Return to work and cardiovascular disease: functional capacity assessment, evidence and limits of applicability and the role of cardio-rehabilitation in occupational medicine

The incidence and prevalence of cardiovascular disease are increasing progressively in the general population and workers due to higher mean age and improved prognosis and survival as a result of new therapeutic and diagnostic options. The assessment of cardiovascular risk in the workplace is complex due to the fact that it is not a specific work risk and because of the absence of a specific assessment methodology, leading to numerous limitations in the formulation of the job fitness certification, the protection of workers' expertise and health, and the applicability of regulations. The tools used in cardiology and, particularly, in cardio-rehabilitation can provide important information to both estimate the residual functional capacity and the cardiovascular load during work activity. A multidisciplinary approach and collaboration between occupational physicians, cardiologists, cardio-rehabilitators, and general practitioners are essential for managing critical cases.