Cardiac Rehabilitation has been defined as: Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community

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

2. Objectives
Introduction to Cardiac Rehabilitation
Definition
Goals of Cardiac Rehabilitation
Benefits of the Program
Indications/Contraindications
Assessment -Pre-enrollment workup
Program Structure- Phase I- Phase IV
Implementation of the Program
Assessment of Outcome

3. DEFINITION
Cardiac Rehabilitation has been
defined as:
Coordinated, multifaceted
interventions designed to optimize a
cardiac patient’s physical,
psychological, and social
functioning so that they may, by their
own efforts, resume and maintain as
normal a place as possible in the
community

4. GOALS OF CARDIAC
REHAB
Curtail the pathophysiologic and
psychosocial effects of heart disease
Limit the risk for reinfarction or sudden
death
Relieve cardiac symptoms
Retard or reverse atherosclerosis by
instituting programs for exercise training,
education, counseling, and risk factor
alteration
Reintegrate heart disease patients into
successful functional status in their
families and in society

5. BENEFITS OF REHAB PROGRAM
Offset deleterious pyschologic and
physiologic effects of bed rest during
hospitalization
Enable patients to return to activities of
daily living within the limits imposed by
their disease
Reduces cardiovascular and total
mortality
Improves myocardial perfusion

6. Acute myocardial infarction
Coronary artery bypass
grafting
Angioplasty with or without
stenting
Valve replacement or repair
Heart transplantation
Surgery involving the great
vessels
Congestive heart failure
Chronic stable angina pectoris
INDICATIONS

7. Acute myocardial infarction
Coronary artery bypass
grafting
Angioplasty with or without
stenting
Valve replacement or repair
Heart transplantation
Surgery involving the great
vessels
Congestive heart failure
Chronic stable angina pectoris
INDICATIONS

8. CONTRAINDICATIONS
Unstable Angina
Uncontrolled Arrhythmias or A-V Block
Resting Systolic Blood Pressure >200
mm hg Resting Diastolic Blood
Pressure >100 mm hg
Recent embolism
Moderate to severe Aortic Stenosis
Acute Systemic illness or fever
Orthopedic problems that would
prohibit exercise
Poorly controlled hypertension
Patients unwilling to exercise 8

9. CORE COMPONENTS
Patient Assessment
Nutritional Counseling
Weight Management
Blood Pressure Management
Lipid Management
Diabetes Management
Tobacco Cessation
Psychosocial Management
Exercise Training
Physical Activity Counseling 9

10. REDUCTION IN RISK
FACTORS
Blood lipids
 Significant reductions of total
cholesterol, LDL-cholesterol, and
triglycerides,
 an increase in HDL-cholesterol
with training
10

11. Hypertension control
 Regular exercise helps keep
arteries elastic (flexible)
 This ensures good blood flow and
normal blood pressure
 Consistent long term exercise can
reslut in atleast 10 to 20mmhg
decrease in both resting and
exercise blood pressure of
hypertension
11

12. Glucose intolerance
 Lower serum insulin level after
training because of increase in insulin
sensitivity at the cellular level
 Decreased serum triglycerides and
body fat levels
12

13. CARDIAC REHABILITATION
PROGRAM

14. PHASE I

15. Duration: 5 to 7 days.
Components:
– Medical evaluation
– Reassurance and education
– Correction of cardiac misconception
– Risk factor assessment
– Early individualized Mobilization
– Discharge planning

16. Goals
Assessment of hemodynamic responses to
self-care and progressive ambulation
activities
Determination of the effectiveness of the
patient’s medications in controlling
abnormal responses to activity
Establishment of clinical data that
contribute to the patient’s prognosis and
thus to optimal medical management
Early behavior modification and risk factor
reduction along with family education

17. Day Protocol
1 Coronary care unit
2 (Stabilization)
3
4 Self-care evaluation
5 Monitored ambulation
6
7 Low-level exercise test
8 Discharge

18. Step 1- PROM, active ankle exercise,
self-feeding, orientation to program
Step 2- same exercise, legs dangling
at the side of bed
Step 3- AAROM, sitting in chair,
bedside commode, more detailed
explanation of the program, light
recreation, Assissted ADL,Walking
Step 4- minimal resistance, increase
sitting time, patient education, light
activities, independet ADL,walking

19. Step 5- moderate resistance, unlimited
sitting, sitting for meals, seated ADL ,
continued patient education
Step 6- increase resistance, walking to
bathroom, Stairs, standing ADL, group
meetings

20. Step 7- increase exercise program,
review energy-conservation and
pacing techniques.
Step 8- increase exercise with light
weight and increase walking distance,
increase craft activities, discuss home
exercise program

21. Phase II

22. Happy to be back HOME……
• Is the immediate post-discharge
phase.
• Duration : 8th day to 6 weeks
• Components:
– Addresses health education
– Exercise
– Stress management

23. Goals
• Increase exercise capacity and
endurance in a safe and progressive
manner
• Teach the patient to apply
techniques of self-monitoring to
home activities
• Relieve anxiety and depression
• Increase patient’s knowledge

24. Exercise program
• Frequency: 3-5 times/week
• Intensity: RHR+20 bpm ; RPE<11;
METs=4
• Time: 5-30 minutes; interspersed with
rest periods and progress to about 30
minutes
• Type: sitting/standing functional
activities; ROM exercises; walking

25. Phase III

26. The patient has stabilized and requires
ECG monitoring only if signs and
symptoms necessitate.
Duration : 6 weeks to 12 weeks
Begins with symptom limited ETT
Result of this test are used to determine
a target HR for exercise training

27. Goals
• Improve and maintain physical
fitness
• Provide professional supervision for
exercise
• Continue with educational and
behavioral program

28. Types of Training
• Steady State Training:
– Is a sustained activity, where
workload and HR are
maintained at a constant sub-
maximal intensity.
– Jogging, walking, stepping and
cycling.

29. • Interval Training:
– The exercise is followed by a
rest interval.
– Is perceived to be less
demanding than continuous
– High-intensity work can be
achieved as there is
appropriate spacing of work-
relief intervals.

30. • Circuit Training:
– Employs a series of exercise
activities. At the end of the last
activity, the individual starts from
the beginning and again moves
through the series.
– Improves strength and endurance
by stressing both the aerobic and
anaerobic systems.

31. Warm-up period
– To increase in muscle
temperature
– Increase need for oxygen
– Dilation of previously constricted
capillaries with increase in
circulation.
– Decreases susceptibility of the
musculoskeletal system to injury
by increasing flexibility.

32. Exercise Program
• Frequency: 3-4 times/week
• Intensity: 60-70% maximal HR; 12-
13 RPE; 40-60% of VO2 max
• Time: 20-60 minutes; inclusive of
warm up and cool down
• Type: aerobic/endurance training

33. Cool-down period:
– Prevent pooling of the blood in
the extremities by continuing to
use muscles to maintain
venous return.
– Enhance recovery period with
the oxidation of metabolic
waste and replacement of the
energy stores

34. Phase IV

35. Goals
• Continued improvement and
maintenance of fitness.
• Unsupervised exercise program
• Self exercise
• Long term behavioral
modifications

36. Exercise Program
• Frequency: one session/day;
3-4 days/week
• Intensity: 60-80% of VO2 ; 70-85% of
HRR; RPE 12-15
• Time: desired 30-60 minutes continuous
workout
• Type: dancing, hill walking, resistance
exercise.

37. Summary
What is Cardiac Rehabilitation
Goals of Cardiac Rehabilitation
Benefits of the Program
Indications & Contraindications
Assessment -Pre-enrollment workup
Program Structure- Phase I- Phase IV
Implementation of the Program
Assessment of Outcome

38. QUESTION
1. Write the indications, contra indication
and core components of cardiac rehab?
5mrks
2. Write benefits, goals and risk factors of
cardiac rehab? 3mrks
3. Explain phase 1 and phase 2 of cardiac
rehab program? 7mrks