise training in special populations: obesity.in: Wenger NC Smith K Frolicher E Cardiac rehabilitation: a guide for the 21st century. Marcel Decker, New York and Basel1999: 151-154Google Scholar Studies of cardiac rehabilitation and exercise training generally report small but statistically significant improvements in obesity indices (such as weight, body mass indices, and percent body fat).1Lavie CJ Milani RV Cardiac rehabilitation.in: Brown DC Textbook of cardiac intensive care. WB Saunders, Philadelphia, PA1997: 1102-1107Google Scholar, 2Lavie CJ Milani RV Cardiac rehabilitation and preventive cardiology in the elderly.Cardiol Clin. 1999; 17: 233-242Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar6Lavie CJ Milani RV Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort.Am J Cardiol. 1995; 76: 177-179Abstract Full Text PDF PubMed Scopus (193) Google Scholar, 7Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women.Am J Cardiol. 1995; 75: 340-343Abstract Full Text PDF PubMed Scopus (167) Google Scholar8Lavie CJ Milani RV Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease.Chest. 1996; 109: 52-56Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar10Lavie CJ Milani RV Patients with high baseline exercise capacity benefit from cardiac rehabilitation and exercise training programs.Am Heart J. 1994; 128: 1105-1109Abstract Full Text PDF PubMed Scopus (45) Google Scholar, 11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar In fact, obese patients who lost ≥ 5% body weight with cardiac rehabilitation had significantly greater improvements in all of their lipid parameters and exercise capacity compared to obese patients who failed to lose weight.9Lavie CJ Milani RV Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.Am J Cardiol. 1997; 79: 397-401Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar Finally, we believe that behavioral and psychological factors, especially symptoms of depression and hostility, have largely been ignored by the medical and cardiology communities. We and others have demonstrated that depression symptoms are present in nearly 20% of coronary patients, and hostility symptoms are present in nearly 15%; these patients have more marked benefits following cardiac rehabilitation programs.15Milani RV Lavie CJ Cassidy MM Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J. 1996; 132: 726-732Abstract Full Text PDF PubMed Scopus (201) Google Scholar, 16Milani RV Lavie CJ Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol. 1998; 81: 1233-1236Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar17Lavie CJ Milani RV Cassidy MM et al.Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol. 1999; 83: 1480-1483Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 18Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training programs in coronary patients with hostility symptoms. Mayo Clin Proc. (In press)Google Scholar Since substantial data indicate that this psychological distress is a risk factor for coronary disease and affects the recovery process following coronary events, reductions in parameters of psychological distress should markedly improve coronary risk. We previously demonstrated that diabetic patients had a higher incidence of depression (26% vs 14%) compared to nondiabetics, and also had more somatization and lower scores for components of quality of life than nondiabetics.11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar Following cardiac rehabilitation, besides the benefits in insulin sensitivity described by Dylewicz et al and the benefits on coronary risk factors that we previously published,11Milani RV Lavie CJ Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med. 1996; 100: 517-523Abstract Full Text PDF PubMed Scopus (89) Google Scholar the incidence of depression was reduced in diabetic patients by 67% and, ultimately, was equal to the 9% prevalence found in the nondiabetic group after rehabilitation. These diabetic patients also had marked benefits in anxiety, somatization, and quality of life components. Therefore, we agree with Dylewicz et al regarding the benefits of cardiac rehabilitation and exercise training programs, especially when extended well beyond just 3 weeks, to markedly improve overall coronary risk in the secondary prevention of coronary artery disease. Greater efforts are needed to increase referrals, attendance, and“ cost-effectiveness” of this underused but valuable therapy.25Lavie CJ Milani RV Cardiac rehabilitation and health-care reform.Chest. 1995; 107: 1189-1190Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar" @default.
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