thunder bay regional health sciences centre (tbrhsc) pilot program servicing nipigon, atikokan, marathon, manitouwadgecardiovascular disease (cvd) remains one of the leading causes of hospitalization, mortality, and potential years of life lost in northern ontario. in northwestern ontario (nwo), the rates as well as the risk factors for cvd are higher than those for the general population of the province (north west local health integration network [nwlhin], 2006). although the impact of cvd has been steadily decreasing in ontario over the last 20 years, northern ontario has not seen the same magnitude of positive change. in 2003, the northwestern ontario district health council (nwodhc) identified inequities in the delivery of cardiac services in nwo and made specific reference to the benefits of cardiac rehabilitation (cr). historically, cr services in nwo have been available consistently only to those patients able to attend cr programming at the thunder bay regional health sciences centre (tbrhsc). recovering cardiac clients outside of thunder bay have been limited by issues of distance (see appendix a) from a cr program and a lack of sufficient numbers to provide economically and functionally viable cr programming in the clients' home communities.