MED FOUND 1

Cardiac Rehabilitation

An interdisciplinary team approach

to patients with functional
limitations secondary to heart
disease
Focus on restoring the patient to
their optimal medical, physical,
mental, psychologic, social
emotional, sexual, vocational and
economic status compatible with
the severity of their HD.
Primary prevention: screening
healthy people to identify and treat
risk factors
Secondary prevention : to improve
HD risk factors and limit further
morbidity and mortality

Epidemiology
CardioVascular disease (CVD) : the
leading cause of morbidity and
mortality in men and women in
USA
Prevalence increases with
advancing age
USA: one coronary event every 26
s, one death every minute from HD
Steady increase in number of
hospital based interventions for the
management of HD
: Angiograms
: Angioplasties
: Coronary artery bypass graft
surgeries (CABG)
: Heart transplants (HT)
: Implantable cardioverter
defibrillators (ICDs)
: Pacemakers
Types of Heart Disease
Myocardial Infarction
> CHF
Post-catheter based intervention
> arrhythmia
CABG
> HT
Valve surgery
Risk factors for CAD (Box 34-1)
Box 34-2
Table 34-1
Table 34-2
Overweight and obesity
Definitions: Overweight BMI > 25 kg/m2
Asia Pacific Guidelines
Category
BMI
Underweight
< 18.5
NORMAL
18.5 22.9
Overweight
23 24.9
Obese Class I
25 29.9

Obese Class II
30 39.9
Morbid Obesity
> 40
Phase I
- Patients are referred when
medically stable.
- Includes:
o Patient and family education
o Self-care evaluation
o Continuous monitoring of
vital signs
o Group discussions
o Low level exercise
Active ROM
Ambulation
Self care
- Exercise intensity is prescribed
according to heart rate and by
rating on a perceived exertion
scale.
- Average of 3 to 5 days
Phase II
- Begins immediately after
hospitalization, lasts for 2 to 12
weeks depending on the ability to
tolerate exercise training
- Monitored closely and supervised
during all activities
- Goals:
o Increase functional capacity
through exercise
o Educate patient on risk
factor modification
o Develop independence on
self-monitoring
- Frequency: 2 3x a week
- Progresses to Phase III when
clinically stable, independent in
self-monitoring techniques and do
not require ECG monitoring
Phase III
- Continuation of Phase II; lasts for 6
-8 weeks
- Emphasis of the program:
o Exercise training
o Physical fitness
o Level of endurance
o Risk factor modification
- Includes: exercise, education and
counselling
- A maximal symptom-limited
exercise test is required to assess
fitness level and appropriately plan
for exercise intensity.
- Average frequency: once per week
Phase IV
- Lasts throughout the patients
lifetime.
- Designed to promote optimal
health
- Requirements:
o Independence with selfmonitoring of exercise
o Stable cardiac status

No contraindications to
exercise

At least 5 MET capacity for

activities