- Regain full physical, psychological and social status
- Optimize long-term prognosis
- To promote and implement secondary prevention measures
Exercise training, education sessions, psychosocial support and support/counselling for patient and family in acute phase, out-patient care and long-term follow-up.
- Decrease cardiac morbidity and relieve symptoms
- Risk modification and secondary prevention
- Decrease anxiety and increase knowledge and self-confidence
- Increase fitness and ability to do normal activities
- Reassurance, support and information
- Behavioural change
- Exercise programme
PHASES OF CARDIO REHAB
Phase I - in-hospital (3-5 days)
Phase II - post discharge (2-6 weeks)
Phase III - outpatient programme (6-12 weeks)
Phase IV - long-term maintenance in community
- Increased cardiovascular endurance is the main aim
- Endurance training = activity using large muscle groups, can be sustained for a prolonged period and is rhythmic and aerobic resulting in an increase in maximal oxygen uptake.
- Maximal oxygen uptake (VO2 max) is limited centrally by cardiac output and peripherally by the capacity of muscles to extract oxygen from the blood.
- In healthy people = endurance training causes increase in CO as a result of increase in SV.
- Increased left ventricular mass and size
- Increased total blood volume
- Reduced peripheral resistance
Training-induced changes in muscles:
- Increased number and size of mitochondria
- Increased oxidative enzyme activity
- Increased capillarization
- Increased myoglobin
Factors that contribute to disease, can influence progression and future events
Exercise in healthy people cause:
- Raised metabolic rate
- Increased synthesis of HDL
- Improved insulin sensitivity
- Decreased blood pressure
Exercise reduces triggers in cardiac events:
- Prevents thrombus formation
- Improves endothelial function
- Reduces potential for serious arrhythmias
Borg 15-point scale or Borg CR10 scale
MET’s
Warm-up
Preparation for activity 15 minute
Low impact, dynamic movements of large muscle groups Take all major joints through normal ROM
Will delay onset of ischaemia by allowing enough time for coronary blood to flow in response to greater myocardial workload
Lessen risk of arrhythmias
Heart rate 20 bpm lower than lower end of prescribed training heart rate after warm-up ( 3 or 10-11 on Borg)
Aerobic exercises
Continious or interval approach
Interval approach – total volume of work done more, stimulus for physiological change greater
Circuit training – station 30s to 2 minutes
Individualisation – duration of station, intensity, period of rest and overall duration (increase duration before intensity)
By discharge patients should know signs and symptoms of excessive exertion and rate level of exertion
Home exercise programme for first 6 weeks, mostly walking Contact and telephonic follow-ups with rehabilitation services
FITT:
F + Time = 5-10 minutes, 2-3x daily and later 5-20 minutes, 1-2x daily
I = RPE < 11
Programme implementation Outpatient exercise programme
Patient should be seen by physician or cardiologist before exercising
Patient safety during exercising very important Assessment of heart rate and blood pressure at rest and during exercising, RPE etc.
Risk factors for exercise
Patients should not exercise if not feeling well, symptomatic or unstable on arrival or with the
following:
