What does cardiac rehab involve? Cardiac rehabilitation doesn't change your past, but it can help you improve your heart's future. Cardiac rehab is a medically supervised program designed to improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery.
2. Definition
Cardiac rehabilitation is a multidisciplinary
program of education and exercise
established to assist individuals with heart
disease to achieve optimal physical,
psychological and functional status within
the limits of their heart disease.
3. It is established through
Education to patient and family members
By reducing the risk factors
By reducing the psychological problems
due to impairment.
Vocational counseling
4. Cardiac rehabilitation team
Team
Team of
doctors
Family
doctor, heart
specialist and
surgeon Physical
therapist
Nurses
Occupational
therapist
Dietitian
Family
members
Vocational
counselor
Social
worker
psychologist
5. Goals of cardiac rehabilitation
Education to the patient and family members in
the recognition, prevention and treatment of
cardiovascular diseases.
To limit the adverse effects of illness
To prevent harmful secondary effects.
(circulatory and respiratory complications)
Stratification of risk factor for a further cardiac
event through proper assessment.
Modifications of risk factor as far as possible.
To improve cardiovascular fitness after illness
6. To identify psychological response to illness
and additional supportive measures to make a
successful rehabilitation
To accomplish all the goals to inter disciplinary
efforts directed at discovering each patients
optimal diet and activity etc..
To create a positive attitude that will motivate
the patient to make a long term commitment.
7. 5 mark question/ do write in
assessment of cardiac rehab
(CABG,PTCA, MI)
RISK STRATIFICTION
CRITERIA FOR CARDIAC
PATIENTS BY THE
AMERICAN COLLEGE OF
PHYSICIANS
8. Low Risk
Uncomplicated MI or CABG
Functional capacity ≥ 8 METs 3 weeks after
clinical event
No ischemia, left ventricular dysfunction or
complex arrhythmias
Asymptomatic at rest with exercise capacity
adequate for most vocational and recreational
activities
9. Moderate Risk
Functional capacity < 8 METs 3 weeks after
clinical event
Shock or CHF during recent MI (< 6months)
Failure to comply with exercise prescription
Inability to self monitor heart rate
Exercise induced ST segment depression< 2mm
10. High Risk Ef=EDV-ESV/EDV= SV/EDV%
Severely depressed LV dysfunction (EF< 30%) (n value
is 55 to 70%)
Resting complex ventricular arrhythmias
PVC (premature ventricular contraction) appearing or
increasing with exercise
Excertional hypotension (≥ 15 mm Hg decrease in
systolic pressure during exercise)
Recent MI (<6months) complicated by serious
ventricular arrhythmias
Exercise induced ST segment depression > 2mm
Survivor of cardiac arrest.
11. Role of PT
To prevent deconditioning effects of disease
To improve cardio vascular endurance and
training
To improve musculoskeletal problems
Plan and formulate home programs and
instructions based on individual needs and
demands.
12. Assessment of patients regularly and report to
CR team
Therapist should be skillful in exercise
physiology, pathology, exercise training
techniques, arrhythmia recognition, cardio
pulmonary equipment knowledge, equipment
monitoring and advance life support
(defibrillators).
13. Cardiac rehab after….
Coronary artery bypass graft (CABG) surgery
Interventional procedures such as balloon angioplasty,
PTCA, atherectomy, rotoblation or stent placement
Angina
Heart attack (myocardial infarction)
Heart failure
Heamodynamic disorders, such as syncope
Peripheral artery disease
Other heart or vascular disorders
Valve repair or replacement
Aortic aneurysm repair or replacement
Heart transplant
14. Phases of recovery
Phase 1: inpatient rehabilitation (1week)
Phase 2: convalescent phase (2nd week to
8 to 12 weeks)
Phase 3: 4-6 months (supervised)
Phase 4: more than 6 months
(unsupervised)
15. A MET or metabolic equivalent is the
amount of energy used by the body to
perform a physical activity or daily task. At
rest, the average person has an oxygen
consumption of 1 MET (or 3.5 ml/kg-min).
MET values increase as more activity is
performed.
17. After 24 hours of event, CPK stabilized and other
factors.
Essential bed rest level 1 day 1
1 -1.5 METs
Bed rest
Education about disease.
Arm supported for meals and ADL
Foot exercises
Breathing exercises
Coughing / huffing.
18. Sitting level 2 day 2
1.5 to 2 METs
Breathing exercises
Sitting 15 – 30 minutes / 2 to 4 times per day
Reliving of orthostatic hypotension
Limited room ambulation
Few steps (highly supervised with assistance)
Leg exercises
Education regarding exercises being performed.
19. Limited hall ambulation level 3 day 3
Breathing exercises, foot exercises.
METs 2 to 2.5
Ambulation for 5 minutes
Standing leg exercises
Bathroom activities.
20. Progressive hall ambulation level 4
day 4
2.5 to 3 METs
Ambulation 5 to 7 minutes. 3 to 4 times/
day
Trunk exercises.
21. Progressive hall ambulation level 5
day 4
3 to 4 Mets
8- 10 minutes. 3 to 4 times/ day
22. Stair climbing level 6 day 5
Usually ETT is performed before stair
climbing
One step at one time
Trunk exercises
23. Termination criteria for exercises
SBP > 200 mm Hg
DBP > 100 mm Hg
Heart rate is more than 12 if B blockers are used
Heart rate is more than 20 if B blockers are not
used
Orthostatic hypotension (more than 20 mm Hg
drop in systolic BP
C/o angina
Fatigue
Confusion, dyspnea, nausea, cramps
25. Home exercise program:
Before giving the home exercise program.
Train the patient to monitor himself
Written form of activity guidelines
20 to 30 minutes of walking daily which should be
gradually increase
No afternoon sleep
Proper diet, low cholesterol
If Any discomfort during exercise, report to doctor
Visit the consultant at regular intervals.
27. Aerobic training program
Intensity of exercise:
70 to 75% of max HR (220- age= max HR)
Karvonen Formula: Target Heart Rate =
((max HR − resting HR) × %Intensity) +
resting HR example
28. For example, for a 25 yr old who has a resting heart rate
of 65, wanting to know his training heart rate for the
intensity level 60% - 70%.
His Minimum Training Heart Rate:
220 - 25 (Age) = 195
195 - 65 (Rest. HR) = 130
130 x .60 (Min. Intensity) + 65 (Rest. HR) = 143
Beats/Minute
His Maximum Training Heart Rate:
220 - 25 (Age) = 195
195 - 65 (Rest. HR) = 130
130 x .70 (Max. Intensity) + 65 (Rest. HR) = 156
Beats/Minute
His training heart rate zone will be 143-156 beats per
minute
29. Duration:
30 to 40 minutes- exercise phase
5 to 10 minutes warm up (dynamic
stretches)
5 to 10 minutes cool down (static
stretches)
Frequency:
3 to 4 times/ week
30. Bruce protocol treadmill
stress test
The Bruce Test is commonly used treadmill
exercise stress test. It was developed as a
clinical test to evaluate patients with suspected
coronary heart disease, though it can also be
used to estimate cardiovascular fitness
aim: to evaluate cardiac function and fitness.
31. equipment required: treadmill, stopwatch, a 12-
lead electrocardiograph (ECG) machine and
leads, sticking tape, clips
procedure: Exercise is performed on a
treadmill. If required, the leads of the ECG are
placed on the chest wall. The treadmill is started
at 2.74 km/hr (1.7 mph) and at a gradient (or
incline) of 10%. At three minute intervals the
incline of the treadmill increases by 2%, and the
speed increases as shown in the table below.
33. results: The test score is the time taken on the
test, in minutes. This can also be converted to
an estimated VO2max score using the calculator
below and the following formulas, where the
value "T" is the total time completed (expressed
in minutes and fractions of a minute e.g. 9
minutes 15 seconds = 9.25 minutes).
Women: VO2max (ml/kg/min) = 2.94 x T + 3.74
Men: VO2max (ml/kg/min) = 2.94 x T + 7.65
34. Avoid or use less isometrics
Use leg exercises more than arm
exercises
Initially 2 extremities then 4 extremities like
jogging swimming
Recent studies suggest that strength
training is important during cardiac
rehabilitation
35. Indication for aerobic exercises
4 to 6 month after CABG (or) MI
1 to 2 weeks after PTCA
Completion of phase 2
DBP< 105 mm hg
Peak exercise capacity > 5 METs
No CHF
36. Contraindications or termination
criteria for exercises
SBP > 200 mm Hg
DBP > 100 mm Hg
Heart rate is more than 12 if B blockers are used
Heart rate is more than 20 if B blockers are not used
Orthostatic hypotension (more than 20 mm Hg drop in
systolic BP
C/o angina
Fatigue
Confusion, dyspnea, nausea, cramps
Sever aortic stenosis
3 rd degree av block
38. Effects of exercise training and
education
Increase cardio vascular fitness
Increase a-vo2 differences
Increase coronary collaterals
Increase myocardial perfusion
Increase functional status
Increase knowledge and prevention of disease
Decrease chances of secondary complications
Early ability to do activities
39. Precautions after PTCA/ CABG
No strict guidelines for PTCA
Post revascularization ETT results are imp
Low intensity aerobic training
Few repetitions throughout the day
rest periods importance
Avoid lifting, pushing, pulling objects for 4
to 6 weeks
Avoid sternal discomfort.
Avoid sexual relations for 3 to 6 weeks
40. Home exercises program
Rest, leisure activity
30 mins walking gradually increase the
frequency.
Sternal protection is important
Add all UE, trunk and LL activities
Begin aerobic and strength training after 6
week.
41. Guideline for strength training
Avoid holding your breath.
Be sure to warm up and cool down to prevent injury and
soreness.
Complete a smooth, controlled, and full range of motion
with each activity.
Balance your exercise between complementary muscle
groups:
Biceps and triceps
Quadriceps and hamstrings
Chest and upper back
Always include exercises that strengthen your trunk (lower
back and abdomen).
42. Avoid gripping the weight handles tightly to prevent
an excessive blood pressure response to lifting.
Typically, weight training is done after aerobic
exercise and/or on alternate days.
Begin with exercises for major muscle groups: work
large muscles, such as chest and back, before
smaller muscles, such as biceps and triceps.
Delayed onset of muscular soreness may occur, so
progress slowly and allow for recovery time.
Do not do strength training every day, because your
muscle groups need at least one day to recover.
43. 5 mark question
Effects of exercises on heart
patients/ cardio protective
effects of exercises.