Cardiac Rehabilitation

This week we celebrated World Heart Day (the 29th of September). In our previous blog posts we have discussed heart health, cardiovascular diseases, and why physiotherapy is important. But many people don’t know what cardiac rehabilitation is, or that it’s actually a specialty of its own. So, this PT weekly we’ll be talking you through all the ins and outs of cardiac rehab.

What is Cardiac Rehabilitation?

Cardiac rehab is a supervised exercise program that also provides education about nutrition, medication use and general lifestyle choices to help patients strengthen their hearts and lead healthier lives. The main goal of any cardiac rehabilitation program is to lower the likelihood of future heart problems or related death.

Phases of Cardiac Rehabilitation

Cardiac rehabilitation consists of 3 phases:

Phase 1- Clinical Phase: This phase begins in the inpatient setting soon after a cardiovascular event or completion of an intervention (like surgery). It begins by assessing the patient’s physical ability and motivation to tolerate rehabilitation. Therapists and nurses may start by guiding patients through non-strenuous exercises in the bed or at the bedside, focusing on a range of motion and limiting the deconditioning that usually happens when a patient stays in the hospital. The rehabilitation team may also focus on activities of daily living (ADLs) and educate the patient on what activities overstress the heart (how to gauge what is safe and what is not).

Phase 2- Out-Patient Cardiac Rehab: Once a patient is stable and cleared for discharge, outpatient cardiac rehabilitation may begin. This phase typically lasts three to six weeks, though some may last up to twelve weeks. Initially, patients have an assessment with a focus on identifying limitations in physical function, restrictions of participation secondary to comorbidities, and limitations to activities. At this phase, a more rigorous patient-centered therapy plan is designed, comprising three modalities: information/advice, tailored training program, and a relaxation program. The treatment phase intends to promote independence and lifestyle changes to prepare patients to return to their lives at home.

Phase 3- Post-Cardiac Rehab Maintenance: This phase involves more independence and self-monitoring. It is centered on increasing flexibility, strengthening, and aerobic conditioning. The long-term goal is maintenance of lifestyle changes, monitoring risk factor changes and secondary prevention.

Who will Benefit from Cardiac Rehabilitation?

• A recent heart attack (myocardial infarction)
• Stable chest pain, also called angina
• Heart failure
• Heart procedures such as percutaneous coronary intervention (PCI), which includes angioplasty or cardiac stenting.
• Heart surgery such as coronary artery bypass surgery, heart valve repair or replacement.
• Heart or heart–lung transplant.
• Anyone with three or more risk factors for coronary artery disease. (Risk Factors include: high LDL cholesterol, low HDL cholesterol, high blood pressure, family history of heart disease, diabetes, smoking, obesity, being post-menopausal for women and being older than 45 for men).

Processes of Cardiac Rehabilitation

The purpose of a cardiac rehabilitation program is to help you develop a heart-friendly lifestyle. It usually consists of three components: exercise, risk factor modification, and dealing with stress and depression.

1. Exercise Rehabilitation
   Exercise may be the most important component of a cardiac rehabilitation program because regular exercise not only directly improves your cardiovascular system, but it also helps you with weight control, improves your response to stress, and helps you stick to your heart-healthy diet.
2. Lifestyle Rehabilitation
   Most cardiac rehabilitation programs today include extensive educational sessions on modifying your cardiac risk factors such as; weight control, smoking cessation, and diet. Now that you have survived your heart attack, your health depends on taking control of those aspects of your life that can be controlled, and that will go a long way towards determining your long-term outcome.
3. Psychosocial Rehabilitation
   It is quite common to go through a period of depression or anxiety after a heart attack. Unfortunately, these problems can not only keep you from engaging in the exercise rehabilitation and lifestyle modifications you need to become healthy but can also directly worsen your cardiac health. The way you handle the daily stresses of life can also impact your health. Many cardiac rehabilitation programs employ individuals who are trained to recognize these issues and help cardiac patients manage stress and work through anything else that may inhibit recovery. If more intensive therapy is needed, they can help make the appropriate referrals.

Physiotherapy as a part of a cardiac rehab program is an effective, low-risk intervention that emphasizes exercise, education, and lifestyle modifications. Cardiac Rehabilitation increases physical activity in patients following cardiac events and encourages the adoption of healthy behaviors leading to a reduction in hospitalization rates, subsequent cardiovascular events, and mortality. Cardiac rehabilitation programs are cost effective across all delivery models and have a significant positive impact on quality of Life. If you have had a cardiac event recently, or you’re generally concerned about your overall heart health, give us a call at PCA for an assessment. Our specialized physios can evaluate your current fitness level, as well as other lifestyle factors in order to determine what type of program is right for you.