Cardiac Rehabilatation .pdf

From Heartbeat to Healing:
A Comprehensive guide to
Cardiac Rehabilitation
Professor Dr. Md. Toufiqur Rahman
MBBS (DMC), FCPS (Medicine), MD (Cardiology),
FACC, FRCP, FESC, FAHA, FAPSIC, FASE, FSCAI, FAPSC
Professor and Head, Department of Cardiology
Colonel Maleque Medical College, Manikganj.
Vice President, Bangladesh Society of Cardiovascular Intervention (BSCI)
E-mail: drtoufiq19711@yahoo.com; drtoufiq1971@gmail.com

Prof. Dr. Md. Toufiqur Rahman
Professor and Head of The Department of Cardiology
978-984-35-4358-5 978-984-35-4358-5
First Published : March 2023
Published by : Dr. T. Rahman Cardiac
Care Foundation
Printed by : Bersha Pvt. Ltd,
Pearsons Tower (6th Floor)
299, Elephent Road, Dhaka-1205
Mobile : 01711544011
E-mail : bersha124@gmail.com
Cover Design : Kazi Atik
Price : 400/- (Four Hundred Taka) Only.
ISBN : 978-984-35-4358-5
“Cardiac rehabilitation is not just about getting back to your
previous level of fitness, it's about reaching new heights and
achieving a healthier, happier you.”

Preface
As a healthcare professional specializing in cardiovascular disease,
I have witnessed the tremendous benefits of cardiac rehabilitation in
improving the lives of patients who have suffered from heart-related
conditions. The positive impact that this comprehensive program
can have on patients' physical, emotional and psychological
well-being is truly remarkable. However, despite the proven
benefits of cardiac rehabilitation, many patients are not referred to
or do not participate in these programs.
It is my hope that this book on cardiac rehabilitation will serve as a
comprehensive resource for healthcare providers, patients and their
families to better understand and appreciate the value of cardiac
rehabilitation. The book covers various components of cardiac
rehabilitation, including medical evaluation, exercise training,
nutrition counselling, psychosocial support and medication
management. In addition, it provides practical guidance on how to
integrate cardiac rehabilitation into patients' overall treatment plans.
The book also explores the latest trends and future directions in
cardiac rehabilitation, including the use of technology, personalized
medicine and expanded target populations. Through this book, I aim
to increase awareness and understanding of cardiac rehabilitation
and inspire healthcare providers and patients to embrace this
valuable program as an essential aspect of the management of
cardiovascular disease.
I hope that this book will be a valuable resource for healthcare
providers, patients and their families and that it will contribute to the
continued advancement of cardiac rehabilitation as a cornerstone of
cardiovascular disease management.
“Your heart is the engine that drives your life. Cardiac
rehabilitation is the tune-up it needs to keep running smoothly.”

Acknowledgement
I would like to take this opportunity to express my deepest gratitude
and appreciation to the following individuals who have played an
instrumental role in the completion of this book:
To Professor ABM Abdullah, Professor Md. Fazlul Haque, Professor
Syed Azizul Haque, Professor Abdullah Al Shafi Majumder,
Professor M. Nazrul Islam, Professor Abdul Wadud Chowdhury and
Professor Khandaker Qamrul Islam, your encouragement and
mentorship have been instrumental in shaping my academic career.
your deadication to the field of medicine have been a source of
inspiration to me.
To Dr. AKM Monwarul Islam, my friend, your insights and expertise
in the field of cardiac rehabilitation have been invaluable. Your support
and guidance have been crucial in the completion of this book.
To my students, your passion for learning and dedication to the field of
medicine have been a constant source of motivation. It is your curiosity
and enthusiasm that has driven me to pursue excellence in my work.
To my wife, your unwavering support, encouragement and
understanding have been my anchor throughout this journey. Your
love and support have been my source of strength.
To my other family members, your constant love and support have
been a driving force in my life. Your unwavering belief in me has
been a source of inspiration and motivation.
Without the support of these individuals, this book would not have
been possible. I am truly grateful for their contributions and I
dedicate this book to them with the utmost respect and gratitude.

Dedication
To the hearts of the healers,
Whose knowledge shall aspire,
To treat with skill and kindness,
And reignite life's fire.
This book on cardiac rehab,
Is a tribute to you all,
Whose passion and dedication,
Will answer every call.
Through pages rich with wisdom,
And the science of the heart,
May you learn to heal with patience,
And give your patients a fresh start.
For in the hearts of the healers,
Lies the power to renew,
And in this book, we offer,
The tools to see it through.
So to the students of medicine,
This book is for you,
May it guide you in your journey,
And help you heal anew.
In Bangladesh, a pioneer emerged,
A visionary leader, hearts he stirred,
Professor Brigadier General Retired Abdul Malik,
Father of Cardiology, a legacy unique.
With passion and knowledge, he paved the way,
To bring modern cardiac care every day,
Founder of National Heart Foundation, Mirpur,
A beacon of hope, where lives find a cure.
His expertise unrivaled, his wisdom profound,
A trailblazer in medicine, renowned,
Training generations, imparting his art,
Guiding young doctors, a mentor's part.
Through innovation and tireless strife,
He transformed the landscape of cardiac life,
Introducing technologies, cutting-edge,
Enhancing treatments, reducing the ledge.
His compassion shone bright, a guiding light,
Healing not just bodies but souls with might,
Empathy and kindness, his virtues true,
Leaving an indelible mark on all he knew.
Professor Abdul Malik, a legend so grand,
In the realm of cardiology, he'll forever stand,
Grateful we are for his remarkable vision,
A true inspiration, a medical mission.
His legacy lives on, a gift to us all,
A testament to his passion and gall,
Father of Cardiology, we honor your name,
In gratitude, our hearts forever claim.
Father of Cardiology in Bangladesh
National Professor
Brig (Retd.) Abdul Malik
To all my undergraduate and post graduate students and
my teachers & mentors

Dedication
In the realm of cardiology, a pioneer's tale,
Professor Abu Zafar, a name that'll prevail,
Father of Echocardiography, his claim to fame,
A visionary cardiologist, deserving acclaim.
With passion and knowledge, he set the stage,
Introducing echocardiography, a diagnostic gauge,
A tool to visualize hearts, its chambers and flow,
Revolutionizing care, a profound breakthrough.
His expertise unmatched, his skills refined,
He delved into hearts, seeking answers to find,
Through sound waves and images, he explored,
Unveiling mysteries, cardiac conditions he adored.
A teacher and mentor, he shared his insight,
Nurturing young minds, igniting their light,
Guiding future cardiologists, a guiding force,
Imparting wisdom, steering them on their course.
Innovation he championed, advancements he led,
Pushing boundaries, expanding what lay ahead,
His contributions profound, his impact vast,
In the world of cardiology, a legacy that'll last.
Professor Abu Zafar, a luminary so grand,
In the field of echocardiography, he'll forever stand,
Grateful we are for his visionary stride,
A true inspiration, with hearts unified.
His legacy lives on, in each beat of the heart,
In the echoes that guide, a vital part,
We honor his spirit, his dedication unmarred,
A cardiologist extraordinary, forever regarded.
In the realm of medicine, a guiding star,
Professor Sufia Rahman, a leader by far,
Founder of Interventional Cardiology, a trail she blazed,
A mentor to many, her wisdom praised.
With dedication and expertise refined,
She ventured into uncharted design,
Pioneering procedures, breaking new ground,
Advancing the field with each patient found.
In the cath lab, her hands steady and sure,
Saving lives, finding solutions to endure,
Through angioplasty and stent deployment,
She brought hope to hearts, a life-changing enjoyment.
A mentor she became, sharing her skill,
Nurturing minds, inspiring a thrill,
Guiding young doctors, igniting their flame,
Passing on knowledge, leaving a lasting name.
With grace and compassion, she led the way,
Empowering others, day by day,
Her wisdom, a beacon, shining so bright,
Inspiring greatness, igniting the light.
Professor Sufia Rahman, a mentor divine,
In the world of Interventional Cardiology, she'll forever shine,
Grateful we are for her guidance profound,
A true inspiration, forever renowned.
Her legacy lives on, a testament true,
In the hearts she touched, in all that she'd do,
We honor her spirit, her impact untold,
A mentor, a leader, a heart of gold.
Father of Ecocaridography in Bangladesh
Professor Abu Zafar
Founder of interventional Cardiology
& my mentor
Professor Sufia Rahman

Contents
Topics Page No.
i. Introduction 01
ii. Goals of cardiac rehabilitation 03
iii. Benefits of cardiac rehabilitation 05
iv. Indications of cardiac rehabilitation 07
v. Contraindications of cardiac rehabilitation 09
vi. Phases of cardiac rehabilitation 11
vii. Assessment and pre- enrollment work up of cardiac rehabilitation 14
viii. Program structure of cardiac rehabilitation 15
ix. Components of Cardiac Rehabilitation 16
x. Implementation of the cardiac rehabilitation program 32
xi. Barriers to accessing and participating in CR programs and
strategies to overcome them. 33
xii. Evidence supporting the effectiveness of CR in improving outcomes. 33
xiii. Recommendations for healthcare providers and policymakers to
promote the uptake and adherence to CR programs 34
xiv. Future directions of cardiac rehabilitation 36
xv. Conclusion 40
xvi. Bibliography 42

Introduction
Cardiac rehabilitation is a vital component of the management of
cardiovascular disease. The goal of cardiac rehabilitation is to
provide a multidisciplinary approach to patient care that addresses
the physical, emotional and social aspects of cardiovascular disease
management. This approach aims to optimize the patient's physical
and mental health, reduce the risk of future cardiac events and
improve their overall quality of life.
Cardiac rehabilitation typically involves several phases of care,
including inpatient rehabilitation, early outpatient rehabilitation and
ongoing maintenance. During these phases, patients receive medical
evaluation, prescribed exercise, cardiac risk factor modification,
education and counseling.
In the inpatient rehabilitation phase, patients receive intensive medical
and nursing care, as well as supervised exercise, education and
counseling. The goal of this phase is to stabilize the patient's condition,
monitor their progress and prepare them for transition to Phase 2.
The early outpatient rehabilitation phase typically begins soon after
the patient is discharged from the hospital and lasts for several
weeks to a few months. During this phase, the patient participates in
supervised exercise sessions, education and counseling and other
interventions designed to promote cardiovascular health and reduce
the risk of future cardiac events.
The ongoing maintenance phase or Phase 3, is designed to help
patients maintain their cardiovascular health and continue to make
lifestyle modifications that support their overall well-being. During
this phase, the patient may participate in less structured exercise
sessions, group support and education and counseling sessions.
Cardiac rehabilitation is typically indicated for individuals with
various forms of cardiovascular disease, including acute myocardial
infarction, coronary artery bypass graft surgery, percutaneous
coronary intervention (PCI) with or without stenting, stable angina,
heart failure, cardiac transplantation, valvular heart disease,
peripheral arterial disease, atrial fibrillation or other arrhythmias
01

and cardiomyopathy. Patients with multiple risk factors for
cardiovascular disease may also benefit from cardiac rehabilitation,
even if they have not yet been diagnosed with a specific
cardiovascular condition.
While cardiac rehabilitation is generally safe and effective for
individuals with cardiovascular disease, there are certain conditions
that may be considered contraindications for participation. Patients
with unstable angina or recent myocardial infarction, uncontrolled
arrhythmias that could pose a risk of sudden cardiac arrest,
uncontrolled heart failure, severe aortic stenosis or other severe
valvular disease, acute systemic illness or fever, active pericarditis
or myocarditis, recent pulmonary embolism or deep vein
thrombosis and severe peripheral arterial disease with resting leg
pain or evidence of tissue necrosis may be considered too high-risk
to participate in cardiac rehabilitation. However, in some cases,
patients with these conditions may be able to participate in a
modified or closely monitored program, under the supervision of a
healthcare professional.
So, cardiac rehabilitation is an essential component of the
management of cardiovascular disease, helping patients to improve
their quality of life, reduce the risk of future cardiac events and
optimize their physical and mental health. A healthcare professional
should be consulted to determine whether cardiac rehabilitation is
appropriate for a particular patient.
02
Distinguished Contributors
Prof. Chaudhury MeshkatAhmed Prof. Bidhan Chandra Goswami
Dr. Candan Kumar Saha Dr. Amirul Khusru Dr.MohammadKabiruzzaman
Prof.Md.MizanurRahman Dr.ShaikhMdShahidulHaque
Prof(MajorGen.Retd.)M.GRabbani
Prof. Sabina Hasem Prof.M.MZahurulAlamKhan

Goals of cardiac rehabilitation
The goals of cardiac rehabilitation are to help individuals with
cardiovascular disease to:
Improve physical function and strength: Exercise training and
physical therapy are critical components of cardiac rehabilitation
that can help patients regain their physical function and strength.
Patients are typically prescribed a structured exercise program that
includes aerobic and resistance training and the program is tailored
to the individual's specific needs and abilities. Physical therapy may
also be included to address specific issues such as joint pain or
muscle weakness.
Manage symptoms: Patients with cardiovascular disease often
experience symptoms such as chest pain, shortness of breath and
fatigue. Cardiac rehabilitation provides techniques and strategies to
help patients manage these symptoms, such as relaxation
techniques, breathing exercises and energy conservation techniques.
By learning to manage their symptoms, patients can improve their
quality of life and feel more confident in their ability to perform
daily activities.
Reduce risk of future cardiovascular problems: Cardiac
rehabilitation provides education and support to help patients make
lifestyle changes that can reduce the risk of future heart-related
problems. This may include quitting smoking, eating a heart-healthy
diet and managing other health conditions such as high blood
pressure or diabetes. Patients also receive education on medications
and their role in reducing the risk of future cardiovascular events.
Improve emotional well-being: Patients with cardiovascular
disease often experience emotional distress such as stress, anxiety
and depression. Cardiac rehabilitation provides psychological
support and counseling to help patients cope with the emotional
impact of their condition. By addressing the emotional needs of
patients, cardiac rehabilitation can improve their overall well-being
and quality of life.
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04
Enhance overall health and well-being: Cardiac rehabilitation
provides a comprehensive approach to patient care that addresses
the physical, emotional and psychological needs of individuals with
cardiovascular disease. By addressing all aspects of patient care,
cardiac rehabilitation can help patients achieve the best possible
outcomes and improve their overall health and well-being.
So, the goals of cardiac rehabilitation are multifaceted, aiming to
improve physical function and strength, manage symptoms, reduce
the risk of future cardiovascular problems, improve emotional
well-being and enhance overall health and well-being. By
addressing all of these goals, cardiac rehabilitation can improve the
quality of life of individuals with cardiovascular disease and help
them achieve the best possible outcomes.
“Cardiac rehabilitation is not just a program, it's a journey
towards a stronger, healthier heart.”
Dr.SumanNazmulHosain
Dr. Md. Mizanur Rahman
Dr.Amiruzzaman Khan Dr. MohammadAbul Khair Dr. Mohammad Nasir Uddin Dr. Mohd. RumiAlam Dr. Rashid Ahmed
Dr. Muhammad Shahabuddin Dr. Ashok Dutta Dr. Md. Ayub Ali Dr. Mohammad MahabubulAmin
Dr. Prabir Kumar Das Dr. Md. Lokman Hossain Dr.Amal Kumar Choudhury
Dr. Abdullah Al Jamil

Benefits of cardiac rehabilitation
Cardiac rehabilitation provides numerous benefits for individuals
with cardiovascular disease, including:
 Improved physical function and exercise capacity: Cardiac
rehabilitation includes exercise training and physical therapy,
which help patients regain strength, flexibility and endurance
and improve their ability to perform daily activities.
 Reduced risk of future heart-related problems: Cardiac
rehabilitation provides education and support to help patients
make lifestyle changes such as quitting smoking, eating a
heart-healthy diet and managing other health conditions, which
can reduce the risk of future heart-related problems.
 Better management of symptoms: Patients learn techniques
for managing symptoms such as chest pain, shortness of breath
and fatigue, which can improve their quality of life.
 Enhanced psychological well-being: Psychological support and
counselling can help patients cope with the emotional impact of
their heart condition and reduce stress, anxiety and depression.
 Improved overall health and well-being: Cardiac rehabilitation
provides a comprehensive approach to patient care that addresses
the physical, emotional and psychological needs of individuals
with cardiovascular disease, which can improve their overall
health and well-being.
 Lower healthcare costs: Cardiac rehabilitation has been shown
to reduce hospital readmissions and healthcare costs associated
with cardiovascular disease.
 Improved cardiovascular health: Cardiac rehabilitation can
improve cardiovascular health by reducing blood pressure,
lowering cholesterol levels and improving blood sugar control
in patients with diabetes.
 Increased social support: Cardiac rehabilitation provides an opportunity
for patients to connect with others who are going through similar
experiences, which can increase social support and improve mental health.
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 Better medication management: Patients learn about their
medications and how to take them properly, which can improve
medication adherence and reduce the risk of adverse effects.
 Enhanced motivation: Cardiac rehabilitation can enhance
patients' motivation to make lifestyle changes and adopt
healthier behaviors, which can have long-lasting benefits for
their overall health and well-being.
 Better overall quality of life: By improving physical function,
reducing symptoms and addressing psychological needs, cardiac
rehabilitation can lead to a better overall quality of life for
patients with cardiovascular disease.
 Cardiac rehabilitation: Provides a comprehensive approach to
patient care that can help individuals with cardiovascular
disease to achieve better outcomes and improve their overall
health and well-being.
Thus, cardiac rehabilitation provides numerous benefits for
individuals with cardiovascular disease, helping them to improve
their quality of life, reduce the risk of future heart-related problems
and achieve the best possible outcomes.
“Cardiac rehabilitation is not a one-size-fits-all approach. It's
tailored to your unique needs and goals, helping you achieve a
stronger, healthier heart.”
Dr.MohammadAnowarHossain Dr. Md. Sarowar Hossain Dr. Md. Nasimul Gani Dr. Md. Faridul Haque
Dr. Md. Ashraf Hossain
Dr.Md.SazzadurRahman Dr. Moeen UddinAhmed Dr. Md. Khalequzzaman
Dr. Md. Shahriar Kabir Dr. Mohammad Ullah

Indications of cardiac rehabilitation
Cardiac rehabilitation is a comprehensive program that is designed
to help patients recover from various forms of cardiovascular
disease and improve their overall cardiovascular health. The
program is typically recommended for individuals who have
undergone specific procedures or have been diagnosed with certain
cardiovascular conditions, but it may also be appropriate for patients
who have multiple risk factors for cardiovascular disease.
Cardiac rehabilitation is typically indicated for individuals with
various forms of cardiovascular disease, including:
Acute myocardial infarction (heart attack), Coronary artery bypass
graft surgery, Percutaneous coronary intervention (PCI) with or
without stenting, Stable angina, Heart failure, Cardiac
transplantation, Valvular heart disease, Peripheral arterial disease,
Atrial fibrillation or other arrhythmias, Cardiomyopathy, one of the
most common indications for cardiac rehabilitation is acute
myocardial infarction or a heart attack. After a heart attack, the heart
muscle may be damaged and the patient may experience chest pain,
shortness of breath and other symptoms. Cardiac rehabilitation can
help these patients recover from their heart attack and improve their
overall cardiovascular health.
Another common indication for cardiac rehabilitation is coronary
artery bypass graft surgery. During this procedure, a surgeon
reroutes blood flow around a blocked or narrowed section of a
coronary artery. Cardiac rehabilitation can help patients recover
from the surgery, improve their physical fitness and reduce their risk
of future heart problems.
Percutaneous coronary intervention (PCI) with or without stenting
is another common indication for cardiac rehabilitation. During this
procedure, a cardiologist uses a catheter to open up a blocked or
narrowed coronary artery. Cardiac rehabilitation can help patients
recover from the procedure, improve their physical fitness and
reduce their risk of future heart problems.
Stable angina or chest pain, is another condition for which cardiac
07

08
rehabilitation may be recommended. Cardiac rehabilitation can help
these patients improve their cardiovascular health and reduce their
symptoms of angina.
Heart failure is another condition for which cardiac rehabilitation
may be recommended. Cardiac rehabilitation can help these patients
improve their physical fitness, reduce their symptoms and improve
their quality of life.
Cardiac transplantation is another indication for cardiac
rehabilitation. After a heart transplant, patients may need to undergo
cardiac rehabilitation to improve their physical fitness and reduce
their risk of complications.
Valvular heart disease, peripheral arterial disease, atrial fibrillation
or other arrhythmias and cardiomyopathy are other conditions for
which cardiac rehabilitation may be recommended. In addition,
patients with multiple risk factors for cardiovascular disease, such
as high blood pressure, high cholesterol or a family history of heart
disease, may also benefit from cardiac rehabilitation, even if they
have not yet been diagnosed with a specific cardiovascular
condition.
It is important to note that the specific indications for cardiac
rehabilitation may vary depending on the patient's individual health
status and medical history. A healthcare professional should be
consulted to determine whether cardiac rehabilitation is appropriate
for a particular patient.
“Cardiac rehabilitation is not a quick fix, but a lifelong
commitment to a healthier heart and a happier you.”
Dr.DipankarChandraNag Dr. SM Habibullah Selim
Dr. Rawnak JahanTamanna Dr. Tamzeed Ahmed
Dr. Md. Eilas Ali

Contraindications of cardiac rehabilitation
Cardiac rehabilitation is generally safe and effective for individuals
with cardiovascular disease. However, there are certain conditions
that may pose a risk to the patient during exercise and other
interventions that are part of cardiac rehabilitation. These conditions
are considered contraindications for participation in a traditional
cardiac rehabilitation program. These include:
Unstable angina or recent myocardial infarction (within the past 2-3
days), Uncontrolled arrhythmias that could pose a risk of sudden
cardiac arrest, Uncontrolled heart failure , Severe aortic stenosis or
other severe valvular disease, Acute systemic illness or fever, Active
pericarditis or myocarditis, Recent pulmonary embolism or deep
vein thrombosis (within the past 6 weeks), Severe peripheral arterial
disease with resting leg pain or evidence of tissue necrosis
Unstable angina or recent myocardial infarction (within the past 2-3
days) are considered contraindications because the patient is at a
high risk of having another cardiac event during exercise. Similarly,
uncontrolled arrhythmias that could pose a risk of sudden cardiac
arrest are contraindications because exercise may exacerbate the
arrhythmia and increase the risk of sudden cardiac arrest.
Uncontrolled heart failure is another contraindication, as the patient
may not be able to tolerate the physical demands of exercise. Severe
aortic stenosis or other severe valvular disease may also be a
contraindication because exercise can increase the workload on the
heart, potentially exacerbating the valve condition.
Acute systemic illness or fever is a contraindication because the
body is already under stress and exercise may exacerbate the illness.
Active pericarditis or myocarditis, inflammation of the heart muscle
or lining, is also a contraindication because exercise can increase
inflammation and potentially cause further damage to the heart.
Recent pulmonary embolism or deep vein thrombosis (within the
past 6 weeks) is a contraindication because exercise can increase the
risk of further blood clots. Severe peripheral arterial disease with
resting leg pain or evidence of tissue necrosis is another
09

10
contraindication because exercise can further compromise blood
flow to the affected limb.
In some cases, patients with these conditions may be able to
participate in a modified or closely monitored program, under the
supervision of a healthcare professional. For example, a patient with
stable heart failure may be able to participate in a cardiac
rehabilitation program that is closely monitored by a healthcare
professional, with exercise intensity and duration adjusted based on
the patient's tolerance and response.
It is important to note that the specific contraindications for cardiac
rehabilitation may vary depending on the patient's individual health
status and medical history. Therefore, a healthcare professional
should be consulted to determine whether cardiac rehabilitation is
appropriate for a particular patient.
“Cardiac rehabilitation is not just about physical fitness, it's
about mental and emotional resilience too. It's about
rebuilding yourself from the inside out.”
Dr. Md.Abdul Karim Dr.A.S.M.GolamRabbani
Dr. Taifur Rahman
Prof. S M Mustafa Zaman Prof. Harisul Haque Dr. Nupur Kar
Dr. Durba Halder
Dr. Reyan Anis
Dr.KhandkerMd.NurusSabah Dr. S MAhsan Habib
Dr. Mashhud Zia Chowdhury Dr. Kamal Pasha Dr. Mustafizul Aziz Dr. Md.Abdul Muttalib Prof.Md.MohsinHossain

Phases of cardiac rehabilitation
Phases of cardiac rehabilitation:
Cardiac rehabilitation is typically divided into three phases, each of
which is designed to provide a specific level of care and support to
the patient based on their individual needs and goals. The three
phases of cardiac rehabilitation are:
Phase 1: Inpatient rehabilitation
Phase 1 of cardiac rehabilitation is an inpatient program that takes
place in a hospital or medical center setting. This phase typically
begins soon after a patient has experienced a cardiac event, such as
a heart attack, heart surgery or other cardiovascular emergency.
The primary goals of Phase 1 are to stabilize the patient's medical
condition, prevent further complications and begin the process of
recovery. During this phase, the patient is closely monitored by a
multidisciplinary team of healthcare professionals, including
physicians, nurses and physical and occupational therapists.
One of the key components of Phase 1 is supervised exercise. The
patient may participate in light aerobic exercise, such as walking on
a treadmill or stationary bike, under the supervision of a physical
therapist. The exercise program is tailored to the patient's individual
needs and medical condition, with a focus on improving cardiovas-
cular function, increasing endurance and restoring strength.
In addition to exercise, patients in Phase 1 also receive education
and counseling on topics such as medication management, diet and
nutrition and stress management. Patients may also receive
emotional support and counseling to help them cope with the
emotional and psychological impact of their cardiac event.
Other components of Phase 1 may include occupational therapy to
help patients regain their ability to perform daily activities, such as
dressing and bathing and social work services to provide support
and resources for patients and their families.
Throughout Phase 1, the patient's progress is closely monitored and
evaluated by the healthcare team. This may include regular
assessments of vital signs, such as blood pressure and heart rate, as
well as monitoring of symptoms and medication management.
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At the end of Phase 1, the patient is evaluated to determine if they
are ready for discharge from the hospital and transition to Phase 2 of
cardiac rehabilitation. The patient may continue to receive
follow-up care and support from their healthcare team after
discharge to ensure that they continue to make progress towards
improved cardiovascular health.
Phase 2: Early outpatient rehabilitation
During Phase 2 of cardiac rehabilitation, the patient continues their
recovery journey with an emphasis on physical activity and lifestyle
modifications. The goals of this phase are to improve cardiovascular
fitness, increase strength and endurance, reduce risk factors and
enhance overall well-being.
The exercise program in Phase 2 is tailored to the individual
patient's needs, medical history and fitness level. The patient is
typically instructed to participate in aerobic and resistance training
exercises for a total of 30 to 60 minutes per day, at least three to five
times per week. The exercise sessions are typically supervised by
trained professionals, such as exercise physiologists or physical
therapists, to ensure safety and efficacy.
In addition to exercise, Phase 2 may also include education and
counseling sessions to help patients make healthy lifestyle choices.
These sessions may cover topics such as diet and nutrition, smoking
cessation, stress management and medication adherence. Patients
may also receive guidance on how to monitor their symptoms, track
their progress and set achievable goals for themselves.
In some cases, additional diagnostic testing may be necessary during
Phase 2 to monitor the patient's progress and adjust their plan of care
as needed. For example, stress testing may be used to assess the
patient's exercise capacity and detect any signs of ischemia or other
cardiac abnormalities. Echocardiography may be used to assess
cardiac function and detect any structural or functional abnormalities.
So, Phase 2 is a critical stage of cardiac rehabilitation that helps
patients to continue their recovery journey and reduce their risk of
future cardiac events. The focus on physical activity, healthy lifestyle
choices and close monitoring and support can help patients to improve
their cardiovascular health and enhance their overall quality of life.

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Phase 3: Maintenance rehabilitation
Phase 3 of cardiac rehabilitation is an essential part of the patient's
long-term recovery plan. This phase typically lasts for several
months to years, depending on the patient's individual needs and
goals. During this phase, the patient is encouraged to continue
making lifestyle modifications that support their cardiovascular
health, such as maintaining a heart-healthy diet, engaging in regular
physical activity and managing stress.
The focus of Phase 3 is on maintaining the progress made in earlier
phases and preventing future cardiac events. The patient may
participate in group support sessions, where they can connect with
other individuals who have experienced similar health challenges
and share their experiences and strategies for managing their
condition. These group sessions may be facilitated by a healthcare
professional or community-based organization.
Exercise sessions in Phase 3 may be less structured than in earlier
phases and may be conducted in a variety of settings, such as
community-based programs or fitness centers. Patients are typically
encouraged to continue engaging in aerobic and resistance training
exercises, with a focus on maintaining cardiovascular fitness and
muscle strength. The exercise plan may be modified based on the
patient's progress and response to treatment.
Education and counseling sessions in Phase 3 may focus on topics
such as stress management, medication management and goal
setting. The patient may also receive ongoing monitoring and
follow-up care, including regular check-ins with their healthcare
provider and additional diagnostic testing as needed.
So, Phase 3 of cardiac rehabilitation is designed to support the
patient's long-term recovery and maintenance of cardiovascular
health. It provides ongoing education, support and guidance to help
patients continue to make healthy lifestyle modifications and reduce
their risk of future cardiac events.
“Cardiac rehabilitation is not just for the heart, it's for the mind,
body and soul. It's a holistic approach to a healthier you.”

Assessment and pre- enrollment work up
of cardiac rehabilitation
The assessment and pre-enrollment workup for cardiac
rehabilitation typically involves a comprehensive evaluation of the
patient's medical history, physical examination and diagnostic
testing to determine their eligibility for participation in a cardiac
rehabilitation program. The following are some of the key
components of the assessment and pre-enrollment workup:
Medical history: The patient's medical history will be reviewed to
assess their overall health status, cardiovascular risk factors and
history of cardiovascular disease or related conditions.
Physical examination: A physical examination will be performed
to assess the patient's overall health status, cardiovascular function
and any potential physical limitations that may impact their ability
to participate in cardiac rehabilitation.
Diagnostic testing: Diagnostic testing may be performed to
evaluate the patient's cardiovascular function and identify any
underlying cardiovascular disease or related conditions. These tests
may include electrocardiogram (ECG), echocardiogram, stress
testing and blood tests to assess cholesterol levels, blood sugar and
other important markers of cardiovascular health.
Psychosocial evaluation: A psychosocial evaluation may be conducted
to assess the patient's emotional and psychological well-being, identify
any potential barriers to participation in cardiac rehabilitation and
provide appropriate support and counseling as needed.
Goal setting: The patient's goals for participation in cardiac
rehabilitation will be discussed and established, with a focus on
developing a personalized plan of care that addresses their
individual needs and preferences.
So, the assessment and pre-enrollment workup for cardiac
rehabilitation is designed to identify the patient's individual needs,
develop a personalized plan of care and ensure their safety and
success in the program. It is important that this assessment is
conducted by qualified healthcare professionals, including
physicians, nurses and other specialists with expertise in
cardiovascular care.
14

Program structure of cardiac rehabilitation
The structure of a cardiac rehabilitation program can vary
depending on the needs and goals of the individual patient, as well
as the specific resources and protocols of the healthcare facility
offering the program. However, most cardiac rehabilitation
programs follow a general framework that includes the following
components:
Initial assessment and goal setting: This is typically the first step
of the program and involves an initial evaluation of the patient's
medical history, physical condition and goals for participation in
cardiac rehabilitation. Based on this assessment, a personalized plan
of care will be developed that includes specific goals and objectives
for the program.
Exercise training: Exercise training is a key component of cardiac
rehabilitation, as it helps to improve cardiovascular function, build
strength and endurance and reduce the risk of future cardiovascular
events. Patients will typically engage in supervised exercise
sessions that include a combination of aerobic exercise, resistance
training and flexibility exercises.
Education and counseling: Patients will receive education and
counseling on a range of topics related to cardiovascular health,
including nutrition, stress management, medication management,
smoking cessation and other lifestyle modifications. This may be
done in a group setting or through one-on-one counseling sessions
with a healthcare professional.
Psychosocial support: Psychosocial support is an important aspect
of cardiac rehabilitation, as patients may experience a range of
emotional and psychological challenges related to their
cardiovascular disease. Patients may receive counseling, support
groups or other interventions to address issues such as depression,
anxiety and social isolation.
Follow-up and maintenance: After completion of the program,
patients will typically have ongoing follow-up with their healthcare
team to monitor their progress and ensure that they continue to
maintain the lifestyle changes and habits that were established
during cardiac rehabilitation.
The duration of a cardiac rehabilitation program can vary, but most
programs last between 8 and 12 weeks, with sessions typically held
two to three times per week. The program may be modified or
extended based on the patient's progress and individual needs. So,
the structure of a cardiac rehabilitation program is designed to
provide a comprehensive approach to patient care that addresses the
physical, emotional and social aspects of cardiovascular disease
management.
15

16
Components of cardiac rehabilitation
1. Medical evaluation and assessment—
Medical Evaluation and Assessment is a critical component of cardiac
rehabilitation that helps to assess the patient's overall health and identify
any underlying medical conditions that may need to be addressed. The
evaluation may include the following:
a. Initial evaluation and assessment: This involves a comprehensive
evaluation of the patient's medical history, symptoms and lifestyle factors
that may affect their cardiovascular health. The initial assessment also
includes a physical exam to assess the patient's overall health.
b. Cardiac imaging and testing: This component involves non-invasive or
invasive cardiac testing, such as electrocardiogram (ECG), echocardiogram,
stress testing, cardiac catheterization and angiography. These tests help to
diagnose and evaluate the extent of any existing heart disease.
c. Laboratory testing: This component involves laboratory testing to
assess the patient's overall health and to identify any underlying medical
conditions that may affect their cardiovascular health, such as high
cholesterol, diabetes and kidney disease.
d. Risk factor assessment: This component involves evaluating the
patient's risk factors for developing heart disease, such as high blood
pressure, smoking, obesity and family history of heart disease.
e. Medical history review: This component involves reviewing the
patient's medical history, including any previous heart conditions,
surgeries and medications they are currently taking.
f. Medication review: This component involves reviewing the patient's current
medications, including prescription medications, over-the-counter medications
and supplements, to ensure that they are being taken correctly and are not
interfering with other medications. Adjustments to medication may be made as
necessary to optimize treatment and prevent adverse drug interactions.
2. Physical activity and exercise training--
Physical Activity and Exercise Training is an important component of
cardiac rehabilitation that focuses on improving cardiovascular fitness and
endurance. The following are some of the details of this component:

17
a. Exercise prescription: To create an exercise plan, the cardiac
rehabilitation team will first assess the patient's medical history, including
any previous heart conditions, surgeries or interventions. They will also
evaluate the patient's current fitness level and any physical limitations or
restrictions.
Based on this assessment, the team will create an individualized exercise
plan that includes specific types of exercise, duration, intensity and
frequency. The plan may include both aerobic exercise, such as walking,
cycling or swimming and resistance training, such as weight lifting or
resistance bands.
The exercise plan should be tailored to the patient's preferences and
lifestyle and should also consider any cultural or socioeconomic factors
that may impact adherence to the plan. The team may also use wearable
devices or other technology to track the patient's progress and provide
feedback and motivation.
b. Types of exercise: Aerobic exercises are physical activities that
increase the heart rate and breathing rate, which help to improve
cardiovascular fitness. The aim of aerobic exercise in cardiac
rehabilitation is to increase the strength and endurance of the heart muscle,
as well as improve the delivery of oxygen and nutrients to the body's
tissues. Examples of aerobic exercises that may be included in a cardiac
rehabilitation program are:
c. Walking: This is a low-impact exercise that can be easily modified to
suit different fitness levels. It is also a great option for patients who may
have mobility issues.
d. Cycling: Cycling can be done on a stationary bike or outdoors,
depending on the patient's preference and accessibility. It is a great option
for patients who have joint issues, as it is low-impact.
e. Swimming: Swimming is a great aerobic exercise that is also
low-impact. It is an ideal option for patients who may have joint or
mobility issues.
f. Jogging/Running: These exercises are high-impact and may not be
suitable for all patients, particularly those with joint issues. However, they
can be modified to a lower impact version such as walking or jogging slowly.

18
Resistance training exercises involve using weights or resistance bands to
strengthen and tone muscles. The aim of resistance training in cardiac
rehabilitation is to improve overall muscle strength, which can help to improve
mobility, balance and functional capacity. Examples of resistance training
exercises that may be included in a cardiac rehabilitation program are:
Weight lifting: This involves using dumbbells or barbells to perform
various exercises that target different muscle groups.
Resistance band exercises: These exercises involve using stretchable
bands that provide resistance to improve muscle strength and tone.
Bodyweight exercises: These are exercises that use the body's own
weight as resistance, such as push-ups, squats and lunges. Bodyweight
exercises can be modified to suit different fitness levels.
Benefits of exercise: Regular exercise has numerous benefits for
cardiovascular health and it is an essential component of any cardiac
rehabilitation program. One of the primary benefits of exercise is
improved circulation. This increased blood flow can also help to reduce
inflammation and promote healing.
Exercise also helps to lower blood pressure, which is a significant risk
factor for cardiovascular disease. Regular exercise can help to reduce the
workload on the heart and blood vessels, making them more efficient at
delivering oxygen and nutrients throughout the body. As a result, blood
pressure can be reduced, which can lower the risk of heart attack and stroke.
In addition to lowering blood pressure, exercise also helps to improve
cholesterol levels. Specifically, regular exercise can help to increase HDL
(or "good") cholesterol levels while reducing LDL (or "bad") cholesterol
levels. This can help to lower the risk of heart disease and stroke.
Exercise is also beneficial for controlling blood sugar levels, especially for
patients with diabetes. Regular exercise helps to improve insulin
sensitivity, which can help to lower blood sugar levels and reduce the risk
of diabetes-related complications.
In addition to its physical benefits, exercise can also have a positive
impact on mental health. Exercise can help to reduce stress and anxiety,
improve mood and promote overall well-being. These benefits are
particularly important for patients with cardiovascular disease, who may
be experiencing a range of emotional and psychological challenges.

19
k. Safety considerations: When designing an exercise plan for cardiac
rehabilitation, safety considerations should be a top priority. Patients with
cardiovascular disease may have unique health risks that need to be
carefully evaluated before beginning an exercise program. Here are some
key safety considerations for cardiac rehabilitation exercise programs:
i. Physical examination: All patients should undergo a physical
examination to evaluate their overall health and to identify any underlying
medical conditions that may affect their ability to exercise. This
examination may include assessments of blood pressure, heart rate, body
composition and lung function.
ii. Exercise stress testing: Patients with cardiovascular disease may
need to undergo exercise stress testing to evaluate their heart function and
to determine safe exercise intensity levels. This testing can help to identify
any potential heart problems that may be exacerbated by exercise.
iii. Medical clearance: Patients with cardiovascular disease should
obtain medical clearance from their healthcare provider before beginning
an exercise program. This clearance should include recommendations for
appropriate exercise intensity levels, duration and frequency.
iv. Monitoring during exercise: Patients should be closely monitored
during exercise sessions to ensure that they are not experiencing any
adverse effects, such as chest pain, shortness of breath or dizziness. This
monitoring may include assessments of heart rate, blood pressure and
oxygen saturation levels.
v. Gradual progression: Patients should gradually progress their
exercise intensity, duration and frequency over time, under the guidance of
their healthcare provider. Sudden increases in exercise intensity can put
undue stress on the heart and increase the risk of adverse events.
vi. Emergency planning:An emergency plan should be in place in case
a patient experiences a cardiac event during exercise. This plan should
include emergency contact information, access to emergency medical
services and procedures for responding to a cardiac event.
 Monitoring progress: Monitoring progress is a crucial aspect of a
cardiac rehabilitation program. By regularly assessing the patient's
progress, the healthcare team can determine if the exercise program is

20
working effectively or if any adjustments need to be made. There are several
ways to monitor progress in a cardiac rehabilitation program, including
measuring heart rate, blood pressure and other vital signs before and after
exercise sessions, as well as regular assessments of strength and endurance.
During exercise, the heart rate should increase to a level that is appropriate
for the patient's age and fitness level. The healthcare team can monitor the
patient's heart rate during exercise to ensure that it is within a safe range
and that the exercise is providing the desired cardiovascular benefits.
Exercise can cause blood pressure to increase, so it is important to ensure
that the patient's blood pressure remains within a safe range. The
healthcare team may also monitor blood pressure outside of exercise
sessions to assess overall cardiovascular health and to determine if any
adjustments to medication are necessary.
Assessing strength and endurance can help to determine if the patient is
making progress towards their fitness goals. The healthcare team may use
various tests, such as grip strength tests, sit-to-stand tests or treadmill tests,
to assess strength and endurance.
In addition to these objective measures, the healthcare team should also
ask the patient about their subjective experiences with the exercise
program. This can include questions about how the patient is feeling
during and after exercise sessions, as well as how they feel in general. By
gathering this information, the healthcare team can assess the patient's
overall well-being and make any necessary adjustments to the exercise
program.
3. Nutrition counseling and education
Nutrition Counseling and Education is an essential component of cardiac
rehabilitation that focuses on improving the patient's diet and promoting
healthy eating habits. The following are some of the details of this component:
 Dietary assessment: This component involves evaluating the patient's
current diet and identifying any dietary deficiencies or excesses that may
be affecting their cardiovascular health. The assessment may include a
review of the patient's food intake, nutrient intake and dietary habits.
 Nutrition education: Nutrition education is a critical component of
cardiac rehabilitation programs that focuses on educating patients about the

21
importance of good nutrition for cardiovascular health. This component
typically involves working with a nutritionist or registered dietitian to
develop individualized dietary plans and education for each patient.
The goal of nutrition education is to provide patients with an
understanding of the role of macronutrients (carbohydrates, proteins and
fats) and micronutrients (vitamins and minerals) in the body and how they
can impact cardiovascular health. Patients may also learn about the
benefits of a heart-healthy diet, such as reducing inflammation, improving
blood pressure and cholesterol levels and maintaining a healthy weight.
Patients may receive personalized dietary recommendations based on their
individual health status, preferences and lifestyle. This may involve guidance
on portion control, meal planning and recipe modifications. Patients may also
be encouraged to make gradual, sustainable changes to their diet rather than
attempting drastic changes that may be difficult to maintain.
Nutrition education may also include guidance on how to read food labels,
how to identify heart-healthy foods and how to make healthy choices
when dining out. Patients may also learn about strategies for overcoming
common barriers to healthy eating, such as time constraints and budgetary
constraints.
Healthy eating habits: Promoting healthy eating habits is an important
component of cardiac rehabilitation programs that aims to help patients
adopt a heart-healthy diet. The goal is to encourage patients to make
sustainable changes to their eating habits that can reduce their risk of
developing cardiovascular disease and improve their overall health and
well-being.
Some healthy eating habits that may be promoted in cardiac
rehabilitation programs include:
 Eating a variety of nutrient-dense foods: Patients may be
encouraged to consume a variety of fruits, vegetables, whole grains, lean
proteins and healthy fats to ensure they are getting all the essential
nutrients they need for good health.
 Reducing intake of processed and high-fat foods: Patients may be
advised to limit their intake of processed foods, high-fat meats and foods
high in saturated and trans fats, which can increase the risk of heart disease.

22
 Limiting intake of sodium: Patients may be advised to limit their
intake of sodium, which can increase blood pressure and put a strain on the
heart. This may involve reading food labels carefully and choosing
low-sodium options when possible.
 Limiting intake of added sugars: Patients may be advised to limit their
intake of added sugars, which can contribute to weight gain, inflammation and
other health problems. This may involve reducing consumption of sugary
beverages, desserts and other foods high in added sugars.
Patients may also be encouraged to make gradual, sustainable changes to
their eating habits rather than attempting drastic changes that may be
difficult to maintain. Nutritionists or registered dietitians may work with
patients to develop individualized dietary plans that take into account their
health status, preferences and lifestyle.
Meal planning: Meal planning is a key component of cardiac
rehabilitation programs that involves developing an individualized meal
plan to meet the patient's dietary needs and preferences while promoting
cardiovascular health. The meal plan may include recommendations for
portion sizes, meal timing and food choices.
The goal of meal planning is to help patients adopt a heart-healthy diet that
is tailored to their individual needs and preferences.
Some key components of meal planning in cardiac rehabilitation programs
may include:
 Determining the patient's daily calorie needs: The nutritionist or
registered dietitian may calculate the patient's daily calorie needs based on
their age, gender, weight, height and activity level.
 Setting goals for macronutrient intake: The nutritionist or registered
dietitian may recommend specific targets for the patient's intake of
carbohydrates, proteins and fats based on their health status and dietary needs.
 Providing guidance on portion sizes: The nutritionist or registered
dietitian may provide guidance on appropriate portion sizes for different
types of foods, such as fruits and vegetables, grains and proteins.
 Recommending specific foods and food groups: The nutritionist
or registered dietitian may recommend specific foods and food groups that
are beneficial for cardiovascular health, such as fruits and vegetables,
whole grains, lean proteins and healthy fats.

23
 Suggesting meal timing and frequency: The nutritionist or
registered dietitian may suggest meal timing and frequency that is
appropriate for the patient's health status and lifestyle.
So, meal planning is an important component of cardiac rehabilitation
programs that can help patients adopt a heart-healthy diet that is tailored to
their individual needs and preferences. By working with a nutritionist or
registered dietitian to develop a customized meal plan, patients can improve
their cardiovascular health and reduce their risk of developing heart disease.
Managing weight: Managing weight is an important component of cardiac
rehabilitation programs that involves promoting healthy weight management
strategies to reduce the risk of cardiovascular disease. Some key aspects of
weight management in cardiac rehabilitation programs may include:
 Setting realistic weight loss goals: The healthcare team may work
with the patient to set realistic weight loss goals based on their current
weight and overall health status. The goal may be to lose a certain
percentage of body weight over a specific period of time.
 Increasing physical activity: Physical activity is an important
component of weight management and cardiovascular health. The
healthcare team may work with the patient to develop an exercise plan that
is appropriate for their health status and fitness level. This may include
both aerobic exercise and strength training.
Monitoring food intake: The healthcare team may work with the patient
to monitor their food intake and make changes to their diet as needed to
support weight loss. This may involve keeping a food diary, tracking
calories and making adjustments to portion sizes and food choices.
 Educating the patient on healthy eating habits: The healthcare
team may provide education on healthy eating habits, such as the benefits
of a heart-healthy diet and strategies for reducing intake of high-calorie
and high-fat foods.
 Providing support and encouragement: The healthcare team may
provide ongoing support and encouragement to help the patient achieve
their weight loss goals. This may involve regular check-ins and monitoring
of progress.

24
4. Psychosocial support and counselling
Psychosocial Support and Counselling is an important component of
cardiac rehabilitation that focuses on addressing the psychological and
social aspects of cardiovascular health. The following are some of the
details of this component:
 Stress management techniques: Stress management techniques are an
important component of cardiac rehabilitation programs that aim to reduce the
risk of cardiovascular disease and improve overall well-being. Some common
stress management techniques that may be taught in these programs include:
 Deep breathing: Deep breathing exercises involve taking slow, deep
breaths in through the nose and out through the mouth. This can help to
slow down the heart rate and promote relaxation.
 Progressive muscle relaxation: Progressive muscle relaxation
involves tensing and then relaxing different muscle groups in the body.
This can help to reduce muscle tension and promote relaxation.
 Mindfulness meditation: Mindfulness meditation involves focusing on
the present moment and paying attention to thoughts, feelings and sensations
without judgment. This can help to reduce stress and promote relaxation.
 Yoga: Yoga involves a series of poses and breathing exercises that can
help to reduce stress and promote relaxation. It may also have additional
benefits for cardiovascular health, such as reducing blood pressure and
improving heart function.
 Cognitive-behavioral therapy: Cognitive-behavioral therapy is a
type of talk therapy that focuses on changing negative thoughts and
behaviors that may contribute to stress and anxiety. It may be used in
cardiac rehabilitation programs to help patients develop coping strategies
for managing stress.
The healthcare team may work with the patient to identify which stress
management techniques are most effective for their individual needs and
preferences. By incorporating these techniques into their daily routine,
patients can reduce stress, improve their overall well-being and reduce
their risk of cardiovascular disease.
 Depression and anxiety management: Depression and anxiety
management is an important component of cardiac rehabilitation

25
programs, as these conditions are common among patients with
cardiovascular disease and can have a negative impact on their health and
recovery. Some common strategies for managing depression and anxiety
in these programs may include:
 Screening: Healthcare providers may use screening tools to identify
patients who may be experiencing depression or anxiety. This can help to
ensure that patients receive appropriate support and treatment.
 Counseling: Patients who are experiencing depression or anxiety may
benefit from counseling or psychotherapy. Cognitive-behavioral therapy is a
type of talk therapy that can be particularly effective for treating these
conditions.
 Medication: In some cases, medication may be recommended to
manage symptoms of depression or anxiety. Healthcare providers may
work with patients to determine which medications are most appropriate
for their individual needs and preferences.
Support groups: Support groups can provide a valuable source of
emotional support and can help patients to connect with others who are
going through similar experiences.
Social support and networking: Social support and networking are
important components of cardiac rehabilitation programs, as they can help
to improve patient outcomes and promote overall well-being. Some
common strategies for promoting social support and networking in these
programs may include:
i. Support groups: Support groups can provide a valuable source of
emotional support and can help patients to connect with others who are
going through similar experiences. Patients may be encouraged to join
local support groups or online communities to connect with others who
have experienced cardiovascular disease.
ii. Community events: Patients may be encouraged to participate in
community events, such as walks or other fundraising activities, to raise
awareness about cardiovascular disease and connect with others in their
community.
iii. Peer mentoring: Peer mentoring programs can be a valuable source
of support for patients with cardiovascular disease. Patients may be paired

26
with a peer mentor who has experienced similar health challenges and can
provide guidance and support as they navigate the rehabilitation process.
Coping strategies: Coping strategies are an important component of
cardiac rehabilitation programs, as they can help patients to manage the
emotional and psychological challenges of cardiovascular disease. Some
common coping strategies that may be taught in these programs include:
Positive self-talk: Patients may be encouraged to practice positive
self-talk, which involves replacing negative thoughts and beliefs with
positive ones. This can help to improve self-esteem, reduce stress and
promote a more positive outlook on life.
Goal setting: Setting realistic goals can be an effective way to stay
motivated and focused on the rehabilitation process. Patients may be
encouraged to set short-term and long-term goals for their health and
well-being, such as exercising for a certain amount of time each day or
reducing their intake of unhealthy foods.
 Reframing negative thoughts: Reframing negative thoughts
involves looking at a situation from a different perspective and finding
positive aspects of it. This can help patients to feel more optimistic and
hopeful about their situation.
Behavioral change support: Behavioral change support is an essential
component of cardiac rehabilitation programs, as many patients with
cardiovascular disease need to make significant lifestyle changes to
improve their health and prevent future complications. Behavioral change
support may involve:
 Smoking cessation: Patients who smoke may be provided with
education and counseling on the health risks of smoking and strategies for
quitting. This may include nicotine replacement therapy, medication and
behavioral support.
Medication adherence: Patients may be educated on the importance of taking
their medication as prescribed and provided with strategies for improving
medication adherence, such as setting reminders or using pill organizers.
Adherence to a heart-healthy diet: Patients may receive education
and counseling on how to follow a heart-healthy diet, including
recommendations for reducing sodium, saturated and trans fats and added

27
sugars. They may also be provided with meal planning tools and resources
to help them make healthy food choices.
Adherence to an exercise plan: Patients may receive guidance on
developing an exercise plan that meets their individual needs and
preferences, as well as strategies for staying motivated and overcoming
barriers to exercise.
5. Cardiac risk factor management
Cardiac Risk Factor Management is an important component of cardiac
rehabilitation that focuses on managing and reducing the risk factors
associated with cardiovascular disease. The following are some of the
 Blood pressure management: This component involves monitoring and
managing high blood pressure, a major risk factor for cardiovascular
disease. Patients may receive education and counseling on lifestyle changes
that can help to lower blood pressure, such as reducing salt intake,
increasing physical activity and maintaining a healthy weight. Patients may
also be prescribed medications to help lower blood pressure as needed.
 Cholesterol management: This component involves monitoring and
managing high cholesterol levels, another major risk factor for
cardiovascular disease. Patients may receive education and counseling on
lifestyle changes that can help to lower cholesterol, such as eating a
heart-healthy diet and increasing physical activity. Patients may also be
prescribed medications to help lower cholesterol levels as needed.
 Diabetes management: This component involves monitoring and
managing diabetes, a condition that can increase the risk of cardiovascular
disease. Patients with diabetes may receive education and counseling on
managing their blood sugar levels through lifestyle changes, medication
management and monitoring of blood sugar levels.
 Weight management: This component involves promoting healthy
weight management strategies to reduce the risk of cardiovascular disease.
Patients may receive education and counseling on strategies to achieve
and maintain a healthy weight, such as making dietary changes, increasing
physical activity and monitoring calorie intake.
 Smoking cessation: This component involves promoting smoking
cessation strategies to reduce the risk of cardiovascular disease. Patients

28
may receive education and counseling on strategies to quit smoking, such
as nicotine replacement therapy, medication management and support
groups. Smoking cessation is essential for reducing the risk of
cardiovascular disease and improving overall health.
6. Medication management
Medication Management is an important component of cardiac
rehabilitation that focuses on the proper use and management of
medications prescribed to treat and manage cardiovascular disease. The
following are some of the details of this component:
Overview of cardiac medications: The use of medication is an essential
part of the treatment plan for many individuals with cardiovascular disease.
Cardiac medications are prescribed to help manage symptoms, reduce the
risk of future heart-related problems and improve overall heart function.
During cardiac rehabilitation, patients will receive education on the
medications they have been prescribed. This may include information on
the purpose of the medication, how it works and how to take it properly.
Patients will also learn about any potential side effects and when to contact
their healthcare provider if they experience any issues.
Some common types of cardiac medications that patients may be
prescribed include:
Antiplatelet agents: These medications are used to prevent blood clots
from forming and are often prescribed after a heart attack or stroke.
Anticoagulants: Similar to antiplatelet agents, anticoagulants are used
to prevent blood clots, but they work in a different way. These medications
are often prescribed for individuals with certain heart conditions, such as
atrial fibrillation or those who have had a blood clot.
Beta blockers: Beta blockers are used to reduce the workload on the
heart and can help manage symptoms such as chest pain and high blood
pressure. Examples of beta blockers include metoprolol and propranolol.
ACE inhibitors and ARBs: These medications are used to lower blood
pressure and can help improve heart function. Examples of ACE inhibitors
include lisinopril and enalapril.
Statins: Statins are used to lower cholesterol levels and reduce the risk of
future heart-related problems.

29
Diuretics: Diuretics are used to remove excess fluid from the body and
can be helpful for individuals with heart failure or high blood pressure.
Adherence counseling: Adherence counseling is an essential component
of cardiac rehabilitation that aims to improve patients' adherence to
prescribed medication. Adherence refers to the extent to which patients
take their medication as prescribed by their healthcare provider. Poor
medication adherence can lead to suboptimal treatment outcomes,
increased healthcare costs and decreased quality of life for patients.
During adherence counseling, healthcare professionals provide education
and counseling to patients about the importance of taking their medication
as prescribed to effectively manage their cardiovascular condition. They
may discuss the benefits of medication adherence, such as reducing the
risk of future heart-related problems and improving overall health and
well-being.
Patients may also receive information on the potential side effects of their
medications and how to manage them. This may include instructions on
when to contact their healthcare provider if they experience any adverse
reactions.
In addition, healthcare professionals may work with patients to identify
strategies to improve medication adherence. This may include using pill
boxes, setting reminders, incorporating medication into daily routines or
involving family members or caregivers in the medication management
process.
Adherence counseling may also involve addressing barriers to medication
adherence, such as cost, transportation or lack of social support.
Healthcare professionals may provide patients with information on
resources or programs that can help them overcome these barriers.
Potential side effects: Potential side effects of cardiovascular
medications can vary widely depending on the specific medication and the
patient's individual health status. Some common side effects of
cardiovascular medications include nausea, vomiting, headache,
dizziness, fatigue, low blood pressure and electrolyte imbalances. It is
important for patients to be aware of potential side effects so they can
recognize them and report them to their healthcare provider.

30
Patients should also be aware of potential drug interactions with their
cardiovascular medications and should always inform their healthcare
provider of all medications, supplements and over-the-counter drugs they
are taking. Certain medications or supplements can interact with
cardiovascular medications and increase the risk of side effects or adverse
reactions.
To manage potential side effects, patients may be advised to take their
medications with food or at a specific time of day and to avoid certain
foods or activities that may exacerbate side effects. In some cases,
alternative medications or adjusted dosages may be necessary to manage
side effects while still effectively managing the patient's cardiovascular
condition.
Monitoring effectiveness: Monitoring the effectiveness of medications is
an important component of cardiac rehabilitation. Patients are advised to
keep track of their symptoms and medication use and to report any
changes or concerns to their healthcare provider. This information can
help healthcare providers evaluate the effectiveness of medications and
make adjustments as needed.
During cardiac rehabilitation, patients may be asked to keep a symptom
diary to track any changes or improvements in their symptoms over time.
They may also be asked to track their medication use and note any changes
in dosage or frequency.
Regular follow-up visits with healthcare providers may also be scheduled to
monitor the effectiveness of medications. During these visits, healthcare
providers may perform physical exams, conduct diagnostic tests and review
patients' symptom diaries and medication logs. Based on this information,
healthcare providers may adjust medication dosages or switch to different
medications to better manage patients' cardiovascular conditions.
7. Tobacco cessation counseling
Tobacco Cessation Counseling is an important component of cardiac
rehabilitation that focuses on helping patients quit tobacco use, which is a
major risk factor for cardiovascular disease. The following are some of the
 Overview of tobacco use and its effects: This component involves
educating patients about the health risks associated with tobacco use,

31
including its negative effects on cardiovascular health. Patients may
receive information on the health risks of smoking, secondhand smoke
exposure and the benefits of quitting tobacco use.
 Counseling and support for quitting: This component involves
providing counseling and support for patients who want to quit smoking or
using other tobacco products. Patients may receive individual or group
counseling sessions, motivational interviewing or behavioral therapies to
help them quit smoking. They may also receive support from peers, family
and healthcare providers to help them quit tobacco use.
 Smoking cessation medications: This component involves providing
information and support for patients who want to use medications to quit
smoking. Patients may receive information about nicotine replacement
therapy, prescription medications and other methods to manage nicotine
withdrawal symptoms and cravings.
 Resources for support: This component involves providing patients
with resources to help them quit tobacco use and maintain their
tobacco-free status. Patients may be referred to quitlines, smoking
cessation support groups or other community resources that can provide
ongoing support and guidance.
Dr. Gobinda Kanti Paul Prof.A.K.M.Ahsan Habib
Dr.Ajoy Kumar Dutta
Dr. Udoy Shankar Roy Dr.Md.MukhlesurRahman Dr. Md. Zillur Rahman
Dr. Syed Dawood Mohammad Taimur
Dr.MirzaMd.NazrulIslam
Dr. Abdul Bari Dr.TariqAhmedChowdhury

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Implementation of the cardiac rehabilitation programme
The implementation of a cardiac rehabilitation program typically
involves a multidisciplinary team of healthcare professionals,
including cardiologists, rehabilitation physicians, nurses, exercise
specialists, nutritionists and mental health professionals. The
following are the general steps involved in implementing a cardiac
rehabilitation program:
 Needs assessment: The first step is to assess the needs of the
target population, including the prevalence and severity of
cardiovascular disease, as well as the resources available for
program implementation.
 Program design: Based on the needs assessment, a program
design is developed. The program should be tailored to the needs
and goals of the target population and should include protocols and
guidelines for patient screening, assessment and treatment.
 Staffing and training: Once the program design is in place,
staffing needs are assessed and appropriate personnel are recruited
and trained to provide the necessary services.
 Facilities and equipment: The physical space and equipment
needed for cardiac rehabilitation are also assessed and acquired.
This may include exercise equipment, diagnostic tools, educational
materials and other resources necessary for patient care.
 Patient recruitment and referral: Patients are recruited and
referred to the program through various channels, including
hospitals, physician referrals, community outreach and patient
education. Screening criteria are established to identify patients who
are eligible for the program and patient consent and enrollment
procedures are developed.
 Program delivery: Once patients are enrolled in the program,
they receive a comprehensive evaluation and an individualized plan
of care that includes exercise training, education and counseling and
psychosocial support. Patient progress is monitored throughout the
program and modifications are made to the plan of care as needed.
 Program evaluation: The final step in implementing a cardiac
rehabilitation program is program evaluation, which involves
assessing the effectiveness of the program in achieving its goals and
objectives.

33
Evidence supporting the effectiveness of
CR in improving outcomes
There is strong evidence supporting the effectiveness of cardiac
rehabilitation (CR) in improving outcomes and reducing mortality
rates in patients with coronary artery disease (CAD). Numerous
randomized controlled trials and meta-analyses have shown that
participation in CR programs is associated with a significant
reduction in all-cause mortality, cardiovascular mortality and
hospital admissions in CAD patients.
Another meta-analysis of 22 randomized controlled trials involving
over 4,000 CAD patients found that participation in CR programs
was associated with a significant reduction in major adverse
Barriers to accessing and participating in CR
programs and strategies to overcome them
There are several barriers that prevent patients from accessing and
participating in CR programs. These barriers can be categorized into
patient-related, healthcare system-related and program-related
factors.
Patient-related factors include lack of motivation, transportation
issues, lack of social support and comorbidities. Healthcare
system-related factors include lack of physician referral, insurance
coverage and distance to CR facilities. Program-related factors
include cost, lack of program availability and concerns about the
safety and efficacy of exercise.
To overcome these barriers, various strategies have been proposed.
For patient-related factors, motivational interviewing and social
support interventions have been shown to be effective in improving
adherence to CR programs . For healthcare system-related factors,
initiatives such as automatic referral systems and insurance
coverage for CR programs can increase enrollment rates. For
program-related factors, telehealth and home-based CR programs
can overcome issues related to distance and accessibility .

34
Recommendations for healthcare providers
and policymakers to promote the uptake
and adherence to CR programs
1. Physician referral: Healthcare providers should prioritize
referring CAD patients to CR programs to improve participation
rates and outcomes .
2. Patient education: Patients should receive education on the
benefits of CR and the importance of adhering to the program .
3. Multidisciplinary team: CR programs should include a
multidisciplinary team to provide comprehensive care and
individualized treatment plans .
cardiovascular events, including non-fatal myocardial infarction,
non-fatal stroke and all-cause mortality (risk ratio 0.73, 95% CI
0.61-0.88) .
A large observational study of over 4,800 CAD patients found that
participation in CR programs was associated with a significant
reduction in all-cause mortality (hazard ratio [HR] 0.68, 95% CI
0.53-0.87) and cardiovascular mortality (HR 0.60, 95% CI
0.43-0.83) over a median follow-up of 8.1 years .
Despite the proven benefits of CR programs, their availability and
accessibility vary widely around the world. In high-income
countries, CR programs are more widely available and utilized,
while in low and middle income countries, access is limited. This is
a significant concern given the rising burden of CAD in these
countries.
A global survey of CR programs found that the majority of
programs are located in high income countries, with low and middle
income countries having fewer programs and lower utilization rates.
Lack of funding, infrastructure and trained personnel were
identified as major barriers to the implementation and sustainability
of CR programs in these countries.

35
Dr. Tanjima Parvin Dr.MohammadSolaimanTanveer
Dr.AKMMohiuddinBhuiyan(Masum)
Dr. Md. Ejaz Hossain Dr. Dipal KrishnaAdhikary Dr. Md. SK. Mamun
Dr.Md.FaroqueRahmanMajumder
Dr.Md.AshrafUddinChow.
Prof.Md.KamrulHasan Dr. Liakat Hossain
Dr.KhondkerMahbubSohail Dr.KhondokerAsaduzzaman Dr. Md. SaidulAlam Dr.Abdul Momen Dr. Refaz Uddin
4. Technology-based interventions: Healthcare providers should
consider using technology-based interventions to enhance
accessibility and effectiveness, especially in underserved
populations .
5. Addressing barriers: Healthcare providers and policymakers
should address barriers to accessing and participating in CR
programs, such as lack of insurance coverage and transportation .
6. International collaboration: International collaboration is
necessary to increase the availability of CR programs in low- and
middle-income countries .
7. Funding and policy support: Policymakers should allocate
funding and provide policy support for CR programs to ensure their
sustainability and effectiveness .

36
Future directions of cardiac rehabilitation
Cardiac rehabilitation is a dynamic field that is constantly evolving
as new research and technology emerges.
Personalized medicine: Personalized medicine in the field of
cardiac rehabilitation involves tailoring treatment plans to meet the
unique needs of each patient based on their medical history, lifestyle
and preferences. This approach considers a patient's genetics,
environment and behavior to create a comprehensive plan that aims
to optimize their health outcomes.
One aspect of personalized medicine in cardiac rehabilitation is the
development of customized exercise programs. These programs are
designed based on a patient's fitness level, cardiovascular health and
specific goals. Exercise programs may include a variety of
activities, such as aerobic and resistance training and may be
adjusted over time based on the patient's progress.
Another important aspect of personalized medicine in cardiac
rehabilitation is nutrition planning. This involves developing a diet
plan that meets the patient's unique nutritional needs and
preferences. For example, patients with high blood pressure may be
advised to reduce their sodium intake, while those with high
cholesterol may be advised to reduce their intake of saturated fats.
Medication regimens are also tailored to individual patient needs.
This may involve adjusting dosages or selecting medications that
are most effective for a patient's specific condition. Behavioral
interventions, such as stress management techniques, may also be
incorporated into a patient's treatment plan.
Technology integration: Technology integration in cardiac
rehabilitation programs is becoming more common as wearable
devices, smartphone apps and telemedicine platforms continue to
advance. These technologies can provide a range of benefits, including
real-time monitoring, patient engagement and improved adherence.
Wearable devices, such as fitness trackers and smartwatches, can
be used to track a patient's physical activity, heart rate and other

37
important health indicators. This data can be used to personalize
exercise programs and monitor patient progress over time. Patients
can also receive real-time feedback and encouragement through
these devices, which can help to increase motivation and adherence.
Smartphone apps can also be used to support cardiac rehabilitation
programs. These apps can provide patients with educational
materials, track their progress and provide reminders for medication
and exercise. Some apps even use gamification to make
rehabilitation more
engaging and enjoyable
for patients.
Telemedicine platforms
can be used to provide
remote consultations and
monitoring for patients
who are unable to attend
in-person sessions. This
can be particularly
beneficial for patients
who live in remote areas
or who have mobility
issues. Telemedicine platforms can also allow for real-time
communication between patients and healthcare providers, which
can help to improve patient engagement and adherence.
Home-based programs: Home-based cardiac rehabilitation
programs are becoming increasingly popular as they offer many
advantages over traditional center-based programs. Home-based
programs are convenient and accessible, which can increase patient
engagement and adherence to the rehabilitation program.
Additionally, they can be more cost-effective than center-based
programs, as they eliminate the need for travel and facility fees.
Telemedicine and mobile technology have made it easier to deliver
cardiac rehabilitation programs in the comfort of the patient's home.
Remote monitoring can be used to track patients' progress and
provide feedback to healthcare providers, who can adjust the
rehabilitation program accordingly. Video conferencing and

38
telephone calls can be used to deliver educational sessions and
provide support to patients.
Home-based programs may include exercise training, lifestyle
modification and medication management. Patients can perform
exercises at home using equipment provided by the rehabilitation
program or using their own equipment. Home-based programs may
also include dietary counseling and smoking cessation support.
One potential disadvantage of home-based programs is the lack of direct
supervision from healthcare providers, which can increase the risk of
adverse events. However, remote monitoring can help to mitigate this
risk by providing real-time feedback and support to patients.
So, home-based cardiac rehabilitation programs offer a convenient
and cost-effective alternative to traditional center-based programs.
The integration of telemedicine and mobile technology has made it
easier to deliver high-quality rehabilitation programs in the comfort
of the patient's home, which can improve patient engagement and
adherence to the program.
Expanded target populations: Traditionally, cardiac rehabilitation
programs have focused on patients who have suffered a heart attack
or undergone cardiac surgery. However, there is a growing interest
in expanding the target population to include patients with other
cardiovascular conditions, such as heart failure, atrial fibrillation
and peripheral artery disease.
Patients with heart failure can benefit from cardiac rehabilitation
programs that focus on exercise training and lifestyle modification,
such as dietary counseling and weight management. These
programs can help to improve exercise capacity, reduce symptoms
and improve quality of life.
Patients with atrial fibrillation may also benefit from cardiac
rehabilitation programs that focus on exercise training and lifestyle
modification. These programs can help to reduce the risk of
recurrent episodes and improve overall cardiovascular health.
Patients with peripheral artery disease can benefit from
exercise-based cardiac rehabilitation programs that focus on walking
and resistance training. These programs can help to improve walking

39
distance, reduce symptoms and improve quality of life.
Expanding the target population for cardiac rehabilitation programs
can help to improve access to care for patients with a range of
cardiovascular conditions. However, it is important to ensure that
rehabilitation programs are tailored to the specific needs of each
patient and that healthcare providers are trained to deliver
high-quality care to these populations.
Multidisciplinary approach: Cardiac rehabilitation programs are
increasingly adopting a multidisciplinary approach that involves
collaboration between healthcare providers from different
specialties. This approach can lead to more comprehensive and
effective care for patients with cardiovascular disease.
The multidisciplinary approach typically involves healthcare
providers from cardiology, nutrition, psychology, physical therapy
and other specialties. Each provider brings a unique set of skills and
expertise to the rehabilitation program, which can help to address
the multiple factors that contribute to cardiovascular disease.
Cardiologists can provide medical management and guidance for
patients with cardiovascular disease, as well as oversee exercise and
lifestyle modification programs. Nutritionists can provide dietary
counseling and education to help patients adopt healthy eating
habits. Psychologists can provide counseling and support to help
patients cope with the emotional and psychological stress of living
with cardiovascular disease. Physical therapists can provide
guidance on exercise and rehabilitation programs to help patients
regain their strength and mobility.
The multidisciplinary approach can help to address the complex
needs of patients with cardiovascular disease and improve their
overall health outcomes. Collaboration between healthcare
providers can lead to more comprehensive care, as providers work
together to develop individualized treatment plans for each patient.
In addition, the multidisciplinary approach can help to improve patient
engagement and adherence to the rehabilitation program. Patients may
feel more supported and motivated when they are working with a team
of healthcare providers who are invested in their care.

40
Conclusion
Cardiac rehabilitation is a comprehensive program designed to help
individuals with cardiovascular disease to manage and improve
their condition. The program consists of several components that
work together to help patients achieve their goals, improve their
quality of life and reduce the risk of future cardiovascular events.
The first component of cardiac rehabilitation is medical evaluation
and assessment. This involves a thorough evaluation of the patient's
medical history, physical examination and diagnostic tests to
determine the severity of their cardiovascular disease and identify
any other health conditions that may be contributing to their
condition. This information is used to create an individualized
treatment plan that is tailored to the patient's specific needs.
Physical activity and exercise training is another key component of
cardiac rehabilitation. Exercise has been shown to be an effective
way to improve cardiovascular health and reduce the risk of future
cardiovascular events. Patients in cardiac rehabilitation programs
participate in a structured exercise program that is tailored to their
individual needs and abilities. Exercise sessions may include
aerobic exercise, strength training and flexibility exercises. Patients
are closely monitored during exercise to ensure safety and
effectiveness.
Nutrition counselling and education is also an important component
of cardiac rehabilitation. Patients receive education on healthy
eating habits, including the importance of a balanced diet and
reducing salt and fat intake. They also receive guidance on meal
planning and portion control to help them maintain a healthy diet.
Psychosocial support and counselling is another key component of
cardiac rehabilitation. Cardiovascular disease can have a significant
impact on a patient's emotional well-being and psychosocial support
can help patients cope with the emotional and psychological aspects
of their condition. Patients may receive counseling on stress
management, coping skills and relaxation techniques.

41
Cardiac risk factor management is an essential component of
cardiac rehabilitation. Patients receive education and counseling on
managing their risk factors, including high blood pressure, high
cholesterol, diabetes and obesity. They may also receive guidance
on tobacco cessation to help reduce their risk of future
cardiovascular events.
Medication management is another important component of cardiac
rehabilitation. Patients receive education on the medications
prescribed for their cardiovascular disease, including the purpose of
the medication, how it works and potential side effects. They may
also receive counseling on strategies to improve medication
adherence and manage any side effects.
Personalized medicine involves tailoring treatment plans to an
individual's unique genetic, environmental and lifestyle factors.
Technology integration involves incorporating digital tools and
resources into cardiac rehabilitation programs to enhance patient
engagement and outcomes. Home-based programs provide patients
with the flexibility and convenience of participating in cardiac
rehabilitation from the comfort of their own homes. Expanded target
populations involve expanding cardiac rehabilitation to include
patients with other conditions, such as heart failure and peripheral
arterial disease. A multidisciplinary approach involves collaborating
with other healthcare professionals, such as nutritionists, social
workers and mental health professionals, to provide comprehensive
care for patients with cardiovascular disease.
So, cardiac rehabilitation is a comprehensive program that helps
individuals with cardiovascular disease to manage their condition
and improve their quality of life. It includes several components that
work together to help patients achieve their goals and reduce the risk
of future cardiovascular events. Healthcare providers should
encourage and refer eligible patients to cardiac rehabilitation
programs as part of their treatment plan to improve outcomes and
quality of life.

42
Bibliography
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https://www.heart.org/en/health-topics/cardiac-rehabilitation
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Martin, N., ... & Taylor, R. S. (2016). Exercise-Based Cardiac Rehabilitation
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10.1016/j.jacc.2015.10.044
3. Lawler, P. R., Filion, K. B., Eisenberg, M. J. (2016). Efficacy of
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tests-procedures/cardiac-rehabilitation/about/pac-20385192
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7. Balady GJ, Ades PA, Comoss P, Limacher M, Pina IL, Southard D, Williams
MA, Bazzarre T. Core components of cardiac rehabilitation/secondary
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Smoking Cessation Motivation. Journal of Smoking Cessation. 2015
Dec;10(3):115-126. doi: 10.1017/jsc.2015.1.
9. Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of Cardiac
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14;123(23):2344-52. doi: 10.1161/CIRCULATIONAHA.110.983536.
PMID: 21632497.
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(cÖvwß¯’vb: †gwW‡bvfv, gvwjevM / ccyjvi, kvwšÍ bMi)
†gvevBj: 01714908651, 01777751251, 01911660914

About the Author
Professor Dr. Md. Toufiqur Rahman was born
in Chuadanga, Bangladesh. He completed his
secondary and higher secondary education
from Ideal School, Motijheel and Notre Dame
College, Dhaka respectively. Dr. Rahman
then went on to pursue his MBBS degree from
Dhaka Medical College in 1997. He excelled
in his studies and was recognized as one of the
top performers in his class.
Following the completion of his MBBS,
Dr. Rahman underwent training and
academic attachments at several institutions.
He obtained FCPS degree in Internal Medicine in 2003. He also
completed his MD degree in Cardiology at the NICVD, Dhaka,
where he went on to serve as an Assistant Registrar, Assistant
Professor, Associate Professor and eventually, Professor of
Cardiology. He worked in this capacity until March 2018 when he
joined Colonel Malek Medical College in Manikganj as the
Professor and Head of Cardiology. He has since been instrumental
in establishing the department of cardiology at the college and has
played a key role in training young doctors in the field of cardiology.
Dr. Rahman has a long list of qualifications and fellowships,
including FACC, FESC, FAPSC, FAPSIC, FAHA, FRCPE,
FRCPG, FSCAI, FCCP, FACP and FASE. He has also served as the
Editorial Associate of Cardiovascular Journal.
Throughout his career, Dr. Rahman has been involved in various
teaching activities in different medical colleges and post graduate
institutions. He has published numerous research papers in both
national and international journals and has presented at many
conferences and workshops. He is considered an authority in the
field of cardiology and is often invited to deliver lectures and
presentations at medical conferences and symposiums.
Apart from his professional achievements, Dr. Rahman is also
known for his philanthropic work. He is actively involved in various
social initiatives and has played a key role in organizing medical
camps in rural areas.In recognition of his contributions to the field
of medicine, Dr. Rahman has received several awards and
accolades. He continues to inspire and mentor young doctors and is
regarded as a role model by many in the medical fraternity.

Books are available at:
Medinova Medical Services Ltd. Malibag Branch
Popular Diagnostic Centre, Unit-2, Shantinagar, Dhaka
Rokomari.com
Mobile: 01714-908651, 01777-751251, 01911-660914
Available books of same author
From Stress to Success:
A Guide to Hypertension
Management
Breaking the Silence:
Understanding and Coping with
Peripartum Cardiomyopathy
Visualizing the Heart: A
Comprehensive Guide to Diagnostic
Tests and Imaging Modalities in
Cardiovascular Medicine
Heart beat Hero:
Manual of basic CPR Techniques for first
responders
Professor Dr. Md. Toufiqur Rahman
Professor and Head, Department of Cardiology
Vice President, Bangladesh Society of Cardiovascular Intervention (BSCI)

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