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Cardiac Rehabilitation Program

consist of :
— Primary preventions
Focus on the reduction of cardiac risk factors :
- education, ideally started in schools with parental support
- physical activity ( decrease obesity, lower SBP, modifies lipid
profiles )
- should begin in childhood
- in order to establish helthy behavior patterns of life
— Secondary prevention
- include all of the features of primary prevention programs
Dr. Luh Kamiati, SpKFR - decreases second cardiac event
Bagian Ilmu Kedokteran Fisik dan Rehabilitasi FK .UNUD/ - lowers mortality post-MI
SMF.Rehabilitasi Medik,RSUP Sanglah, Denpasar
- improve hypertension and Diabetes management

GOALS OF THE CARDIOVASCULAR

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
REHABILITATION
— To prevent the harmful effects of prolonged 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--à to
resume activities of normal life without significant cardiac-
symptom

Contra Indication Exercise Coronary Artery Disease Risk Factors

— Heart rate increase > 50 / minute Reversible risks : Irreversible risks :

— BP systolic > 210 mmHg, Diastolic > 110 mmHg • Sedentary lifestyle
— Unstable angina • Cigarette smoking
— Heart failure acute • Hypertension
— Uncontrolled arrhytmias • Low HDL cholesterol ( < 0.9
— Moderate / severe aortic stenosis mmol/L [35 mg / DL ] )
— Decompensated CHF • Hypercholesterolemia ( > 5.20
— Acute systemic illness/ fever mmol/L [200 mg / DL ])
— Active pericarditis/myocartitis • High lipoprotein A
— Embolism • Abdominal obesity
— Thrombophlebhitis acute • Hypertriglyceridemia ( >2.8
— Resting ST diplacement > 3 mm mmol/L [250 mg / DL] )
— Uncontrolled diabetes • Hyperinsulinemia
• Diabetes mellitus
• Age
• Male gender
• Family history of premature
CAD ( before age 55 in a parent
or sibling )
• Past history of CAD
• Past history of occlusive
peripheral vascular disease
• Past history of cerebrovascular
disease

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POST MYOCARD INFARCT Phase I :

REHABILITATION
Classic model as first described by Wenger et al :
— Phase I (acute phase)
— Phase II (convalescent phase)
— Phase III (training phase)
— Phase IV (maintenance phase)
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 : Phase III

Convalescent Phase Rehabilitation The Training Phase
Is done at home
— Usually starts after 4 – 6 weeks
Continues the program started in phase I
— Conditioning exercise program and education
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 IV
The Maintenance phase
— To keeping the aerobic conditioning gains
— Be taught risk-factor modifications

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CHF Rehabilitation
EFFECT EXERCISE:

— Improvement exercise tolerance

— Improvement cardiopulmonary function
— Reduce patient symptoms

Guideline for Exercise in CHF Outcome Cardiovascular Rehab

— Aerobic exercise — Decreased length of hospital stay.
— Intensity : sub maximal — More rapid and complete resumption of usual
— Duration : 20 – 45 min activities
— Frequency : 2 – 5 X/week — Increased self confident
— Prolonged warm ups and cool downs — Fewer readmission
— Avoided isometric exercise — Less psychological distress
— Improve quality of life

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BORG PERCEIVED EXERTION SCALE

Table 21-6, Sinaki M, Basic Clinical Rehabilitation Medicine, St.Louis, Mosby, 1993

SCALE EXERTION
6
7 Very, very light
8
9 Very light
10
11 Fairly light
12
13 Somewhat hand
14
15 hard
16
17 Very hard
18
19 Very, very hard
20