Lifelong adherence to regular physical activity, a heart-healthy diet, a prescribed medication regimen, and smoking cessation is needed to maintain the benefits of cardiac rehabilitation/secondary prevention programs. Monitoring patient progress toward achieving goals is a responsibility of the Medical Director and staff of the cardiac rehabilitation/secondary prevention program. Close interaction with the patient's primary care provider, cardiologist, or cardiovascular surgeon, who cares for the patient's cardiovascular health, is essential. Cardiac rehabilitation/secondary prevention programs play a pivotal role in fostering a patient's commitment to lifestyle modification, but individual patient-physician interaction linked to evidence-based guidelines is key to maintaining this process. Medical Directors of cardiac rehabilitation/secondary prevention programs are uniquely positioned to assure that secondary prevention programs function effectively to improve quality of care for patients with cardiovascular disease. The interactive role of the multiple physicians and team members involved in the patient's care cannot be overemphasized in the process of cardiac rehabilitation and secondary prevention. The active leadership of the Program Medical Director is key. The Medical Director's role is pivotal to develop and implement program policies and procedures, assure appropriate patient assessments are completed and an individualized plan of care for each patient is developed, assure patient safety, and insure that patient and program outcomes are consistent with current clinical practice standards. Optimal outcomes of cardiac rehabilitation/ secondary prevention rely on a multidisciplinary rehabilitation team approach, with strong leadership and direction provided by the program Medical Director.