Cardiac rehabilitation programs appear to be primary adjuncts for the treatment and continue decline of CAD There are numerous studies showing effects of cardiac rehab on following parameters: improved functional capacity improved psychosocial function health education morbidity and mortality risk factor modification

1. CARDIAC
REHABILITATION
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Dr. Nidhi Ahya (Asst Prof)
Cardio-Vascular & Respiratory PT
DVVPF College of Physiotherapy
Ahemednagar 414111

2. OBJECTIVES
Rationale for exercise training in Cardiac
Rehabilitation
Response to exercise training
Core components
Beneficial effects cardiac rehab
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3. Rationale for cardiac
rehabilitation
Cardiac rehabilitation programs appear to be primary
adjuncts for the treatment and continue decline of
CAD
There are numerous studies showing effects of
cardiac rehab on following parameters:
 improved functional capacity
 improved psychosocial function
 health education
 morbidity and mortality
 risk factor modification
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4.  A meta analysis of 10 cardiac rehabilitation
after MI estimated that cardiovascular
mortality and death from all cases were
reduced 25% and 24% respectively after
cardiac rehabilitation
Before conducting a cardiac rehabilitation
program one must have understanding of
normal human responses to exercise
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5. Heart Rate
Normal
At normal and submaximum levels of
exercise, CO and HR increase linearly as the
workload and oxygen consumption demand
increase
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7. Abnormal
patients with coronary artery disease
demonstrate a clear abnormal response. These
include:
 low resting heart rate
 max symptom limited HR achieved during
exercise is well below the persons predicted
maximal heart rate
 Poor, slow HR increase in response to
incremental increases in exercise workload
 Poor exercise tolerance
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9. Clinical significance
failure to perform symptom limited maximum
exercise tests may mask the patient with
abnormal resting HR responses
Patients should be monitored carefully and
medically supervised closely if they are
enrolled in a cardiac rehab program
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10. Blood pressure
Normal
 systolic rises with increasing levels of
workload
 Diastolic rises or remains same or drops(
less than 10 mmhg)
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12. Systolic abnormality
 Flat response in which pressure may rise
slightly but fails to continue to rise and
remains generally below 140mmhg
 Systolic pressure is low to begin with(less
than 10mmhg), rises slightly and then begins
to fall inspite of increase in workload
 A normal submaximum response with a
precipitous fall in systolic pressure at higher
workloads
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14. Diastolic abnormality
 Persistent rise in diastolic pressure with
increase in exercise workloads
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15. Clinical significance
Systolic
 exhibited in patients with severe
ischaemia, poor ventricular dysfunction
 Have higher annual morbidity and
mortality
 Can still undergo cardiac rehab but must
be closely monitored for digns and
symptoms
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16. Diastolic
 A progressive rise in diastolic blood
pressure with exercise may indicate
severe coronary artery disease
 The rise should be atleast 20mmhg or
more above 90mmhg and persist after
exercise testing
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18. Anginal responses
Myocardial oxygen consumption
increases in a linear manner with
exercise intensity
In coronary arteries affected by
athersclerosis a point is reached where
the supply can no longer be increased
and further demand produces a relative
lack of myocardial oxygen, or ischaemia
or angina
This point is considered as anginal
threshold
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19. A patients anginal threshold is rougly
equivalent to a fixed, clinically recordable of
heart rate multiplied by systolic blood
pressure
This is referred to as rate-pressure product
and is linearly corelated with myocardial
oxygen demand
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21. Clinical significance
Angina may be succesfully treated by
exercise training
Angina threshold is not a fixed value
Exercise can increase the rate pressure
product
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22. Therapists should consider all of the
above mentioned responses before,
during and after cardiac rehab program
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23. Core Components
Patient Assessment
Nutritional Counseling
Weight Management
Blood Pressure Management
Lipid Management
Diabetes Management
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24. Tobacco Cessation
Psychosocial Management
Exercise Training
Physical Activity Counseling
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25. Beneficial effects of cardiac rehab
Improved functional capacity
 Exercise training increases functional capacity and
maximal oxygen uptake by increasing the
arteriovenous oxygen difference
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26. Reduction in symptoms of ischaemia
 Exercise training reduces submaximal heart rate
at any given workload or activity and delays the
onset of symptoms during exercise
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27. Ischaemia and perfusion
 exercise training increases in the rate pressure
product at the onset of ischemia and reduced ST
segment depression at similar rate pressure
products, implying enhanced coronary flow
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28. Reduction in risk factors
Blood lipids
 Significant reductions of total cholesterol,
LDL-cholesterol, and triglycerides,
 an increase in HDL-cholesterol with
training
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29. Hypertension control
 Regular exercise helps keep arteries elastic
(flexible)
 This ensures good blood flow and normal blood
pressure
 Consistent long term exercise can reslut in
atleast 10 to 20mmhg decrease in both resting
and exercise blood pressure of hypertension
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30. Glucose intolerance
 Lower serum insulin level after training because of
increase in insulin sensitivity at the cellular level
 Decreased serum triglycerides and body fat levels
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31. Cardiovascular mortality
Studies have shown 20-25% reduction in
cardiovascular mortality due to beneficial effects of
cardiac rehab
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32. SUMMARY
Defintion of cardiac rehab
Team members
Indications and contraindications
Normal and abnormal response to
exercise
Beneficial effects of cardiac rehab
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33. QUESTIONS
1. BENIFICIAL EFFCTS OF CARDIAC RHEHAB? 3MARKS
2. WRITE ABOUT REDUCTION IN RISK FACTORS OF
CARDIC REHAB? 5MARKS
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34. THANK YOU
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