2. Cardiac Rehabilitation
comprehensive, long-term programs involving medical
evaluation, prescribed
exercise, cardiac risk factor modification, education, and
counseling.
These programs are designed to limit the physiological and
psychological
effects of cardiac illness, reduce the risk of sudden death or
reinfarction,
control cardiac symptoms, stabilize or reverse the
atherosclerotic process,
and enhance the psychosocial and vocational status of selected
5. Phase I
In-hospital cardiac rehabilitation is often referred to as Phase I.The
goals of Phase I are to minimize the deconditioning that occurs as a
result of bed rest and to begin a gradual progressive approach to
exercise and education about risk factor modification and the
lifestyle changes necessary to reduce future mortality and
morbidity.
Much of the deterioration in exercise tolerance can be countered
through simple exposure to orthostatic or gravitational stress (by
intermittent sitting or standing) and range of motion exercises.
Patients who suffer an MI should resume limited physical activity,
as soon as they are free of chest pain and hemodynamically stable.
6. Phase II
Patients with an uncomplicated MI can begin outpatient
cardiac rehabilitation 1 week after discharge. Outpatient
cardiac rehabilitation is often referred to as Phase II. Phase II
is a multifaceted program lasting 1–3 months which
emphasizes supervised physical activity to improve
conditioning and lifestyle changes to modify risk factors such
as smoking cessation, weight management, healthy eating,
and other factors to reduce future all-cause and cardiac
mortality.
7. Phase III
Maintenance cardiac rehabilitation is referred to as Phase III
(and IV) and involves continuation of exercise habits while
additional lifestyle changes are encouraged.
9. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
ExerciseTolerance
The beneficial effect of cardiac rehabilitation exercise
training on exercise tolerance was one of the most clearly
established favourable outcomes for coronary patients with a
wide variety of clinical presentations.
Objective measures of exercise tolerance improved
consistently, without significant cardiovascular
complications or adverse outcomes. Appropriately
prescribed and conducted exercise training is recommended
as an integral component of cardiac rehabilitation, with
particular benefit identified for patients with decreased
exercise tolerance. It was highlighted that continued exercise
10. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
StrengthTraining
Strength or resistance training improves skeletal muscle
strength and endurance in clinically stable coronary patients.
The absence of signs and symptoms of myocardial ischemia,
abnormal hemodynamic changes, and cardiovascular
complications in the studies reviewed suggest that training
measures designed to increase skeletal muscle strength can
safely be included in the exercise-based rehabilitation of
clinically stable coronary patients, typically those who
previously participated in rehabilitative aerobic exercise
training. Appropriate instruction and surveillance must be
provided. Improvement in muscle strength can benefit
11. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
Symptoms
Exercise rehabilitation decreases angina pectoris in patients
with coronary heart disease and decreases symptoms of
heart failure, particularly dyspnea and fatigue.
Exercise Habits
This effect does not persist long term after completion of
exercise rehabilitation. Health care providers must
encourage patients to continue exercise activities following
formal cardiac rehabilitation, since long-term exercise
training is requisite to maintain the benefit of enhanced
exercise tolerance
12. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
Lipids
Exercise training as a sole intervention has an inconsistent
effect on lipid and lipoprotein levels, emphasizing the need
for multifactorial interventions to achieve optimal lipid levels.
The rehabilitation studies that reported the most favorable
impact on lipid levels were multifactorial, providing exercise
training, dietary education and counseling, and in some
studies, pharmacological treatment, psychological support,
and behavioral training.The specific effects of exercise
training could not be isolated.
13. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
Body Weight
Exercise training as a sole intervention has an inconsistent
effect on controlling overweight, although no exercise
training studies specifically targeted overweight patients.
Optimal management for overweight patients to promote
maintenance of weight loss requires multifactorial
rehabilitation, including nutrition education and counseling,
and behavioral modification in addition to exercise training.
14. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
Blood Pressure
Exercise training as a sole intervention has no demonstrable
effect on lowering blood pressure levels. Expert opinion
supports a multifactorial education, counseling, behavioral,
and pharmacological approach as the recommended
strategy for control of hypertension.
15. OUTCOMES OF AND
RECOMMENDATIONS FOR EXERCISETRAINING
Psychological Well-Being
Exercise training improves measures of psychological status
and functioning, although inconsistent effects were evident
in improving measures of anxiety and depression. Patients
participating in exercise rehabilitation perceive themselves
as improving in a number of psychosocial domains, although
these perceptions may not be objectively documented.
Education, counseling, and/or psychosocial interventions,
either alone or as a component of multifactorial cardiac
rehabilitation, result in improved psychological well being
and are recommended to complement the psychosocial
benefits of exercise training.
16. Morbidity and Safety Issues
The safety of exercise cardiac rehabilitation is well-
established, with very low rates of myocardial infarction and
cardiovascular complications during exercise training. No
increase in cardiovascular complications or serious adverse
outcomes was reported in any trial that evaluated exercise
training of patients with coronary heart disease. No
deterioration in measures of exercise tolerance was reported.
Cardiac rehabilitation exercise training does not change rates
of nonfatal reinfarction.Total and cardiovascular mortality
are reduced in patients following myocardial infarction who
participate in cardiac rehabilitation exercise training,
especially as a component of multifactorial rehabilitation.
17. Effect of Cardiac Rehabilitation ExerciseTraining on
Special Populations
Cardiac rehabilitation exercise training improves functional
capacity and symptoms in patients with heart failure.This
approach is recommended to attain functional and symptomatic
improvement in such patients. Adaptations in the peripheral
circulation and skeletal musculature, rather than adaptations in
the cardiac musculature, appear to mediate the improvement in
exercise tolerance. Cardiac rehabilitation exercise training also
improves measures of exercise tolerance in patients following
cardiac transplantation. Elderly coronary patients have exercise
trainability comparable to younger patients participating in
similar cardiac rehabilitation exercise training, with elderly
female and male patients showing comparable improvement.
No complications or adverse outcomes of exercise training at
angina pectoris, myocardial infarction, and following myocardial revascularization with coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, as well as for patients with compensated heart failure, decreased ventricular ejection fraction, and following cardiac transplantation.
