Cardiac Rehab

CARDIAC
REHABILITATION
BY:
DR TAHREEM MEMON
definition
 The sum of activities required to influence favourably the
underlying cause of the disease as well as the best
possiblephysical,mental and social conditions so that they may
by their own efforts preserve or resume when lost as normal a
place as possible in the community.
(WHO)
 Cardiac rehabilitation is the process by which persons with
cardiovascular disease (including but not limited to patients with
coronary heart disease) are restored to maintained at their
optimal physiological, psychological, social, vocational and
emotional status.
(American Association of Cardiovascular abd Pulmonary
Rehabilitation)
 the major goal of a comprehensive cardiac rehabilitation
programme is the achievement of an optimal health status
for each patient.(not only physically and psychologically
but also in social, vocational and economic terms)
 More specific goals of cardiac rehabilitation include:
limitation of adverse effects of illness.
Efficient and effective symptom management
Stratification of risk for a further cardiac event to assisst in
clinical decision making regarding further treatment.
Modification of cardiac risk factors to Prevent progression
of IHD.
Inorder to acieve a good functional
capacity and a good quality of life cardiac
rehabilitation should not only limited to
exercise program but also include
councelling and education so that patient
become responsible for a large part of their
own management ideally.
Rehabilitation should begin at time of
admission to hospital and continue after
discharge.
Team
Cardiologist
Physiotherapist
Occupational therapist
Dietician
Staff
family/ support people
Role of physiotherapist
The Physiotherapist is primarily concerned with
physical aspects of recovery.
Minimizing deconditioning effects of bed rest and
enhance cardiovascular and musculoskeletal function.
Instruction of home exercises
It involves
Assessment (initially)
Breathing exercises
Assisstive or active exercises
Supervised ambulation
Stairs climbing
PHYSIOTHERAPY
mostly indicated for:
 angina
 MI
 PTCA
Assessment
Demographic data:
 usually from medical record
 occupation
 must involve support person/attendant
Personal hx:
 smoking
 addiction
 life style
Cardiac status
 date of cardiac event:
post surgical rate of healing of sternum
may alter activities.
hx of previous MI:
if occurred how it affects your functional
capacity.
Site of MI:
this may affects the outcomes
it may be recognized by graphings(ECG,
ECHO etc)
Size of MI:cardiac enzymes level
increases(Trop-I, CPK)
Current management: medications, diet,
exercises
Current signs and symptoms: at the
beginning of a program and at the level of
activity at which it occurs.
It helps in treatment planning.
Anginal symptoms, breathlessness and
diziness must be noted.
Occupational and recreational activities: helps in
home exercise plan.
Functional capacity: to recognize the severity of
patients.
◦ Exercise test: for long term pts (out patients)
includes treadmill and cycling exercises
progresses from lower level to high level.
bruce exercise test protocol(1973)
Monitor:
continuous ECG
heart reta
blood pressure
symptoms appearance
RPE
RPE SCALE
TREATMENT
Activities which give the best cardiovascular
protection involve regular and rythemical use
of large muscle groups such as: walking,
running, swimming, dancig,cycling.
(the most common and safest form of
exercise is walking)
In order to meet needs associated with daily
activities, it may be necessary to ensure that
some arm exercises is included as part of a
whole body exercise program.
Arm exercises impose a great stress on the
heart than the same amount of leg exercises,
so a lesser intensity of arm exercise should
be used to be safe and effective.
Isometric exercises: increases blood
pressure such as heavy weight lifting.
sustained and high intensity isometric
exercise has been discouraged for cardiac
patients.
Isotonic activities: have been used in
increasing strength and endurance in
cardiac patient. (Verrill et.al 1992)
Phases of Recovery
Cardiac rehabilitation is divided in to phases
 According to american and australian literatures
Phase: 01- time of inpatient management.

Phase: 02- out patient recovery.
Phase: 03- Long term maintenance .
 British association of cardiac rehabilitation continues to
classify four phase of rehabilitation as:
Phase:1- Hospital in pt period.
Phase:2-Immediate post discharge period .
Phase:3- Intermediate post discharge period.
Phase:4- Long term maintainance.
INPATIENT
 In Hospital inpatient physiotherapy is usually directed at preventing or
treating the sequelae of bed rest.
 Include techniques to prevent lung collapse .
 Simple assissted or free range of movement activities.
 This phase may last from few hours to days or weeks.
 Activities should be slowly increased and include a graduated exercises
and moblization programme
 Outcomes should be:
◦ Pt should be able to attend His /her own activities (ADLs)
◦ Ambulant
◦ Negotiate stairs
• advice for home activity and exercise must be given predischarge.
 Formal arrangement for followups as an out patient.
AFTER HOSPITAL DISCHARGE (OUT PATIENT)
Home exercise programs
Home based exercise training programs.
It includes:
Warmup & Cool down
1. Stretches.
2.Flexibility.
3.Coordination exercises.
Aerobic component
Includes one or combination of activities:
1. Walking
2. Exercise cycle
3. Rowing machine
Exercise cycle & Rowing machine
Long term
Long term continuation is desireable for:
Stable post MI
Post CABG patients
Community in general
Many people find company assissts as a
stimulus or motivation to participate- as
community exercise program.
MONITORING
LEVEL OF EXERCISE
Always monitor the level of exercise, the pt has
achieved in a session- it might be:
 distance covered in a given time
 number of repetitions
SIGNS AND SYMPTOMS
If signs and symptoms occur at any level of
activity must be recorded as:
◦ Heart rate: suggests the stress imposed on the body
by exercise.
Resting, peak and recovery heart rate.
If pts are on beta blockers leads to the
attenution in heart rate so, in this case:
measures such as R.R and RPE are more
reliable and sensitive.
 Breathlessness: is normally associated
with vigourous and prolonge exercises.
If a cardiac patient is exercising at a
moderate level, he/she should not be so
brethless that he/she can not talk.
Infact the ability to answer a simple
question verbally during exercise is a simple
clinical method for assessment of
breathlessness.
 Blood pressure: usually rise during
aerobic exercises but should not drop
dramatically during activity.
usually checked at initial inpatient
exercise session unless there is a problem
with stability as if pt complaints of
lightheadedness and dizziness B.P should be
checked.
 Other signs: pallor, fatigue and excessive
perspiration indicates poor exercise tolerance.
 Crackles: should be checked in patients who are
extremely breathless.
 Angina: major sign of myocardial insufficiency.
if occurs exercise should be stopped and give rest.
If rest is not sufficient to relieve angina than
sublingual nitroglycerine should be available for
use.
Should be document and discuss with relevant
medical personnal.
Outcome evaluation
Categorized as:
Health (quality of life)
Clinical (change in fitness)
Behavioural (exercise activity)

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CARDIAC

Phase: 01- time of inpatient management.

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