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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