• A Brief History of Cardiac Rehab
    Learn about Herman Hellerstein, a 1950s pioneer in cardiac rehab who is credited with paving the way for clinical exercise physiology and cardiac rehab. Hellerstein's discovery that aerobic conditioning led to more efficient hearts opened the door to use exercise rehabilitation for heart conditions.
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  • Cardiac rehab

    Paving the Way for Cardiac Rehab

    The year was 1950, the name was Herman Hellerstein and the place was Cleveland, Ohio. Herman Hellerstein was a medical doctor who specialized in cardiology, hematology, and electrophysiology and is credited for his attention to cardiovascular disease patients (3). Hellerstein conducted his residency at various university hospitals in Cleveland in the 1940s before starting his own clinic in 1950 – The Cleveland Work Classification Clinic.

    By demonstrating that exercise was a healthy and effective way to rehabilitate from heart conditions, he was able to pave the way for clinical exercise physiology, and more specifically, cardiac rehab. Early 20th century prescriptions for heart disease recovery included mostly bed rest, which became a poorly substantiated dogma of cardiac rehab in the 1950s after medical community advocates, such as Hellerstein, advised that a “graded step” program be implemented for patients (1).


    Cardiac Rehab Leads to Improvements

    In 1963, Hellerstein published a study on the benefits of aerobic conditioning for patients diagnosed with heart disease (myocardial infarction, angina, or both) (2). Specifically, Hellerstein’s study was able to show that cardiac patients were able to improve their heart rate, oxygen uptake, and blood pressure responses to exercise.

    Put simply, patients participating in an aerobic conditioning program had more efficient hearts.

    This study demonstrated to the cardiac rehab community that aerobic conditioning causes the heart to become stronger, thereby delivering more oxygen-rich blood to tissues with each beat (also known as increased stroke volume). Furthermore, improved blood pressure and exercise workload capacity allowed the cardiac patients to increase their heart’s efficiency gradually over time.

    In 1993, Hellerstein published a popular book for the medical community titled, “Healing Your Heart.” Hellerstein passed away just three years later at the age of 77 of complications due to cancer. Clinical exercise physiology has come a long way since the pioneering cardiac rehab studies of the 1950s.

    Over the last 60 years, clinical exercise physiology has expanded to take care of patients with other ailments including pulmonary, neuromuscular, and immunological disorders.

    Fitness professionals such as the NSCA’s Certified Special Population Specialists (CSPS) have an opportunity to make a significant impact on cardiac rehab patients as well as patients with other health conditions. For more information on the CSPS credential including exam preparation materials and exam format, please visit the NSCA Certification page.
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    About the Author:

    Derek Grabert, MS, CSCS,*D

    Derek Grabert, MS, CSCS,*D is an Education Content Coordinator for the NSCA. He holds a master's degree in nutrition and has experience as a university instructor for human nutrition, anatomy, and physiology classes. He has coached high school athletes, special populations clients, and general fitness enthusiasts on the health benefits of strength training, aerobic training, and the integration of proper nutrition.

    REFERENCES →

    Certo, CM. History of cardiac rehabilitation. Phys Ther 65(12): 1793-1735, 1985.
    Hellerstein, HK. Exercise therapy in coronary disease. Bull N Y Acad Med 44(8): 1028-1047, 1968.
    Weinberg, SL. Herman Hellerstein remembered. Clin Cardiol 19(2): 156-157, 1996. 

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