Cardiac Rehabilitation, “The sum of activities required to ensure patients the best possible physical, mental and social conditions so that they may resume and maintain as normal a place as possible in the community”.
Cardiac rehabilitation is comprehensive program that prepares the patient for a full, vital & productive life within the limitations imposed on him by the cardiac disease.
Who should Participate in Cardiac Rehabilitation
Person who are Medically stable or who can be stabilized
- Person With Myocardial Infarctions And Are Medically Stable.
- Person who have had angioplasty .
- Person who have had a CABG .
- Person who have undergone
- Cardiac transplant surgery .
- Person with other cardiac diseases
- Person who have several risk factors who are hospitalized for other reasons
Team of cardiac rehabilitation
Following team member are require in rehabilitation of person
- The Physician
- The Physical Therapist
- The Nurse
- The Occupational Therapist
- The Dietician or Nutritionist
What are the Contra indications
- If person is having Hypotensive (Low Blood Pressure) response to exercise.
- Persons functional capacity is low
- If person unable to self monitor his/her heart rate.
Goals Of Cardiac Rehabilitation
- Laboratory Values
- Physiological parameters
Goals of Cardiac Rehabilitation
|Blood Pressure||Less than 140/90 mm Hg|
|LDL||Less than 100 mg/dL|
|Triglycerides||Less than 100 mg/dL|
|HDL||40 mg/dL for men and 50 mg/dL for women|
|Blood sugar||Less than 100 mg/dL|
|Diabetes||Glycosylated hemoglobin of less than 7 percent|
|Weight||Ideal BMI: 8.5–24.9 kg/m2|
|Physical Activity||At least 150 minutes of physical activity (brisk walking, jogging, cycling, etc.) per week in bouts of at least 10 minutes (preferably) spread out through the week|
Phases of Cardiac Rehabilitation
- Phase I: In-patient (period of acute illness)
- Phase II: Immediate post discharge (Period of less acute stage)
- Phase III : 2-4 weeks post discharge (Period of convalescence )
- Phase IV: Long-term, on-going (Maintenance phase )
Phase I : In-Patient (period of acute illness)
In-patient means during admission period. We have to assess the client condition following way…
- Understanding of condition of the client.
- Information about disease condition and educate client / relative related to that
- Assessment of Risk factor which will occurs due to disease condition or treatment.
- Explain the health plan to the client
- Do Psychological assessment of client and try to solve it
- Drug therapy
Phase II : Immediate Post Discharge (Period of less acute stage)
- After discharge health care worker has to visit the client’s home to do follow up f health condition of client.
- Provide telephone number to the client so whenever requirement they can call the doctor.
- Explain client when they have to do follow up in clinics
Phase III : 2-4 weeks post discharge (Period of convalescence )
- After 2-4 weeks of post discharge reassess health condition and risk factors of client.
- Give health education to the client related to disease condition and medications
- Explain how frequently to do exercise and when to do it. Also teach them to observe the systems of tiredness. So client can stop or reduce the exercise
- Teach the client related to relaxation techniques
Phase IV: Long-term, on-going (Maintenance phase )
- In this phase client try to adjust with his new life style with exercise / activity and also try to maintain it.
- Health care providers help client to support in his on-going lifestyle
What are the Components of Cardiac Rehabilitation
When rehabilitation starts, person has to change his daily living style. Person has follows following things to maintain lifestyle.
- Modify diet as per body requirement with the help of dietician and weight management with regular follow up
- Smoking cessation means person has to quit smoking
- In physical activity person should do daily regular exercise which you would tolerate
- Secondary prevention
- Education related to lifestyle.
- Always try to solve person’s problem which is increase anxiety.
- Always encourage person to follow long-term management strategy
Diet and Weight Management
Goals of management are
- Salt restricted,
- Low fat
- High fiber diet
- Ideal BMI: 8.5–24.9 kg/m2
Eat in large quantity
- Fruits: Apple, guava , banana orange water melon.
- Salad : vegetables& sprouts
- Vegetables : Leafy vegetable cabbage , tomato, bean , cucumber carrot beetroot , radish , mushroom
- Starch: Tapioca, sweet potato .
Eat moderate quantity
- Cereals: Wheat, rice, Bajara
- Pulses: Lentil, Cow peas, Chick peas, Toor, Mong, Massor, Urad dal
- Snacks: Khakara, corn flakes, Pop corn flakes and popers.
- Milk: Cows milk, Toned milk, Paneer
- Egg white, Fish
Eat in very small quantity
- Oil, Ghee, Butter, Cheses
- Egg yolk (Only twice a week)
- Sweets and Desserts: Gulab Jamun, Jalebi, Ice cream etc.
- Red Meat: Mutton, beef, Pork
- Bakery Items : Cake, Biscuits
- Fast Food: Burgers, Pizzas, Hot Dog etc.
- Pickles, Papads
- All salted and preserved foods
- Body mass index (BMI)
- Waist to hip ratio (WHR)
Table of BMI
|Obesity||30.0 and Above|
Table of fat composition in body
|Classification||Women (% fat)||Men (% fat)|
|Obese||32% plus||25% plus|
How To Calculate WHR
WHR is calculated by dividing the narrowest distance around your abdomen by the widest distance around your hips and buttocks area.
If your waist measurement is greater than or equal to your hip measurement (WHR >= 1), your body is said to be apple shaped — meaning that you tend to store most of your body fat on your waist..
If your hip measurement is greater than your waist measurement (WHR < 1), your body is said to be pear shaped — meaning that you tend to store most of your body fat on your hips
As a rule of thumb, people with apple shaped bodies can have a 2 to 4 times greater risk for heart disease than those with pear shaped bodies.
Waist Hip Ratio
If most of fat is around waist rather than at hips, it is at higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men.
Tips for healthy weight loss
- Never skip meals
- Avoid heavy dinner; maintain at least 2 to 3 hours of gap between meal and sleep.
- Replace cold drinks with coconut water, vegetable soup or butter milk.
- Drink at least 2 to 3 liters of water everyday
- Fiber is excellent for weight loss, so consume more of raw vegetables , sprouts & fruit.
- All carbohydrates s are not bad; avoid simple carbohydrates s like sugar, sweet and processed food.
- Avoid Bakery products.
- Replace fried food with sauté or steam
- Avoid taking water along with the meal.
Goal : Quit smoking
ONLY YOU CAN DECIDE IT
To Quit Smoking
There is no one way to quit smoking that works for everyone. To quit, one must be ready both emotionally and mentally. One must also want to quit smoking for self, and not to please your friends or family
Physical activity and exercise
- Before you start exercises of any kind exercises consult your doctor/ physiologist .
- Start with light exercises like Yoga, brisk walking etc.
- If you can not find time for them combine them with your daily routine work e.g. walk to the work place, do your own work, do exercise on holidays only.
- Assess and risk stratify
- Develop individual exercise plan
- Teach target zone principle
- Regain/develop physical fitness gradually
- Regain confidence in physical activity
- Develop long-term activity plan
- Self motivation & monitoring
- Increase the exercises
- Do warm up & cool down exercises.
- Do not exercise at least two hrs after meals
- Avoid prolonged period of exercising in extreme weather.
- If you start getting chest pain stop immediately .
Target heart rate
One gain the most benefits and lessen the risks when he exercise in target heart rate zone. Usually this is when one exercise heart rate is 60 to 80 percent of maximum heart rate.
220 – your age = predicted maximum heart rate
- Cholesterol management
- BP management
- Blood sugar management
- Cardio-protective drug therapy
- CHD as a disease
- Treatment including medication
- Recovery process
- CHD risk factors
- Symptom management
- Living with CHD
- To understand & manage the disease process.
- Accept the limitations.
- Cope up with new lifestyle
Providing vocational guidance
Patient can return to former job but with modification of certain activities
- Prevent further damage.
- Maintain existing ability.
- Restore much functions.
Family support & emotional support
- Involvement of the family members in rehabilitation
- Enable to lead a normal or near normal life.
- Planning of the daily activities.
- Adjusting o new routines.
- Relaxation in any form gives rest to mind and so to heart
- One must decide what is best for him /her
Activity , Rest & sleep
- Plan work in such way that
- one get the rest in between.
- One must ensure that he rest for
- some time after lunch & then only resume your work.
- One should take 6-7 hrs of undisturbed sleep. This need will vary according to activities, age & individual preferences.
Compliance of treatment
One can add life to the years and years to your life
Customized rehabilitation program tailored to ones needs.