What is Cardiac rehabilitation?
The basic goal of cardiac rehabilitation is to provide quality of life and secondary prevention. It helps cardiac patients restore healthy living and get back to their lives independently through education, support, and exercise. It reduces the risk of future cardiac problems and prevents heart problems from worsening.
The rehabilitation should begin as early as possible in the intensive care unit if the patient is vitally stable. The intensity and duration of rehabilitation depend on the condition and complications of the patient.
At the initiation of the program brief assessment and evaluation of cardiovascular risk factors is needed.
In order to help patients attain the best quality of life possible, cardiac rehabilitation programs seek to minimize the psychological and physiological pressures associated with cardiovascular disease, lower the risk of death from Cardiovascular disease and enhance cardiovascular function. By enhancing total heart function and capacity, preventing or reversing the course of coronary artery disease, and gradually increasing the patient’s self-confidence through training, these objectives can be accomplished.
All cardiac rehabilitation professionals must possess the appropriate training, qualifications, abilities, and competencies to practice within the parameters of their scope of practice and to acknowledge and value the professional expertise of all other disciplines engaged in the provision of thorough cardiac rehabilitation. To develop a long-term strategy for CVD care, the cardiac rehabilitation team should aggressively engage and effectively connect with community chemists, general practitioners, practice nurses, the sports and leisure industry, where phase IV research is done, and other pertinent bodies.
These elements ought to maximize the decrease of cardiovascular risk, decrease impairment, promote active and healthful lifestyle modifications, and assist in sustaining those beneficial behaviors once rehabilitation is over. Programs for cardiac rehabilitation should be prioritized:
- Nutritional counseling and patient assessment
- Weight control
- Blood pressure control
- Lipid management
- Diabetes management
- quitting tobacco
- psychosocial monitoring
- Physical exercise guidance
- Training exercises
- Personal Risk Evaluation
Indication
- Post Myocardial infarction, but a patient should be medically stable
- CABG(coronary artery bypass grafting)
- PCI (Percutaneous intervention)
- Stable angina
- Stable heart failure
- Valve replacement valve repair
- PAD(peripheral artery disease)
- Stroke
- Pacemaker
Contraindication:
- The significant change in ECG
- Unstable angina
- Serum systolic blood pressure (SBP) of 180 mmHg or diastolic blood pressure (DBP) of 110 mmHg at rest are uncontrolled hypertension.
- orthostatic reduction in blood pressure of more than 20 mmHg accompanied by symptoms
- unstable angina
- Serum systolic blood pressure (SBP) of 180 mmHg or diastolic blood pressure (DBP) of 110 mmHg at rest is uncontrolled hypertension.
- orthostatic reduction in blood pressure of more than 20 mmHg accompanied by symptoms
- Uncontrollable arrhythmias of the ventricle or atrium
- Excessive sinus tachycardia (>120 beats per minute)
- Untreated cardiac failure
- Atrioventricular (AV) block of the third degree without a pacemaker
- Myocarditis or active pericarditis
- embolus
- Acute thrombophlebitis
- Fever or an acute systemic illness
- Uncontrollably high blood sugar
- severe orthopedic disorders that would make exercising impossible
- Additional metabolic disorders, such as hypovolemia, hyperkalemia (a high level of potassium), hypokalemia (low potassium levels,) or acute thyroiditis (unless appropriately treated
What are the phases of cardiac rehabilitation?
It consists of four phases
- PHASE 1 (in hospital period)
- PHASE 2(post-discharge exercise period)
- PHASE 3(education and exercise period)
- PHASE 4 (maintenance)
Phase 1
Phase 1 of cardiac rehabilitation depends on the duration of the hospital stay.
In an acute care setting, when the patient is in the ICU or CCU. Phase duration depends on the initial diagnosis of the patient and the severity of the condition.
It initiates with the patient’s physical ability.
Gentle exercise is recommended to limit deconditioning of the body during a hospital stay. The basic purpose is to educate the patient regarding their disease, focus on daily living activities, and to educate the patient on avoiding unnecessary Stress.
The rehabilitation team evaluates patient needs. Assistive device. Patient family and caretaker education. They also emphasize discharge planning.
Avoid isometric exercise, which increases heart rate. Valsalva maneuver, which promotes arrhythmia, avoids exercise that raises leg movement above the heart and can increase heart preload.
When the patients transfer from the intensive to the medical ward intensity of exercise is gradually increased by increasing duration and speed.
Early ambulation is encouraged, starting from the patient room and corridor, etc.
An acute care physiotherapist can be appointed to you, and their job is to help you get back on your feet by creating a very limited, progressive, and well-monitored activity program. To start, you may need to sit up in bed, stand up, and assess your range of motion. Later, you might go for quick walks about the hospital wing.
The treadmill can be started, but the intensity should be very low and then gradually increased as easily tolerated by the patient.
The primary objective of the initial phase of cardiac rehabilitation is to facilitate a prompt and secure transition from the hospital to the patient’s residence. Upon completion of this phase, you ought to possess:
A home-based exercise regimen that is both secure and restricted.
A detailed understanding of your cardiac rehabilitation program and your condition
knowledge with wound self-care (if you have undergone open heart surgery).
If necessary, an assistive implement like a cane or walker
If necessary, access to private oxygen therapy
You should have sufficiently recovered by the end of Phase 1 to return home and initiate the second phase of cardiac rehabilitation.
Phase 2 (post-discharge period)
- The duration of this phase is typically 4 to 6 weeks. Sometimes, it lasts up to 12 weeks.
- The functional goal of phase 2 is the training in exercise under supervision at home.
- Counseling for the cessation of smoking should be made.
- Anxiety and depression management
- Proper dietitian appointments should be recommended to control BMI and diet plan, keeping in mind the comorbid blood pressure, cholesterol, and diabetes.
- Exercise duration should be 40 min /day. Training should include stretching, strengthening, balance exercises, and aerobic exercise.
- Aerobic should start with a warm-up of the body for at least 5 min at low intensity, followed by a conditioning phase of at least 20 minutes, which finally ends up at a cool-down phase for 5 minutes.
- Exercise should be maintained for 30 to 40 minutes daily.
- . Exercise class will consist of warm-up, exercise class, and cool down – may also include resistance training with active recovery stations where appropriate.
Phase 3
It generally lasts 6 weeks with the addition of resistive training
The functional goal of phase 3 includes a return to work, hobbies and lifestyle, and secondary prevention. At this point, the rehab program will include exercise, training, and close monitoring and assessment. Medical personnel will regularly monitor your workout regimen to protect your safety throughout cardiac rehab. Before you start, a physical therapist will assess you, paying close attention to your blood pressure, respiration, muscle strength, range of motion, endurance, and, if you’ve had surgery, any problems with scar mobility. You’ll typically conduct a warm-up, cardiovascular exercise (on a stationary bike or treadmill), and cool-down during your cardiac rehab exercise sessions. It can also be suggested that you incorporate some resistance training, depending on your current state of health.
You must have all the knowledge necessary at this stage to optimize your quality of life, control your symptoms, and have faith in your ability to take care of yourself in spite of your heart problem. At this point, training will most likely concentrate on:
- Dietary
- Way of Life
- Managing Stress
By the time your rehab program is over, you have to know exactly how to take care of your chest discomfort, monitor your blood pressure and degree of effort, and take charge of your own oxygen, medication, and other therapies.
Additionally, you want to know the components of a heart-healthy lifestyle, such as how to control your stress levels, eat healthily, and exercise safely. You are expected to have effectively quit smoking and implemented any required lifestyle adjustments to enhance your general health. Ideally, your heart disease symptoms will be less severe, and you won’t need to go back to the hospital or experience a second incident as frequently.
Phase 4
It generally helps to maintain a long-term maintenance phase. It may be facilitated in the cardiac rehabilitation unit, or the patient may want to exercise independently.
This stage encompasses the elements required for the sustained implementation of lifestyle modifications and the expert observation of clinical conditions. Patients exit the structured Phase 3 programme at this point and permanently incorporate exercise and other lifestyle modifications into their routines. It may be facilitated in the CR unit itself or a local leisure center. Alternatively, individuals may prefer to exercise independently, and Phase 4 may involve helping them set a safe and realistic maintenance program.
How long does cardiac rehabilitation should last
The majority of insurance plans (including Medicare) pay for 36 sessions in a 12-week cardiac rehabilitation program. That equates to three one-hour meetings every week.
What possible advantages might cardiac rehabilitation offer?
Studies show that completing a cardiac rehabilitation program can extend your life by up to five years. Cardiac rehabilitation has numerous benefits. It is capable of
- assist you in recuperating and strengthening following a heart attack, heart surgery, or other cardiac condition.
- Get your body moving to make your daily tasks simpler.
- Boost your standard of living on a daily basis.
- Reduce your chance of suffering a heart attack again.
- Reduce your chances of developing a serious illness or passing away from heart disease in the upcoming years.
- Assist you in managing your mental health and potential post-heart attack emotions of anxiety and sadness.
- Show you how to reduce your Stress.
You can reconstruct your life—both physically and emotionally—with the aid of cardiac rehabilitation. You’ll learn how to control your condition and become stronger.
What are the benefits of cardiac rehabilitation?
Cardiac rehabilitation may eventually assist you in:
- Reduce the chance of developing coronary artery disease and other cardiac disorders
- Adopt heart-healthy habits, such as eating a balanced diet and getting frequent exercise.
- Boost your strength
- Discover how to control your worry and tension.
- Control weight
- Give up unhealthy behaviors like smoking.
- An enhanced quality of life is among heart rehabilitation’s most important advantages. After completing cardiac rehab, some patients report feeling better than they did prior to heart surgery or a cardiac disease.
Conclusion
Each person’s cardiac rehabilitation journey ends differently based on their unique health status, personal objectives, and level of program engagement.