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These patients need support, from a holistic perspective, with changing their lifestyle, monitoring and managing their condition. The main goal of the support is to improve the patient's quality of life, which can be acquired by achieving smaller physiological and psycho-social goals; such as managing lipid and blood pressure, smoking cessation, maintain mental well being. These smaller goals can be achieved through numerous ways, including education, diet, medication, exercise, social services... Some of these goals can be delivered through cardiac rehabilitation while some do not. 

 

High-intensity exercise also could provoke acute coronary thrombosis by deepening existing coronary fissures. Vigorous physical exertion, which increases myocardial oxygen demand and simultaneously shortens diastole and coronary perfusion time, may induce myocardial ischemia and malignant cardiac arrhythmias. Reduced coronary perfusion can be exacerbated by a decrease in venous return secondary to abrupt cessation of activity, which possibly explains the clinical observation that collapse not infrequently occurs immediately after exercise (Thompson et al., 2013). Ischemia can alter depolarization, repolarization, and thereby trigger threatening ventricular arrhythmias (Thompson et al., 2013). 

Image: pathophysiological basis for exertion-related cardiovascular events  (Thompson et al., 2013)

The studied samples were randomly assigned to either an intervention group (the cardiac rehabilitation program) or control group (the routine care) (Bulut et al., 2015). The change of health behaviours (walking performance, diet adherence, medication adherence, smoking cessation) and physiological risk parameters (serum lipids, blood pressure, body weight) were assessed to evaluate the program effect (Bulut et al., 2015). 

Results:
- Patients in the intervention group demonstrated a significantly better performance in walking, diet adherence, medication adherence; a significantly greater reduction in serum lipids including triglyceride, total cholesterol, low-density lipoprotein; and significantly better control of systolic and diastolic blood pressure at three months (Bulut et al., 2015). 
- The majority of these positive impacts were maintained at six months (Bulut et al., 2015). The research was conducted which revealed that the amount of cigarette smoking, blood pressure control, frequency of physical activity and dietary behaviour were modified within 3 months of discharge. 

Other studies: 
- Cardiac Rehabilitation program provides individualised exercise prescription as the ability of exercise differs from individuals. The minimum frequency for exercising was 5 times weekly during the 6 weeks. Patients were allowed 30-60 minutes for each session. In addition to exercise, lifestyle changes were encouraged such as weight reduction and smoking cessation. Therefore effective strategies are to be promoted depending on the individual to help patient lead active and healthy life. designed for individuals (Kadda et al., 2012).
- In conclusion therapeutic lifestyle change intervention into rehabilitation program effectively modifies cardiac risk factors and may improve the prognosis (Kadda et al., 2012).

- Psychiatric troubles like anxiety and depression are quite frequent following coronary events and are associated with lower exercise capacity, fatigue and a reduced quality of life and sense of well being (Halliday, 2010).

- In cardiac rehabilitation centers, patients learn stress management and other self-control tools, which in return will affect the control of the risk factors (Halliday, 2010).

- Cochrane systematic review and meta-analysis of exercise-based cardiac rehabilitation for coronary heart disease shows that exercise-based cardiac rehabilitation reduces cardiovascular mortality and showing reductions in hospital admissions and improvements in quality of life (Anderson et al., 2016).
- Cardiac rehabilitation programs includes perspective exercise, health education and counseling, yield compelling improvements in cardiac morbidity and mortality of participants (Bulut et al., 2015). 
- Cardiac rehabilitation has been proven to be safe and effective in improving cardiovascular patients' life quality and reducing morbidity and mortality (Mampuya, 2012).  

- International guidelines have recommended the provision of comprehensive rehabilitation that includes education and psychological input focusing on health and life-style (Anderson et al., 2016). 
- Another thing is educating the client about the risk modification such as smoking cessation, hypertension and adherence. Smoking cessation decreases coronary risk and improves psychosocial well-being and quality life (Sathian et al., 2015).

- Cardiac rehabilitation programs are acknowledged as essential care for coronary heart disease and (Anderson et al., 2016).