this ppt is made only for learning purpose for final bpt students. it will provide guidance how to write this question in examinatiion.

1. CARDIAC
REHAB
DR. SAMIR JADAV (PT)

2. DEFINITION
▪ Cardiac rehabilitation is the programme or sum of
activities to achieve and maintain optimal physical,
mental, social and psychological health in patients with
cardiac pathologies in partnership with multidisciplinary
team of health professionals.

3. REHABILITATION TEAM
▪ Patient
▪ Cardiac surgeon
▪ General physician
▪ Medical and nursing staff
▪ Physiotherapist
▪ Dietician
▪ Occupational counsellor
▪ Medical social worker
▪ Family members

4. INDICATIONS
▪ Post MI
▪ CABG
▪ Angina
▪ Chronic heart failure
▪ Angioplasty
▪ Cardiac transplantation
▪ Congestive heart failure

5. SHORT TERM GOALS
1) To prevent cardiac complications
2) To prevent infections
3) To prevent DVT
4) To prevent bed sores
5) To prevent deconditioning effect of bed rest
6) To improve psychology of patient
7) To return the patient to normal ADL

6. LONG TERM GOALS
1) To decrease the frequency and severity of cardiac
problems.
2) To provide psychological benefits of exercise
3) To increase ex. Tolerance and functional capacity
4) To restore patient’s confidence in his/her ability to live
normal life
5) To prevent thromboembolism
6) Reduction in anxiety and depression
7) To increase aerobic capacity

7. PHASES
Phase 1
In pt.
phase
0-5 days
Phase 2
Early out pt.
phase
1-4 weeks
Phase 3
Out pt.
phase
4-6
WEEKS
Phase 4
Home
programme
>6
weeks

8. PHASE – 1 (In pt. phase)
 Post op. day
• Immediate post op. assessment include vital
parameters assessment, level of consciousness,
and alertness.
• Positioning of patient
• Nebulizer + Humidification (ventilatory support)

9. PHASE – 1 (In pt. phase)
Post op. day 1 – 2 :
1) Positioning
- to prevent bed sores
2) Ankle-toe movements
- active or active assisted
3) Relaxed passive movements
- to all four limbs
4) Proper posture maintenance
- to prevent kyphotic deformity
5) Suctioning
6) Care of tracheostomy wound
- regular dressing and cleaning

10. PHASE – 1 (In pt. phase)
Post op. day 3 – 5 :
1) Chest PT
2) Positioning
3) Spirometry
4) Vigorous Ankle-toe movements
5) Assisted coughing techniques
6) Relaxed passive or active assisted movements
7) Make the patient sit with support and gradually rise the
bed end in order to prevent postural hypotension

11. PHASE – 2 (Early Out pt. phase)
Continue with Chest PT and Circulatory ex.
Once the patient is stable then patient is shifted to
medical ward.
In this, gradually conditioning programme is started in
order to prevent physical deconditioning.
It is divided into 5 stages:-
Stage 1: Alternate knee bending
Alternate SLR
Alternate arm rising

12. PHASE – 2 (Early Out pt. phase)
Stage 2 : Sitting to standing
May walk to toilet and around the bed.
Stage 3 : Walk to and from the toilet and
around ward more frequently.
Stage 4 : Increase frequency and distance of
walk.
Stage 5 : Add stair climbing.
5-7 steps up and down.

13. PHASE – 2 (Early Out pt. phase)
Intensity of exercise :
- Submaximal work load are used to train the
cardiac patient are compensated by a
greater duration activity.

14. PHASE – 3 (Out pt. phase)
Aims
1. Counselling pt. and family.
2. To prevent secondary complication.
3. To maintain bronchial hygiene.
4. To improve physical performance and maintain ex.
tolerance test.
5. To maintain quality of life.

15. PHASE – 3 (Out pt. phase)
(1)Counselling pt. and family
(2)To prevent secondary complication
Proper diet :- Low calary
Low salt
Low cholesterol
High proteins
Smoking cessation
Control B.P. and DM.
(3) To maintain bronchial hygiene

16. PHASE – 3 (Out pt. phase)
 Loosening, mobilize, draining and removal of secretion.
 PD, Breathing exs., ACBT, AD, Suction, etc.
(4) To improve physical performance and maintain
ex. tolerance test.
 Aerobic ex. :- it includes: warm up
Exercises
Cool down

17. PHASE – 3 (Out pt. phase)
WARM UP
Mode :- Stretching, Relaxation technique,
Spot marching, Walking,
Trunk rotations, Pass and catching ball.
Intensity :- at the RHR. (Resting heart rate)
Frequency :- 3 - 5 session per week.
Duration :- 5 – 10 minutes
Progression :- by increasing duration or frequency and
intensity.

18. PHASE – 3 (Out pt. phase)
EXERCISE PERIOD
Stride jump Jogging
Marching Fast walking
Stair climbing Push-ups
Squatting Treadmill training
Bicycle ergometry Arm swing with dumbells
Free ex.

19. PHASE – 3 (Out pt. phase)
Intensity :- At THR or MHR
Frequency :- 3 – 5 session per week
Duration :- 10 – 15 minutes
COOL DOWN
Mode :- Same as warm up ex.
Intensity :- At RHR or mild above it or below.
Frequency :- 3 – 5 / week
Duration :- 5 – 10 minutes

20. PHASE – 3 (Out pt. phase)
Termination of exercises :-
▪ Breathlessness
▪ Tachycardia >100 bpm
▪ Tachypnoea
▪ Fatigue
▪ Dizziness
▪ Swelling of ankles
(5) To maintain quality of life.
- With regular checkup, ex and follow up.

21. PHASE – 4 (Home programme)
Home ex, adaptation, and instruction should be given to
pt. clearly
Continue gentle ex in routine.
Ex. : walking, Mild jogging, Swimming, etc.
Regular Yoga and Pranayam
Lifestyle modifications
General support and counselling
Family member support and education
Regular check-up.