CARDIAC REHABILITATION

DEFINITIONS
 According to American College of Physicians-“It is a multiphasic
program designed to assist the patient with CAD in returning to a full and
productive life .A multi disciplinary team typically consists of
Physician ,Nurse, Physiotherapist, Occupational therapist, Nutritionist
,Psychologist ,Social worker & Vocational Counselor to provide rehab
components”.

 According to WHO(1993)-“Cardiac rehabilitation is the sum of activities

required to influence favorably the underlying cause of the disease, as well
as to ensure the patient the best possible physical, mental, and social
condition so that they may, by their own efforts preserve or resume when
lost, as normal a place as possible in the life of the community.”

 According to British Association for Cardiac Rehabilitation(BACR

2002)-“It is a process by which patients with cardiac disease ,in
partnership with a multidisciplinary team of health professionals are
encouraged and supported to achieve and maintain optimal physical and
psychosocial health.”
Goals

 Improvement in cardiopulmonary function

 Prevention and treatment of complications
 Increased understanding of the disease
 Increased patient responsibility for self-care
and compliance with medical treatment
 Improvement in level of activity and quality of
life, return to work.
TEAM MEMBERS
 Cardiologist/Physician and co-coordinator to lead cardiac
rehabilitation
 Clinical Nurse Specialist
 Physiotherapist
 Clinical nutritionist/Dietitian
 Occupational Therapist
 Pharmacist
 Psychologist
 Smoking cessation counsellor/nurse
 Social worker
 Vocational counsellor
 Clerical Administration
PHASES
 The American College of Sports Medicine has
defined the rehabilitation program into four
distinct phases
 Phase 1: Inpatient phase
 Phase 2: Early out patient phase
 Phase 3: Late out patient phase
 Phase 4: Community based maintenance
phase.
 PHASE 1(In Patient)
Phase 1 is designed primarily for those recovering from
 MI
 CABG
 PTCA
 Valve replacement
 Cardiac transplant
 Stable angina and CAD risk factor patients.

Program Include: low level exercises and patient

education.
Duration: 3-6 days or 9-12 days depending upon
each patient.
 Phase 1 Goals
 To preserve adequate ventilation.
 To assist with removal of excess secretions in the
airways.
 To assist the circulation in the legs and there by help to
prevent post-operative venous thrombosis.
 To maintain mobility of the shoulders, shoulder girdle
and spine.
 To assist patient in becoming ambulatory
 To prevent postural defects.
 To restore exercise tolerance
 To teach and encourage relaxation.
 To maintain Adequate Ventilation , Reduce
Dyspnea and the Work of Breathing
1.Positioning
Relaxation position

2. Breathing control
Diaphragmatic breathing
Pursed lip Breathing
Thoracic Expansion exercises
Maintain an Adequate Airway

Airway clearance techniques are used

 Controlled cough
 Huffing
 The AD technique
 Active Cycle Of Breathing
 Postural Drainage
 To improve Lung volume and Capacities & to
increase inspiratoy muscle strength
 Incentive Spirometry : It is designed increase maximum
inflation of lungs and preventing the build up of secretions. It
provides visual feedback on how deep a breath are taking.
 The aim is to take long slow deep breaths in through the incentive
spirometer, raising two of the balls and trying to hold them up for
three seconds

Inspiratory resistive loading

 ACTIVITY LEVELS
LEVEL 1
 Re education of neuro muscular relaxation to
counteract muscle tension.
 Re education of thoracic and diaphragmatic
breathing.
 Review of postural principles, body mechanics
and transfer techniques.
 Exercises (up to 10 repetitions, supine)
Shoulder flexion, abduction, horizontal abduction
Hip/Knee flexion and extension.
Hip Abduction
Ankle Pumps
Up in chair 10-20 minutes.
Performed with a wand.
 LEVEL 2
 Breathing and relaxation techniques
 Exercises up to 10 repetitions seated
 Wand exercises per level 1
 Shoulder circling
 Trunk rotation
 Hip/Knee flexion(seated marching)
 Knee extension
 Ankle pumps
 Gait : standing pregait
activities(dips ,weight shifting)
 Up in chair 30-50 minutes.
 LEVEL 3
 Exercises in Standing 10 rep.
 Head circles
 Arm circles
 Trunk rotation
 Trunk lateral flexion
 Toe raises
 Wand exercises
 Gait: short walks in the room as tolerated.
 LEVEL 4
 Increase no.of rep.
 Stationary cycle:5 min
 LEVEL 5
 Exercises as previous levels add cool down stretches
 LEVEL 6
 LEVEL 7
PHASE 2 Early out patient phase
It is a supervised out patient program of individually prescribed
exercise with continuous or intermittent ECG monitoring .Exercise
program is based on an individualized prescription of intensity,
duration, frequency and mode of exercise. It includes early at home
period following hospitalization for 8-12 weeks after discharge.
Phase 2 Goals
 Increase exercise capacity and endurance in a
safe and progressive manner.
 Educate the patient on proper technique of
exercises.
 Work with the patient and family to establish
healthy life style.
 Prepare the patient to return to work.
 Enhance psychological status.
 To provide the patient with guideline of long
term exercises.
 ASSESSMENTS:
 Haemodynamic changes, RPE, stress testing,
Diet, body fat.
 METs prescribed is 5-9 METs.
 Exercise program consists of:
 -Warm up
 -Aerobic exercises
 -Cool down
 -Relaxation
The methods of aerobic training include:

 Continuous training
 -Circuit training
 -Interval training
 -Circuit-Interval training.
PHASE 3 & 4
PHASE 3 AND 4
 Phase 3 program may be conducted in an organized
and supervised community based setting.
 Phase 4 denotes a long term maintenance program
that can be unsupervised.
 In Phases 3 and 4 the cardiac patients should
continue the same conditioning programs of phases 1
& 2.
 These start after 6-12 weeks after discharge from
hospital .In addition to that the patient should be
stable clinically , know about the signs and
symptoms and should have a maximum functional
capacity of 5 METs and should be able to regulate
exercise regimens by themselves.
OBJECTIVES:
 Maintain function.
 Promote life long commitment to physical fitness and
personal health management.
 To provide professional supervision of exercise.
 To prevent recurrences and complications of coronary
heart disease.
 To introduce new exercise activities.
 To teach skills for self monitoring and self awareness.
 To continue educational and behavioral goals consistent
with previous phases.
 To provide the foundation for safe and effective home
based programs.
THANK YOU