Cardiac Physiotherapy Rehabilitation|Cardiac Rehabilitation Physio Study

Cardiac rehabilitation

Definitions

In individuals with cardiac problem it is a process of restoring the maximal level of activity for improving the functional capacity of the heart .

According to USPHS (United State Public Health Service) is defined as a rehabilitation program that involve: Medical evaluation, prescription of Exercise , education, psychological counseling.

cardiac rehabilitation

Aims of cardiac rehabilitation program

Increase functional activity & Return to safe vocation and recreation activities

Restore pt to active and productive life style & Decrease sign and symptoms such as angina

Implement safe and effective home exercise program

Rehabilitation team

Cardiologist, Pulmonologist, Physiotherapist, Occupational therapist, Dietician, Medical social worker, Psychiatrist

Indication

Most common Myocardial infarction and angina

Second commonest CABG( Coronary Artery Bypass Grafting)

And others Cardiac transplant, Pre-cutaneous angioplasty, valve replacement

Contraindication

Uncontrolled diabetes, angina, post MI infarct and arterial/ventricular arrhythmia

And other like orthostatic hypotension, recent embolism

Phases of cardiac rehabilitation

There are 4 phases of cardiac rehabilitation

A. 1^st Phase [Acute phase]

It is the initial phase 0 – 7 days, the multidisciplinary team act:

1^st day:-Monitoring (ECG report), Observation (position of the patient), Auscultation (Cardiac & pulmonary), Check Vitals (BP,HR,PR,RR,Temp)

2^nd day:- Add exercise like upper limb exercise till 90⁰ , chest expansion exercise like deep breathing exercise& spirometry. Along with step marching can be done.

1^st-2^nd day :-Patient is encourage to sit at the edge of bed or in a chair.

3^rd day:-Same like above all the exercise is repeated.

2^nd-3^rd day :- Short distance ambulation around 6 – 9 steps is taught.

4^th day :-Discontinue the BP line & check for the vitals.

5^th day :- Increase the short distance ambulation around 10 – 13 steps is advised , along with stair climbing is done but before that check for the vitals.

6^th day :-Six minute walk test is done and if the patient vitals and ejection fraction (50 – 60) is normal then the patient is eligible for the training of phase 2.

B.2^nd Phase [convalescent phase]

After the discharge from the hospital 3 – 6 weeks of home exercise program are taught to the patient for maintaining the early mobilization & gradual increase in endurance exercise.

1^st week :- Advise to have 8 – 10 hrs of rest at night and stair climbing once or twice daily.

2^nd week :-Able to walk out of the doors in the gardens.

3^rd week :-The daily walk can be gradually extended so by the end of 6^th week the patient walk 1 – 2 miles.

C.3^rd Phase [Training phase]

Both aerobic and anaerobic exercise is done.

The training that have to be followed is

1. Warm up exercise like arm swinging, trunk sideflexion, Trunk rotation with arm swing,

2. F I T T

 Frequency:- based on 6 mnts walk test

Intensity:- Moderate slowly

Type :- Walking (1RM=3 steps), jogging

Time :-20 – 30 minutes

3. Cool down period.

D.4^th phase [Maintaining phase]

Exercise should be done at least twice a week for 30mnts like walking, bicycling, jogging, swimming, resisted exercise with dumbbells & pulleys.

Exercise prescription for Hypertension