Cardiac rehabilitation is a complex, inter professional intervention customized to individual patients with various cardiovascular diseases such as:

  •  Heart Attack
  •  Coronary artery disease (CAD),
  • Heart failure Myocardial infarctions

Cardiac rehabilitation programs:

It aim to limit the psychological and physiological stresses of CVD, reduce the risk of mortality secondary to CVD, and improve cardiovascular function to help patients achieve their highest quality of life possible. Accomplishing these goals is the result of improving overall cardiac function and capacity, halting or reversing the progression of atherosclerotic disease, and increasing the patient's self-confidence through gradual conditioning

CR the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals are encouraged to support and achieve and maintain optimal physical and psychosocial health. 

 Indication:

Cardiac rehabilitation should be offered to all cardiac patients who would benefit: 

  • Recent myocardial infarction 
  • Acute coronary artery syndrome 
  • Chronic stable angina 
  • Congestive heart failure
  •  After coronary artery bypass surgery
  •  After a percutaneous coronary intervention
  •  Valvular surgery
  •  Cardiac transplantation 

CR begins as soon as possible in intensive care units (only if the patient is in stable medical condition). Intensity of rehabilitation depends on the patient's condition and complications in the acute phase of disease.

Goals of Cardiac Rehabilitation:

 Comprehensive cardiac rehabilitation program should contain specific core components .These components should optimize cardiovascular risk reduction, reduce disability, encourage active and healthy lifestyle changes, and help maintain those healthy habits after rehabilitation is complete. Cardiac rehabilitation programs should focus on:

  •  Patient assessment nutritional counseling
  •  Weight management 
  • Blood pressure management
  •  Lipid management 
  • Diabetes management 
  • Tobacco cessation 
  • Psychosocial management
  •  Physical activity counseling 
  • Exercise training

Phases of Cardiac Rehabilitation:

 Cardiac rehabilitation consists of 3 phases.

 Phase I: Clinical phase

 This phase begins in the inpatient setting soon after a cardiovascular event or completion of an intervention. It begins by assessing the patient's physical ability and motivation to tolerate rehabilitation. Therapists and nurses may start by guiding patients through non-strenuous exercises in the bed or at the bedside, focusing on a range of motion and limiting hospital deconditioning. The rehabilitation team may also focus on activities of daily living (ADLs) and educate the patient on avoiding excessive stress. Patients are encouraged to remain relatively rested until completion of treatment of comorbid conditions, or post-operative complications. The rehabilitation team assesses patient needs such as assistive devices, patient and family education, as well as discharge planning.

 Phase II: Outpatient cardiac rehab 

Once a patient is stable and cleared by cardiology, outpatient cardiac rehabilitation may begin. Phase II typically lasts three to six weeks though some may last up to up to twelve weeks. Initially, patients have an assessment with a focus on identifying limitations in physical function, restrictions of participation secondary to comorbidities, and limitations to activities. A more rigorous patient-centered therapy plan is designed, comprising three modalities: information/advice, tailored training program, and a relaxation program. The treatment phase intends to promote independence and lifestyle changes to prepare patients to return to their lives at home 

Phase III: Post-cardiac rehab. 

Maintenance This phase involves more independence and self-monitoring. Phase III centers on increasing flexibility, strengthening, and aerobic conditioning. 

Goal:

Facilitate long term maintenance of lifestyle changes, monitoring risk factor changes and secondary prevention.

Options:

  •  Educational sessions
  •  Support groups 
  • Telephone follow up 
  • Review in clinics
  •  Outreach program
  •  Exercise program organized by qualified phase IV gym instructor 
  • Links with GP and primary health care team
  •  Ongoing involvement of partners/spouses/family

Requirements for cardiac rehabilitation

 Facilities and Equipment 

The minimum facilities necessary to provide a cardiac rehabilitation service are: Separate office space and facilities for cardiac rehabilitation staff An Education Room furnished with seats, TV and DVD player and with a selection of information booklets and DVD’s provided. The size of the education room will depend upon the number of participants (patients, spouses, and staff) in the education sessions and given resources. It is recommended that the exercise warm-up area and the exercise room combined should be approximately 300m2The exercise room should be air-conditioned In addition, patients should have access to Toilet Shower and changing room Available drinking water[4]Equipment in the exercise room may include

Physiotherapy treatment:

1. Warm up exercise

2. Stretching exercises

3. Cardio exercises

4. Strengthening exercises

5. Cool-down exercises

1. Warm-up:

Always warm-up for 15 minutes with light exercise e.g. walking, marching on the spot, or low-level cycling, followed by stretching of the muscles, that reduces the risk of injuries.

2.  Stretching Exercises Include:

 1: Upper back stretch Lock the fingers together with the arms stretched in front. Lower the head forward to look at the floor with feet moving. Hold the stretch for 10-15 seconds.

2: Chest stretch Place the hands on the lower back. Gently move the elbows towards each other by keeping the back straight and feet moving. Hold the stretch for 10-15 seconds

3: Calf stretch Press the heel of the back leg into the floor till a gentle stretch is felt in the back of the lower leg. Adjust the position by moving the back foot further back and the hips forward in case the stretch is not felt. Hold the stretch for 10-15 secs for each leg.

4: Hamstring stretch Stand and lean forward slightly with one leg in front of the other and hands-on the hips. Slightly bend the back leg, straighten the front leg. Lean until a stretch is felt in the back of the leg placed. Hold for 10-15 seconds. Repeat on the other leg.. 

3. Cardiovascular Exercises:

After a warm-up and stretching exercises, cardio exercises are started. These exercises strengthen the heart muscles and help them to pump harder and faster. These aerobic exercises include :Stationery biking Elliptical machine exercising Jumping rope, Walking, Jogging ,Running ,Swimming ,Dancing

4. Strengthening Exercises 

Strengthening exercises keep the body in shape and increase the strength for daily activities like opening a jar or carrying groceries. 

1: Monitoring the exercise level One should ensure that the body is not pushed too hard during the rehabilitation program, there are various ways by which this can be checked, so that the exercises are done safely and effectively, under the supervision of a trained physiotherapist.

2: Measuring your heart rate (pulse)Heart rate is the no, of times the heartbeats per minute. It is an indicator of how hard the patient is working. During exercise the heart rate increases to fulfill the demand of working muscles to supply blood and oxygen. The heart rate can be palpated between the tendons in the middle of the wrist and the bone on the outside of the up-turned arm, about 1 inch from the base of the thumb. Gently place the index and middle fingers over the area, feeling a slight pulse in the heart pushes blood around the body. Count the number of beats that are felt for 15 secs .Multiply this by 4 and this will give, how many times per minute the heart beats, this gives the heart rate .The heart rate should be measured soon after each exercise before it starts to slow down There is a recommended heart rate range when the exercise is started. The target heart rate is just a guide. Certain medications, like beta-blockers, affect the way the heart rate responds to exercise. It might not increase much. In case the top end of this range is reached there is no need to worry just reduce the level.

3: Effort score Another way of measuring how hard the exercise is, measure the level of effort and give it a score of between 1 and 10.During the stage of recovery moderate, somewhat strong exercise is recommended, if the effort level is strong, then the exercise is too hard and needs to slow down. The exercise level should be checked and kept within comfortable limits

4: Talk test This is another simple way of assessing how hard the exercise is. This test can be done by asking the person to talk, if the person is able to speak in complete sentences, then the exercise level is correct. Shortness of breath or gasp indicates that exercise is too hard and needs to slow down. 

5. COOLDOWN:

Cooldown exercises are done for 10 minutes to bring the body back to its resting state, this reduces the risk of dizziness or fainting that can occur due to a sudden drop in blood pressure as a result of suddenly stopping exercise. Stretching during the cool down also helps to reduce muscle soreness that may be caused by the activity. The cool-down exercise should be performed at a slower speed.

 Wear soft-soled shoes, tracksuits and keep a bottle of water by the side.