Cardiac rehabilitation programs aim to limit psychological and physiological stresses from cardiovascular disease, reduce mortality risks, and improve cardiovascular function to help patients achieve their highest quality of life. A comprehensive program includes assessment, counseling for nutrition/weight management, blood pressure/lipid/diabetes management, tobacco cessation, exercise training, and psychosocial support. Exercise training in cardiac rehabilitation increases aerobic capacity and reverses atherosclerosis progression. Home-based high-intensity interval training can be as effective as hospital-based programs in improving peak oxygen uptake.

1. CENTER FOR PHYSIOTHERAPY AND
REHABILITATION SCIENCE
JAMIA MILLIA ISLAMIA
SUBMITTED TO: DR. JAMAL ALI MOIZ
SUBMITTED BY: FARZANA KHATOON
MPT 3RD SEM

2. ROLE OF CARDIAC REHABILITATION
IN CORONORYARTERY DISEASE

3. • Coronary artery disease (CAD) is the most common
form of heart disease.
• It is the result of atheromatous changes in the vessels
supplying the heart.
• CAD is used to describe a range of clinical disorders
from asymptomatic atherosclerosis and stable angina
to acute coronary syndrome (unstable angina,
NSTEMI, STEMI).
• In the US, it is still one of the leading causes of
mortality.

4. Epidemiology
• Coronary artery disease is a leading cause of death
worldwide.
• The World Health Organization (WHO) reported that
ischemic heart disease was responsible for approximately
nine million deaths in 2016.(Nowbar AN; et al 2019)
• Developed and developing countries show opposite trends
in mortality due to CAD. In developed countries like the
U.S. and the UK, mortality rates due to ischemic heart
diseases are decreasing. Nevertheless, according to AHA,
16.5 million people older than 20 in the U.S. had
coronary artery disease in 2018, and 55% of them were
males.(Benjamin EJ.,et al;2018)

5. • The status of CAD in developing countries is worse
with increasing trends of mortality.
• Increased implementation of primary and secondary
prevention methods of cardiovascular is responsible
for the decline in mortality in developed countries.
• Primary prevention methods are to prevent
cardiovascular events with high risks but no previous
history.
• Secondary prevention methods are therapies that
prevent any further cardiac damage to those with a
history of CAD.

6. Risk factors of coronary artery disease
Non-Modifiable
• Age
• Gender
• Race
• Family history

7. Modifiable
• Type 2 diabetes mellitus
• Hypertension
• Smoking
• Dyslipidemia
• Chronic kidney disease
• Obesity and metabolic syndrome

8. Pathophysiology
• Due to risk factors
• Atherosclerosis primarily affects the intima of the
arterial wall and normally takes years to develop and
is a gradual process.
• The continued development of atherosclerosis
involves an inflammatory response, which begins
with injury to the vascular endothelium.

9. • The injury may be initiated by smoking, HTN and
other factors.
• The blockage of CA when partially or completely it
will cause inadequate blood and oxygen supply to the
heart muscle. It causing the ruptured plaque,is
contributing for thrombus formation.
• The thrombus may then obstruct blood flow, leading
to sudden Cardiac death and AMI.

10. EVALUATION
• History taking is the most valuable technique to
differentiate among different causes of chest
discomfort. History taking and physical exam is the
hallmark for the diagnosis of coronary artery disease.
For example, a history pertinent for typical anginal
symptoms, decreased exercise tolerance, syncope,
pre-syncope, orthopnea,

11. • diagnostic tests
• (e.g., electrocardiogram and cardiac enzymes for
patients who present with chest pain).
• Echocardiogram
• Stress testing,
• Cardiac CT, and angiography

12. ROLE OF CARDIAC REHABILITATION IN CHD
• Cardiovascular disease (CVD) is one of the leading
causes of death worldwide and is the leading cause of
death in the United States.
• Cardiac rehabilitation, or cardiac rehab, is a complex,
interprofessional intervention customized to
individual patients with various cardiovascular
diseases such as ischemic heart disease, heart failure,
and myocardial infarctions, or patients who have
undergone cardiovascular interventions such as
coronary angioplasty or coronary artery bypass
grafting.

13. • Cardiac rehabilitation programs aim to limit the
psychological and physiological stresses of CVD,
reduce the risk of mortality secondary to CVD, and
improve cardiovascular function to help patients
achieve their highest quality of life.
• It improve overall cardiac function and capacity,
reversing the progression of atherosclerotic disease,
and increasing the patient's self-confidence through
gradual conditioning.

14. • Several organizations including the American Heart
Association (AHA), The American Association of
Cardiovascular and Pulmonary Rehabilitation
(AACVPR), and the Agency for Health Care Policy
and Research agree that a comprehensive cardiac
rehabilitation program should contain specific core
components.
• These components should optimize cardiovascular
risk reduction, reduce disability, encourage active and
healthy lifestyle changes, and help maintain those
healthy habits after rehabilitation is complete.

15. Cardiac rehabilitation programs should focus on-
• Patient assessment nutritional counseling
• Weight management
• Blood pressure management
• Lipid management
• Diabetes management
• Tobacco cessation
• Psychosocial management
• Physical activity counseling
• Exercise training

16. INDICATION
• Recent myocardial infarction
• Acute coronary artery syndrome
• Chronic stable angina
• Congestive heart failure
• After coronary artery bypass surgery
• After a percutaneous coronary intervention
• Valvular surgery
• Cardiac transplantation

17. CONTRAINDICATION
• Unstable angina
• Acute decompensated congestive heart failure
• Complex ventricular arrhythmias
• Severe pulmonary hypertension (right ventricular systolic
pressure > 60 mm Hg)
• Intracavitary thrombus
• Recent thrombophlebitis with or without pulmonary
embolism
• Severe obstructive cardiomyopathies
• Severe or symptomatic aortic stenosis
• Uncontrolled inflammatory or infectious pathology
• Any musculoskeletal condition that prevents adequate
participation in exercise

18. • Cardiac rehabilitation under an
interprofessional approach has well-established
benefits.
• The cardiac rehabilitation team is made up of
members including the following-
 Patient
 Patient's family
 Physicians (surgeons, cardiologists, physiatrists, other
specialists)
 Pharmacists
 Nurses
 Physical therapists

19. • Occupational therapists
• Speech and language pathologists
• Behavioral therapists
• Dietitian

20. PHASES OF CARDIAC REHABILITATION
Phase I: Clinical phase
• This phase begins in the inpatient setting soon after a
cardiovascular event or completion of an intervention.
It begins by assessing the patient's physical ability
and motivation to tolerate rehabilitation.
• Therapists and nurses may start by guiding patients
through non-strenuous exercises in the bed or at the
bedside, focusing on a range of motion and limiting
hospital deconditioning.

21. Phase II: Outpatient cardiac rehab
• Once a patient is stable outpatient cardiac
rehabilitation may begin.
• Phase II typically lasts three to six weeks though
some may last up to twelve weeks.
• Initially, patients have an assessment with a focus on
identifying limitations in physical function,
restrictions of participation secondary to
comorbidities, and limitations to activities
• The treatment phase to promote independence and
lifestyle changes to prepare patients to return to their
lives at home.

22. Phase III: late outpatient or community based or home
based
• This phase involves more independence and self-
monitoring. Phase III focus on increasing flexibility,
strengthening, and aerobic conditioning.
• Patients receive encouragement towards maintaining
an active lifestyle and continue exercise.

23. Clinical Significance
• Overall cardiac rehabilitation increases quality of life
and decreases health care costs. (J. Am. Coll.
Cardiol;et al 2016).
• Cardiac rehabilitation has many physiologic benefits
due to its exercise component. Exercise training has
been shown to increase maximal oxygen uptake
(VO2max), improve endothelial function, and
improve myocardial reserve flow.
• Additionally, cardiac rehabilitation can reduce
smoking, body weight, serum lipids, and blood
pressure.(McMahon SR;et al 2017).

24. • Milani et al. found that cardiac rehabilitation
decreased depression in heart disease patients who
suffered a major coronary event
• A Cochrane review noted that cardiac rehabilitation
reduced hospital admissions and showed a long-
term decrease in all-cause mortality in patients heart
failure patients with preserved ejection fraction.

25. JOURNAL/AUT
HOR/YEAR/IM
PACT FACTOR
TITLE METHODOLOG
Y
RESULTS CONCLUSION
•European Journal
of Preventive
Cardiology
•Inger-Lise
Aamot;2013
•IF: 5.64
Home-based versus
hospital-based
high-intensity
interval training in
cardiac
rehabilitation: a
randomized study
90 participants
with CAD (80
men/10 women
•mean age 57 8
years) were
randomly assigned
to one of three
exercise
groups:(GE),(TE),(H
E)
•HIT was
performed twice a
week for 12 weeks
with an exercise
intensity of 85–95%
of peak heart rate.
•The primary
outcome measure
was change in peak
oxygen uptake
(peak VO2).
Change in peak
VO2 was
significantly
higher in the
TE compared
to the HE.
•whereas
differences
between the
other groups
were non-
significant.
High-intensity
interval
training can be
efficiently
performed in
cardiac
rehabilitation
with respect to
exercise
intensity,
exercise
attendance,
and peak VO2.

27. THANK YOU