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DEFINITIONS:
Cardiac Rehabilitation is a multidisciplinary
program of education and exercise
established to assist individuals with heart
disease in achieving optimal physical,
psychological, and functional status within the
limits of their disease
Cardiac rehabilitation
Secondary prevention
-
immobilization.
To develop cardiovascular fitness after acut illness
To maximize exercise tolerance and ADL performance
To control risk factors for coronary artery disease (CAD)
To provide guidelines for safe activities and work
To help patiens cope with perceived stressor
To improve quality of life
through program : - education
- behavior modification
- secondary prevention and exercise-- to resume
activities of normal life without significant cardiacsymptom
Sedentary lifestyle
Cigarette smoking
Hypertension
Low HDL cholesterol ( < 0.9
mmol/L [35 mg / DL ] )
Hypercholesterolemia ( >
5.20 mmol/L [200 mg / DL ])
High lipoprotein A
Abdominal obesity
Hypertriglyceridemia ( >2.8
mmol/L [250 mg / DL] )
Hyperinsulinemia
Diabetes mellitus
Irreversible risks :
Age
Male gender
Family history of premature
Outcome Cardiovascular
Rehab
Decreased length of hospital stay.
More rapid and complete resumption of usual
activities
Increased self confident
Fewer readmission
Less psychological distress
Improve quality of life
MYOCARD INFARCT ( MI )
Post MI Rehabilitation
Phase I :
Acute Phase Rehabilitation
Immediately following the MI up to discharge :
Early mobilization to prevent complication of
prolonged immobilization
Alleviation of anxiety and depression
Establish modifiable risk factor reduction
strategies
Prescription and education with guidelines for
activity and work after discharge
Phase II :
Convalescent Phase
Its done at home
Rehabilitation
Continues the program started in phase I
until the myocardial scar has matured :
To achieve cardiovascular conditioning and
fitness via aerobic exercise
To achieve control modifiable risk factors
using physical activity,psychosocial and
pharmacologic interventions and lifestyle
changes
To an early return to work
Phase III
The Training Phase
Usually starts after 4 6 weeks
Conditioning exercise program and education
Phase IV
The Maintenance phase
To keeping the aerobic conditioning gains
Be taught risk-factor modifications
CARDIOMYOPATHY
the most common cardiomyopathies are
CHF Rehabilitation
EFFECT EXERCISE:
Improvement exercise tolerance
Improvement cardiopulmonary function
Reduce patient symptoms
: sub maximal
Duration
: 20 45 min
Frequency
: 2 5 X/week
Prolonged warm ups and cool downs
Avoided isometric exercise
METs
mL 02. kg-1
.min -1
Kcal / min
(70 kg person
)
WEEK 1
Any light activity that can be done
while sitting
Walking, 1 2 mph , on level
Stationary cycling , minimal
resistance
Light household work
dishes or meal
preparation ( alternate with
rest periods )
dusting
sweeping
Personal hygiene
shaving
showering
dressing
1.5 - 3
5 - 11
2-4
METs
mL 02. kg-1
.min -1
Kcal / min
(70 kg person
)
WEEK 2
Increased social activity
playing cards at home
visiting neighbors
card riding
Walking, 2 - 4 mph , on level
Stationary cycling , slight resistance
increased household work
bed making
ironing
minor appliance repair
bench work
supervising farm work
11 - 14
4-5
ACTIVITY
METs
mL 02. kg-1
.min -1
Kcal / min
(70 kg person
)
WEEK 3
Driving with another driver present
Household work, vaccuming
Resumption of sexual intercourse
Social activity
movies
church
conceds
walking, 3 4 mph
Stationary cycling , slight resistance
Lifting , 10 15 lb
14 - 15
5-6
METs
mL 02. kg-1
.min -1
Kcal / min
(70 kg person
)
WEEK 4
Potential return to part-time work
Driving alone
Light gardening
Pitch and pull golfing
Social group activities
club meetings
parties
dancing
grocery shopping ( no heavy lifting )
walking, stationary cycling
<6
18 21
6-7
Phases of Cardiac
Rehabilitation
Table 21-3. Sinaki M, Basic Clinical Rehabilitation Medicine, St. Louis, Mosby,
1993
Phase
Type of Program
Duration
inpatient
days
2 12 weeks
Minimum of 9
months beyond
phase 2
Maintenance program
indefinite
Days of Program
Sta
ge
6Day
Plan
9Day
Plan
12Day
Plan
Activity Schedule
Days of Program
Sta
ge
2
6-Day
Plan
9Day
Plan
12Day
Plan
Activity Schedule
Days of Program
Sta
ge
6Day
Plan
9Day
Plan
12Day
Plan
Activity Schedule
11
12
SCALE
EXERTION
6
7
8
9
Very light
10
11
12
Fairly light
13
14
Somewhat hand
15
16
hard
17
18
Very hard
19
20