Although clinical exercise physiology is relatively new as a defi ned body of knowledge, individuals have been interested in how physical activity and exer- cise infl uence health and recovery from illness and diseases since the time of the early Greeks (11). Early historic events in medicine, physiology, and exercise that helped defi ne many of the disciplines in exercise science have also infl uenced the development of clinical exercise physiology. Many of those important historic events are described in Chapters 1 and 3. The material contained in this section should be considered a supplement to these chapters and will contain only infor- mation specifi c to the development of clinical exercise physiology.
Early Infl uences
The use of physical activity and exercise in cardiovascular disease recovery can be traced to the eighteenth and nineteenth centuries (43). William Heberden
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(1710–1801) was the fi rst to describe the condition of angina pectoris (chest pain) during physical exertion (21) and the use of physical activity with patients who experienced angina pectoris (22). Heberden and William Stokes (1804–78) are credited with being the fi rst physicians to recommend the use of physical activity and exercise to promote the recovery from heart disease (41,43). Unfor- tunately, prior to the middle of the twentieth century, there was little written about the role of physical activity and exercise in the prevention of chronic dis- ease development or in the recovery process from diseases conditions (25).
Recent Infl uences
One of the most signifi cant events in the development of clinical exercise physiol- ogy was a renowned study of coronary heart disease in London bus drivers and con- ductors performed by Jeremy N. Morris and his colleagues and published in 1953 (33). This study is considered the fi rst to demonstrate the relationship between physical activity and the reduced risk of developing heart disease and it helped ini- tiate interest in disease risk reduction and public health epidemiology. The founda- tion for cardiac rehabilitation began to take shape in the 1950s with the major focus on the restoration of functional capacity after a cardiovascular event. Around this time, Samuel A. Levine and Bernard Lown were the fi rst to recommend arm- chair exercises for patients with heart disease (30) and H. K. Hellerstein provided a step-by-step plan for the rehabilitation of the cardiac patients (23). Although the use of physical activity and exercise in heart disease patients was not common prior to 1960 (19), the work of Hellerstein, Levine, Lown, and Morris and colleagues created a foundation for using physical activity and exercise to promote the pre- vention of and recovery from various diseases. Throughout the 1960s and 1970s, experiments in both animals and humans led to using physical activity and exer- cise in the recovery process for patients with acute heart attacks (19). For example, several prospective studies supported the use of a structured physical activity and exercise program for reducing morbidity and mortality and improving the various clinical, medical, and psychological factors in patients with heart disease (14,28).
The development of cardiac rehabilitation programs advanced signifi cantly during the 1970s when professional organizations such as the American Heart Association and the American College of Sports Medicine released textbooks addressing the proper procedures for the testing and training of healthy and diseased individuals (5–7). These books were very popular and remain in wide use today.
The use of physical activity and exercise to promote recovery in patients with pulmonary disease is credited to Alvin L. Barach (43). Considered by many
Therapeutic Of or relating to the treatment of disease or disorders by remedial agents or methods.
Functional Performing or being able to perform a regular function.
Pathophysiology Functional changes that accompany a disease condition.
Angina pectoris Severe chest pain caused by an insufficient supply of blood to the heart.
Cardiac rehabilitation A medically supervised program to help heart patients recover quickly and improve their overall physical and mental functioning.
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experts to be the “Father of modern day pulmonology,” Barach used a variety of procedures and strategies to improve the conditions of individuals with congestive heart failure, pneumonia, and other pulmonary disorders (10). Beginning in 1958, William F. Miller and Thomas Petty published a series of papers promoting the use of physical activity and exercise for treating individuals with chronic pulmonary disorders including airway obstruction and emphysema (31,32,36). The develop- ment of pulmonary rehabilitation as an appropriate part of the treatment for diseased individuals was further advanced when, in 1981, the American Thoracic Society released a statement supporting pulmonary rehabilitation as a necessary procedure for enhancing functional status in pulmonary patients (9,43).
In 1974, the Journal of Cardiac Rehabilitation began publication, providing prac- titioners access to a scientifi c, peer-reviewed journal devoted to the dissemination of information vital to the rehabilitation of individuals with various forms of heart disease (43). In 1986, the content of the journal was expanded to include pulmo- nary rehabilitation and the journal was renamed the Journal of Cardiopulmonary Rehabilitation (43). The development of a professional association for practicing cardiopulmonary rehabilitation specialists occurred in 1985, when the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) was established (43). The mission of the AACVPR is to reduce morbidity, mortality, and disability from cardiovascular and pulmonary diseases through education, prevention, rehabilitation, research, and aggressive disease management (43).
The knowledge base in cardiac and pulmonary rehabilitation was expanded through research and the publication of guidelines and position statements by the AACVPR. Table 4.1 lists some important publications that helped further the development of cardiopulmonary rehabilitation. The AACVPR further enhanced the profession of cardiopulmonary rehabilitation with the establishment of certi- fi cation for cardiac and pulmonary rehabilitation programs in 1996 (43).
The development of individual certifi cation programs by a number of other pro- fessional organizations has led to further professional growth of cardiopulmonary rehabilitation. Major professional organizations such as the ACSM and the National Strength and Conditioning Association offer professional certifi cations to individuals
Table 4.1 Important Publications in Cardiopulmonary Rehabilitation
PUBLICATION DATE
Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, 4th Edition (2)
2004
Guidelines for Pulmonary Rehabilitation Programs, 3rd Edition (3) 2004 Clinical Competency Guidelines for Pulmonary Rehabilitation
Professionals (40)
1995
Outcome Measurement in Cardiac Rehabilitation (16) 2002
Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines (37)
2007
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desiring to work with healthy and diseased populations. Additional information about certifi cation and licensure opportunities can be found in Chapter 11.
The endorsement of the health benefi ts obtained from physical activity and exercise by the United States Surgeon General in 1996 was a signifi cant milestone in the promotion of physical activity and exercise for healthy and diseased indi- viduals. The Surgeon General’s report highlighted the
positive health effects of physical activity and exercise on the musculoskeletal, cardiovascular, respiratory, and endocrine systems including a reduced risk of pre- mature mortality and reduced risks of coronary heart disease, hypertension, colon cancer, and diabetes mel- litus. Recommendations for the appropriate amount of physical activity and exercise helped establish the standards for using exercise to assist in the treatment of diseased individuals (35).
Throughout the 1990s and early into the twenty fi rst century, government agencies such as the Department of Health and Human Services and the Centers for Disease Control and Prevention established health promotion programs designed to reduce the risk of disease development in healthy individuals and improve the health of those with disease conditions. The National Institutes of Health and other professional organizations such as the American Heart
Association and the American Diabetes Association continue to promote research activities and public health programs designed to improve health and reduce disease risk. As we move further into the twenty fi rst century, additional education and health promotion programs will be instrumental in promoting the use of physical activity and exercise for ensurin g good health
and promoting recovery from disease conditions. Table 4.2 provides a list of the sig- nifi cant events in the historic development of clinical exercise physiology.