10&12-Feb Cardiac Rehabilitation

Cardiac Rehab

Definition:

• Sum of activities ensuring optimal physical, mental, and social conditions for cardiac patients.
• Aim: Resuming normal roles in the community through personal efforts.

Indications:

• Post-M.I.
• Coronary Heart Disease
• Post-C.A.B.G.
• Valve Replacement
• Heart Transplantation
• Other Cardiogenic Disabilities

Aim:

• Regain full physical, psychological, and social status.
• Optimize long-term prognosis.
• Implement secondary prevention measures.
• Provide exercise training.
• Conduct educational sessions.
• Offer psychological support and counseling for patients and families.
• Facilitate acute phase care, outpatient care, and long-term follow-up.
• Decrease cardiac morbidity and relieve symptoms.
• Decrease anxiety and increase knowledge and self-confidence.

Phases of Cardiac Rehab:

1. Inpatient
2. Outpatient
3. Post-Discharge
4. Long-Term Maintenance

Benefits of Cardiac Rehab:

1. Improved Exercise Capacity:
   • Increased cardiovascular endurance through aerobic exercises involving large muscle groups.
2. Central Changes:
   • Increase in cardiac output achieved by:
     • Increased systolic volume
     • Increased total blood volume
     • Reduced peripheral resistance.
3. Peripheral Changes:
   • Increase in the number and size of mitochondria.
   • Increased oxidative enzyme activity.
4. Increase in VO2max:
   • Notably seen in cardiac patients, primarily due to peripheral changes.
5. High-Intensity Exercise Requirement:
   • Essential for inducing central changes.
6. Repeated Submaximal Daily Activities:
   • This leads to less psychological stress.

Exercise Prescription:

• FITT Principle

Phase 1: Inpatient Phase

• Initiated within the first 24-48 hours after surgery.:
• • Breathing exercises
  • Simple arm and leg range of motion (ROM) exercises
  • Limited self-care activities.
• Progression over 2-3 days to:
  • Positioning
  • Bed mobility exercises
  • Sitting out of bed
  • Taking short walks
  • Dressing
  • Chest physiotherapy if needed.
• Upon discharge, patients should:
  • Be familiar with the signs and symptoms of excessive exertion
  • Understand their level of exertion.
• Instruction on the use of a spirometer and suctioning if required.

Phase 2: Outpatient Phase

• Duration: 6 to 8 weeks
• Purpose: Increase exercise capacity, enhance cardiac functions, and induce favorable metabolic changes.
• Intervention Exercises:
  • Active exercise
  • Aerobic exercise
  • Endurance exercises such as cycling, running, jogging, swimming
  • Breathing exercises
  • Resistance exercises

Phase 3: Post-Discharge

• Educate the patient to continue all necessary exercises.
• Exercise regimen should continue for at least six weeks, focusing mainly on walking.
• Regular monitoring of blood pressure and heart rate at rest and during exercise is crucial.

Risk Factors for Exercise:

• Patients should refrain from exercising if feeling unwell.
• Exercise is not recommended for patients with unstable conditions such as:
  • Fever
  • Angina
  • High blood pressure
  • Low blood pressure
  • Tachycardia
  • Breathlessness
  • Dizziness
  • Uncontrolled diabetes

Phase 4: Long-Term Maintenance

• Community-based exercise program where patients must manage their exercise routine independently.
• Patients should be self-motivated to maintain fitness, avoid alcohol consumption, quit smoking, and engage in activities such as yoga, asanas, and pranayama.