Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. In India, coronary heart disease and stroke are the fourth and ninth leading contributors to years of life lost. Specific presentations of CVD in India are: 1) high mortality rates; 2) premature mortality; 3) increased disease burden on society as a whole; and 4) considerable regional variation.
Epidemiological transition and increasing urbanization associated with unhealthy lifestyle, in combination with demographic changes, have led to an increase in cardiovascular risk factors, i.e., smoking, sedentary lifestyle, obesity, hypertension, and hypercholesterolemia, in India. Increasing risk factor prevalence and lack of systematic preventive approaches are currently driving an acceleration of the CVD epidemic in India. It has been estimated that by the year 2030, every second myocardial infarction worldwide will occur in India.
Patients with CVD are a great challenge for secondary prevention measures, and recent research developments have demonstrated that tremendous benefits can be derived from the optimal use of cardiac rehabilitation (CR) in patients recovering from an acute coronary heart disease event or heart failure, as well
after cardiac surgery. The benefits of exercise-based CR include reduction of mortality, symptom relief, smoking cessation, improved physical fitness, risk factor modification, and improved overall psychosocial wellbeing. However, adequate policies and structures to take care of patients after CVD events using this evidencebased intervention are missing in India.
During the past decades, CR has evolved from a simple intervention aimed at a safe return to an active and productive life to a multidisciplinary approach that focusses on patient education, individually tailored exercise training, modification of risk factors, and the overall well-being. A multidisciplinary CR program should normally be started as soon as possible after a recent cardiac event during the hospital phase and should continue as a long-term treatment with all the necessary drugs and interventions, while motivation to long-term treatment adherence is a major challenge.
Although CR should be provided in the framework of a comprehensive secondary prevention program by a multidisciplinary team, only exercise-based CR has proven to reduce CVD mortality, reduce hospital admission, and improve the quality of life. The solid scientific evidence of the health benefits of exercise is
based on epidemiological studies, basic science at a molecular and functional level, translational research, and interventional trials. Therefore, it is not surprising that “exercise is medicine” has become a new and widely accepted term in today’s medical care.
This special issue of the Journal of Preventive Cardiology is devoted to “Exercise and the Heart” and covers different aspects of exercise, cardiovascular health, and CR. We hope that it will contribute to the recognition of CR as an important part of care for CVD patients and to initiate a range of activities to improve secondary prevention after cardiac events and interventions in India. I am most grateful to my co-authors who accepted to contribute to this issue of the JPC.
Prof. Dr. med. Hugo Saner
Preventive Cardiology and Sports Medicine
University Hospitals, Inselspital Bern, Switzerland