Cardiac rehabilitationCardiac rehabilitation is a physician-supervised program for people who have either congenital or acquired heart disease. Program participants may or may not have had a heart attack or heart surgery (or other heart procedures). Cardiac rehabilitation can often improve functional capacity, reduce symptoms, and create a sense of well-being for patients. A
physician may prescribe cardiac rehabilitation for a patient in certain situations.
Heart disease causes distress and impairs quality of life. Cardiac rehabilitation is a multidisciplinary approach to improve short-term recovery and promote long-term changes in lifestyle which help to correct adverse risk factors. It is a process by which patients are restored to and maintained in optimal physical, emotional, social, vocational and economic state.
Cardiac rehabilitation services usually include exercise training, risk factor modification, education and counselling. The principal justification for rehabilitation is the encouragement of return to full activities and a reduction in well-documented convalescence problems of lack of confidence and sleep, anxiety, depression fatigue and worry about non-specific physical symptoms together with excessive caution about everyday activities.
Heart attack survivors, bypass and angioplasty patients, and individuals with angina, congestive heart failure, and heart transplants are all candidates for a cardiac rehabilitation program. Cardiac rehabilitation is prescribed to control symptoms, improve exercise tolerance, and improve the overall quality of life in these patients.
Before you enter the program, you will have an interview so that you can become familiar with the program and what is expected of you, while we learn about you and can begin customizing our program to fit your needs. During your first session, you will go through the program on a one-on-one basis with a member of our staff. Your blood pressure and heart rate will be recorded at the beginning and end of each session. Your heart rate will be recorded during each exercise; your heart rate and rhythm will be monitored constantly while you are exercising. Your exercise program will start up slowly, gradually increasing to your target heart rate. Your physician will be sent a monthly update of your progress.
Cardiac rehabilitation is overseen by a specialized team of doctors, nurses, and other healthcare professionals. Members of the cardiac rehabilitation team may include a dietician or nutritionist, physical therapist, exercise physiologist, psychologist, vocational counselor, occupational therapist, and social worker. The program frequently begins in a hospital setting and continues on an outpatient basis after the patient is discharged over a period of 6-12 months.
Components of a cardiac rehabilitation program vary by individual clinical need, and each program will be carefully constructed for the patient by his or her rehabilitation team.
- Exercise. Exercise programs typically start out slowly, with simple range-of-motion arm and leg exercises. Walking and stair climbing soon follow. Blood pressure is carefully monitored before and after exercise sessions, and patients are taught how to measure their heart rate and evaluate any possible cardiac symptoms during each session. Patients with advanced coronary disease may require continuous ECG monitoring throughout their exercise sessions. Once discharged from the hospital, the patient works with his cardiac team to create an individual exercise plan.
- Diet. Cardiac patients will work with a nutritionist or dietician to develop a low-fat, low-cholesterol diet plan. Patients with high-blood pressure may be put on a salt-restricted diet and instructed to limit alcohol intake. Weight loss may also be a goal with obese cardiac patients.
- Counseling. A psychologist or social worker can help cardiac patients with issues that may be contributing to their heart condition, such as stress and anxiety. Relaxation techniques may be taught to patients to help them deal with these feelings. Cardiac patients frequently experience a period of depression, and group or individual counseling can be beneficial in overcoming these feelings. Vocational counselors can assist cardiac patients in returning to the workforce.
- Education. The patient and family should be fully educated on the physical limitations of the patient, his recommended diet and exercise plan, his emotional status, and the lifestyle changes required to improve the patient's overall health.
- Smoking Cessation. Cardiac patients who smoke are twice as likely to have a heart attack in the following 5 years than non-smoking patients. These patients are strongly encouraged to enroll in a smoking cessation program, which typically includes patient education and behavioral counseling. Nicotine replacement therapy, which uses nicotine patches, nose spray, or gum to wean patients off of cigarettes, may also be part of the program. Antidepressants and anti-anxiety medication may be helpful in some cases.
- Psychological rehabilitation is designed to treat the anxiety and depression that often occur with heart disease. A person may be afraid to walk or to have sex. The individual may be depressed about being unable to do what he or she used to do. Lack of confidence and low self-esteem are also common. Counseling or medications can help with these symptoms.
- Vocational rehabilitation helps get interested people back to work. A person can learn his or her limitations and when it is safe to return to work. Specialized training programs may also play a role.
In each of the four parts of rehabilitation, short-term and long-term goals are usually set. Some rehabilitation may start in the hospital, before a person even goes home. Most activities will occur after the person gets home. The rehabilitation team may include doctors, nurses, physical therapists, occupational therapists, dietitians, job counselors, psychologists, and others. Each programme should keep a record of the numbers attending (including partners) and the drop out rate and reasons for non-attendance.
Outcome measures should include risk factor reduction outcomes (smoking, physical activity, blood pressure, weight, cholesterol), physical outcomes (mortality, reinfarction, cardiac arrest, ventricular function, myocardial ischaemia, physical working capacity, symptom limitations, task and activity performance), psychosocial outcomes (return to work, quality of life) as well as other outcomes (adverse events, non compliance, readmission).