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Introduction Power Point
Introduction Power Point
INTRODUCTION
Definition by WHO Sum of activities required to influence
before discharge.
Low-risk patients should be encouraged to sit in a bedside
chair and to begin performing self-care activities
to sit up, stand, and walk in their room. Subsequently, they should start
to walk in the hallway at least twice daily either for certain specific
distances or as tolerated without being unduly pushed or held back.
Standing heart rate and blood pressure should be obtained followed by
5 minutes of warm-up or stretching. Walking, often with assistance, is
resumed, with a target heart rate of less than 20 beats above the resting
heart rate and an RPE of less than 14.
Starting with 5-10 minutes of walking each day, exercise time gradually
can be increased to up to 30 minutes daily.
continue for the patient's lifetime. The exercise sessions usually are scheduled
3 times a week.
Activities consist of the type of exercises the patient enjoys, such as walking,
bicycling, or jogging
ECG monitoring usually is not necessary.
The main goal of phase 3 is to promote habits that lead to a healthy and
satisfying lifestyle.
Phase 3 programs do not usually require medical supervision.
Moderate intensity exercise are incorporated and also exercise with weight .
RISK FACTORS
STRATIFICATION
PATEINTS IDENTIFICATION FOR INCLUSION IN
CARDAIC REHABLITATION.
THREE RISK STRATIFICATION ARE THERE
ACCORDING TO WHICH PATEINT IS IDENTIFIED
AS .
LOW RISK
MODERATE RISK
HIGH RISK
Patient Selection
Lower-risk patients following an acute cardiac event
Patients who have undergone coronary bypass surgery
Patients with chronic, stable angina pectoris
Patients who have undergone heart transplantation
Patients who have had percutaneous coronary angioplasty
Patients who have not had prior events but who are at risk because of a remarkably unfavorable risk
factor profile
Patients with stable heart failure
Patients who have undergone noncoronary cardiac surgery
Patients with previously stable heart disease who have become seriously deconditioned by
intercurrent, comorbid illnesses
The short-term goals of cardiac rehabilitation include the restoration of the physical, psychological,
and social condition, while the long-term goals involve the promotion of heart-healthy behaviors that
enable the individual to return to productive and/or joyful vocational and avocational activities.
The cardiac rehabilitation programs benefit women and men equally.10 Elderly patients also can derive
significant benefit from rehabilitation programs.
conditions:
Severe residual angina
Uncompensated heart failure
Uncontrolled arrhythmias
Severe ischemia, LV dysfunction, or arrhythmia during exercise testing
Poorly controlled hypertension
Hypertensive or any hypotensive systolic blood pressure response to exercise
Unstable concomitant medical problems (eg, poorly controlled or "brittle" diabetes,
diabetes prone to hypoglycemia, ongoing febrile illness, active transplant rejection)
In such patients, every effort should be made to correct these abnormalities through
optimization of medical therapy, revascularization by angioplasty or bypass surgery, or
electrophysiologic testing and subsequent antiarrhythmic drug or device therapy.
Patients should then undergo retesting for exercise prescription.
Exercise testing
Two forms of exercise tests are performed in patients following an acute cardiac event:
submaximal exercise testing and symptom-limited exercise testing. Furthermore, CPX also
may be performed, particularly in patients with cardiomyopathy or CHF, to determine
objectively the patient's exercise capacity.
Submaximal exercise testing
In this strategy, the patients exercise enough to achieve 70% of maximum predicted heart
rate for their age (ie, 70% of 220 minus age in years).
This test is commonly performed prior to discharge and is followed by maximal exercise
testing 6-8 weeks later (when patients aim to achieve 90% of maximum predicted heart
rate).
Symptom-limited exercise testing
The patients exercise soon after a cardiac event.
A representative schedule might begin exercise at intervals, such as 7-21 days following
uncomplicated acute myocardial infarction (MI), 3-10 days following angioplasty, or 14-28
days after bypass surgery.
Physiology
of exercise in cardiac events
Normally there exit balance between nitrous oxide which is
a vasodilator which is produce by activity of nitrous
synthase and reactive oxygen
This balance get disturbed in
patient with CAD
Correction in
nitrous
synthase
activity
Decrease in
deactivation of
nitrous synthase
by reactive
oxygen
Reversal of
endothelial
dysfunction
Reduction in mortality and
morbidity
Increase
endothelial
relaxation
Control
group
Phase 2 of a cardiac rehabilitation program is initiated based on the result of the exercise testing, and the exercise prescription is
Intensity - The intensity prescribed is in relation to one's target heart rate. Aerobic conditioning is emphasized in the first few weeks
of exercise. Strength training is introduced later. The Borg scale of Rate of Perceived Exertion (RPE) is used. Patients usually should
exercise at an RPE of 13-15.
Borg scale of perceived exertion
6
7 - Very, very light
8
9 - Very light
10
11 - Light
12
13 - Somewhat hard
14
15 - Hard
16
17 - Very hard
18
19 - Very, very hard
20 - Exhaustion