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Vimukthi Chandula

Role of Physiotherapy in Cardiac Rehabilitation



What is Cardiac rehabilitation?


Cardiac rehabilitation is defined as:


“The coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse the progression of the disease.”




Benefits from CR


▪️ Improves symptoms

▪️ Improves Quality of Life

▪️ Improves compliance with secondary prevention

▪️ Reduces mortality and recurrent events


Indications for Cardiac Rehabilitation


  • Post – Myocardial Infarction

  • Post – Coronary Artery Bypass Graft

  • Post – Percutaneous Coronary Intervention

  • Stable angina

  • Valve replacement or repair

  • Heart failure and transplant

  • Peripheral arterial disease

  • Other conditions


Contraindications of CR


  • Severe residual angina

  • Uncompensated heart failure

  • Uncontrolled arrhythmias

  • Severe ischemia, Left Ventricular dysfunction, or arrhythmia during exercise testing

  • Poorly controlled hypertension

  • Hypertensive or any hypotensive systolic blood pressure response to exercise

  • Unstable concomitant medical problems (eg, poorly controlled or "brittle" diabetes, diabetes-prone to hypoglycemia, ongoing febrile illness, active transplant rejection)


The role of physiotherapists in CR


Physiotherapy play a major role mainly in,

  • Physical activity education

  • Exercise training


Physiotherapy is involved in all 3 phases of Cardiac Rehabilitation


1. Phase I (Hospital phase)


Minimize the effects of restriction to bed and ends with hospital discharge.


This phase begins in the inpatient setting soon after a cardiovascular event or completion of an intervention.


Physiotherapists 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.They check the patient’s lungs, mobilize the patient and undertake steps ready for hospital discharge.


2. Phase II (Early out-patient phase)


Intends to promote independence and lifestyle changes to prepare patients to return to their lives at home.


Once the patient has been discharged from the hospital, patients will be enrolled in a Cardiopulmonary Rehabilitation Program. In the physiotherapy focus Cardiopulmonary Rehabilitation Program run in small classes (6-10) and involves an individualized exercise program and group education sessions.


3. Phase III (Post-cardiac rehabilitation phase)


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


Phase III centers on increasing flexibility, strengthening, and aerobic conditioning on a individualized based exercises program.



Effects of Aerobic Exercises


  • Lowers Blood Pressure

  • Reduces the risk of diabetes by helping the muscles process glycogen

  • Maintains a healthy weight

  • Reduces inflammation in the body

  • Improves the muscles ability to remove oxygen out of the blood. This reduces the need for the heart to pump more blood to the muscles.

  • Reduces stress hormones

  • Slows Heart Rate

  • Increases High-Density lipoprotein (HDL)


Effects of Weight (Resistance) Training


  • Increases independence in activities of daily living

  • Increases muscle strength

  • Increases muscle endurance

  • Reduces the risk of falls

  • Reduces the rate of perceived exertion (RPE)

  • Reduces the risk of high blood pressure, insulin sensitivity and dyslipidemia (abnormally elevated cholesterol)


The Physiotherapist is considered to be an integral and valued member of the CR team, supporting patients to be physically active and embrace activity as part of a range of lifestyles improvement measures with individually tailored exercise programmes.


References:-

https://www.heartsupport.org.au/post/role-of-physiotherapy-in-cardiac-rehabilitation

https://www.csp.org.uk/publications/physiotherapy-works-cardiac-rehab


Sajani Gamlath

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