JACR Statement
Mission of the Japanese Association of Cardiac Rehabilitation■ Mission of JACR
The Japanese Association of Cardiac Rehabilitation (JACR) aims to promotewidespread implementation of cardiac rehabilitation and to improve its quality as anadvanced cardiovascular therapy with preventive intervention, and thus to enhance
the quality of life (QOL) and long-term prognosis of patients with cardiovasculardiseases, thereby contributing to the health and welfare of Japanese citizens.
To achieve these goals, JACR will make every effort to promote and developscientific research on cardiac rehabilitation, and will work towards developing
human resources through the education, training and academic exchange of its
members. JACR will also promote mutual cooperation and collaboration with relatedorganizations both in Japan and overseas, and will distribute information, raiseawareness, and make recommendations on cardiac rehabilitation to the citizens,
health professionals, and general public.
■ Origin of JACR
JACR was established in 1995, having been preceded by the Cardiac Rehabilitation
Research Conference in Japan. JACR has members from a broad range of disciplines,
including physicians, nurses, physical therapists, occupational therapists, clinicallaboratory technicians, dietitians, clinical psychologists, health fitness programmers,and researchers. From its inception until the present day, membership has continued
to increase steadily, and currently stands at approximately 9,000 (2012).
■ Definition of Cardiac Rehabilitation
Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program
designed to optimize a cardiac patient’s physical, psychological, social, andvocational status, in addition to stabilizing, slowing, or even reversing theprogression of the underlying atherosclerotic or heart failure processes, thereby
reducing recurrence, rehospitalization and mortality and enabling patients to live
comfortably and actively. Cardiac rehabilitation programs include "medicalassessment, prescribed exercise training, coronary risk factor modification, patienteducation, counseling and optimal medical therapy" for individual patients, which
are provided by a multidisciplinary team in a coordinated manner.
■ History of Cardiac Rehabilitation
Cardiac rehabilitation was introduced in Europe and the United States during the1960s for hospitalized patients with acute myocardial infarction. The purpose at thattime was to address physical deconditioning (physical function disorders such asp. 1

decreased exercise capacity, abnormal heart rate/blood pressure responses, disuse
atrophy of skeletal muscles, and osteoporosis) caused by prolonged bed rest, toimprove exercise capacity, and to expedite patients’ discharge from hospital andreturn to society. In other words, cardiac rehabilitation was "functional recovery
training aimed at early ambulation and return to society." Thereafter, however,post-discharge outpatient comprehensive cardiac rehabilitation programs for patientswith ischemic heart disease or chronic heart failure have proven to be effective in not
only increasing exercise capacity but also improving coronary risk factors, QOL andthe long-term prognosis, resulting in a major change in the concept of cardiac
rehabilitation to "disease management programs targeting improvements in QOL andlong-term prognosis" or "cardiovascular preventive intervention."■ Position of Cardiac Rehabilitation in Clinical Practice Guidelines
Current clinical practice guidelines from Japan, the United States and Europe
strongly recommend participation in a cardiac rehabilitation program for patientswith a wide spectrum of cardiovascular diseases, including recent acute coronary
syndrome (acute myocardial infarction and unstable angina), post-coronary
revascularization (coronary artery bypass grafting or percutaneous coronaryintervention), stable angina, chronic heart failure, and peripheral arterial occlusivedisease.
■ Current Status of Cardiac Rehabilitation in Japan
Despite abundant evidence of effectiveness of cardiac rehabilitation and the strong
recommendations in various guidelines, the spread of cardiac rehabilitation has beensubstantially delayed in Japan compared with Europe and the United States. In
particular, the implementation of post-discharge outpatient cardiac rehabilitation
remains extremely poor, indicating an inadequate outpatient receptacle care systems
after early hospital discharge in the era of a rapidly shortened hospital stay.
Furthermore, social awareness of cardiac rehabilitation has been shown to besignificantly lower than that of cerebrovascular or orthopedic rehabilitation. JACR
will work towards eliminating the large gap between clinical evidence and thecurrent reality of cardiac rehabilitation, and will strive to achieve the goals declaredat the beginning of this statement.
(January 25, 2013)p. 2