CARDIAC PHYSIOTHERAPY REHABILITATION.pptx

CARDIAC
REHABILITATION
Dr. ANERI PATWARI(MPT)
CARDIO-RESPIRATORY
03-01-2024 Dr. Aneri Cardiac Rehab 1

CONTENT
• Definition
• Objectives
• Centre & Team
• Core components
• Cardiac rehab assessment
• Training principles
• Management
• Summary

DEFINITION
•“Cardiac rehabilitation is a multidisciplinary program
of education, exercise, and behavioral change
established to assist individuals with heart disease in
achieving optimal physical, psychological and
functional status within the limits of their disease.”

OBJECTIVES
• Education of the patient and family in the recognition, prevention, and Rx of
cardiovascular disease.
• Amelioration or reduction of risk factors
(prepare pt, family and significant others for a healthy lifestyle there by ↓ing
further risk of CAD)
• Dealing with the psychological factors that influence recovery from heart disease
(following MI, CABG, Diagnosed CAD)
• Structured, progressive physical activity either in a rehabilitation setting or home
program
• Vocational or return to leisure activities counseling
• Activity of daily living (ADL) and functional training

CARDIAC REHABILITATION
CENTER
• It is the facility in which an interdisciplinary team provides the
planned and monitored program to promote psychological,
educational and vocational improvement of the cardiac patient.

CARDIAC REHABILITATION TEAM

INITIAL CARDIAC REHAB ASSESMENT

MEASUREMENT
• These activities can best be accessed via the aerobic capacity,
which is defined by the ACSM as the product of the capacity of the
cardiorespiratory system to supply oxygen and the capacity of the
skeletal muscles to utilize oxygen.
• The criterion measure for aerobic capacity are
1.the peak oxygen consumption (VO2max). Denote as ml/kg/min
2.MET= 1 met= 3.5ml/kg/min
3.HR

VO2MAX
MALE FEMALE

MET VALUES

TRAINING PRINCIPLES

TRAINING PRINCIPLES
GENERAL
• Overload Principle
• Specificity Principle
• Individual Differences Principle
• Reversibility Principle
AEROBIC
• Frequency
• Intensity
• Time
• Type
• Volume
• Pattern
• progression

TRAINING PRINCIPLES:
components of training sessions
CONTINOUS
INTERVAL
CIRCUIT
CIRCUIT
INTERVAL
WARM UP CONDITIONING COOL DOWN STRETCHING

TRAINING PRINCIPLES
Patient’s instruction before exercises
• Don’t eat a large meal for at least 2 hours prior to the exercise session
• Alcohol not consumed
• Beverages, coffee, tea, cola not had before exs at least 2 hours prior 2
exercise
• Don’t smoke 1 hour prior to exercise
• Wear comfortable clothing to exercise
• Information about any changes in medications before exercising.

PHASE 1

STEP 1
2 MET
• Diaphragmatic breathing exercise+ventilatory patterns
• Active assisted exercise of extremities
• Milking draisn
STEP2
2 MET
• Patent in lying
• Active exercise of extremities , Exercise with ventilatory incentive & flutter
STEP3
3-4
• Standing
• Active exercise & stretch, marching
• Exercise with ventilatory incentive , 35 meters ambulation
STEP4
3-4
• 60 meters ambulation
• Descending stairs (1 floor)
STEP 5
3-4
• 100 meter ambulation
STEP 6
3-4
• 160 meters ambulation, descending stairs (2 floor)
• Encourage breathing exercise
STEP 7
3-3
• 200 meters ambulation
• Descending stairs( 3 floor)

PROTOCOL
• Frequency: Early mobilization: 3-4 times/day (days 1-3)
Later mobilization:2 times/day (beginning on day 4)
• Intensity: RPE: < 13: Post MI: HR < 120 bpm or HRrest + 20 bpm
Postsurgery: HRrest + 30 bpm To tolerance if asymptomatic
• Duration: Intermittent bouts lasting 3-5 min Rest Periods
At patient’s discretion, lasting 1-2 min, shorter than exercise bout
Total duration of up to 20 min
• Progression: Initially increase duration up to 10-15 min, then increase intensity.

PHASE 2

ASSESSMENT BEFORE PHASE II
TEMPT HR BP RR auscultation ECG
PAIN POSTURE STRENGTH

COMPONENTS
PHYSICAL CORE COMPONENTS
• Evaluation
• Intervention
• Expected outcome
EXERCISE TRAINING CORE
COMPONENTS
• Evaluation
• Intervention
• Expected outcome

PROTOCOL
• Warm up: 7-15 min; 40-50% vo2 peak, rom exercises
• Frequency: 3-4 sessions/week
• Intensity: 50-70%
RPE:12-13
• Duration: 20-60; continuous or intermittent
• Time: walking, jogging, stationary cycling, arm ergometer, stairclimbing
• Progression: frequency>>duration>>intensity
• Cool down: 5-10 min; 40% vo2 peak; stretching

PHASE 3

OUTCOMES
• Functional capacity goals > 8 METS or 2x energy
• No cardiac symptoms
• EKG monitoring happens occasionally or when increasing activity
parameters
• Self monitoring of HR & symptoms knowledge to the patient
• Improved exercise tolerance
• Return to work
• Improved quality of life
• Decreased risk factor (secondary prevention)

COMPONENTS

RISK STATIFICATION BEFORE
EXERCISE
ISCHEMIC RISK
• Postoperative angina
• LVEF (EF <35%)
• NYHA grade III or IV CHF
• Ventricular tachycardia of
fibrillation in the postoperative
period
• SBP drop of 10 points or more
with exercise
• Excessive ventricular ectopic with
exercise
• Myocardial ischemia with exercise
ARRHYTHMIC RISK
• Acute infarction within 6 weeks
• Active ischemia by angina or
exercise testing
• Significant left ventricular
dysfunction (LVEF <30%)
• History of sustained VT
• History of sustained life-
threatening SVT
• Initial therapy of a patient with a
rate adaptive cardiac pacemaker

SCALES
RPE NYHA SCALE

SCALES
PITTING OEDEMA SCALE/SCORE WEBER CLASSIFICATION

PROTOCOL
CARDIORESPIRATORY
ENDURANCE
• Frequency – 3-5 days
per week
• Intensity – 55-90%
maximum heart rate
• Time/Duration – 20-
60 minutes
STRENGTH
per week
• Intensity – enough to
enhance muscle
strength, muscle
endurance, and
improve body
composition
• Time/Duration – 8 to
12 repetitions of 8 to
10 different exercises
FLEXIBILITY
per week
• Intensity – enough to
develop and maintain
a full range of motion
• Time/Duration – 4
repetitions of 10-30
seconds per muscle
group

PHASE 4

NUTRITIONAL MANAGEMENT

WEIGHT MANAGEMENT

SMOKING/TOBOCCO CESSATION

BEHAVIOURAL MODIFICATION
Provide a Tailored and
Individualized Approach
Recognize ThatKnowledge Is
Necessary but NotSufcient
or Behavior Change
Promote a Positive Sense OF
SelF and the Personal
Relevance of Risk Reduction
Set Goals to Promote a
S.M.A.R.T. Plan o Action
Promote Readiness
toChange
Promote Self-Efficacy
andthe Power of Control
promote
IndependenceThrough
Consciousness Raising
andSel -Monitoring Skills
Provide RoutineFeedback
and Rewards toCelebrate
Success
Help Patients CreatePositive
Environmental Cuesto
Action,
Promote
HelpingRelationships and
Engage RoleModels

PSYCHOLOGICAL MANAGEMENT

SUMMARY

REFERENCES
• KISNER & COLBY
• KATCH & CATCH
• ACSM , AHA & AACVPR GUIDELINES
• WILLMORE
• CASH CARDIO
• CASH PTMS
• SULLIVAN
• SADOWSKY

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