cardiac rehabilitation


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Cardiac Rehabilitation

 

Definition

Cardiac rehabilitation is a comprehensive exercise, education, and behavioral modification program designed to improve the physical and emotional condition of patients with heart disease.

Purpose

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.

Precautions

A cardiac rehabilitation program should be implemented and closely monitored by a trained team of healthcare professionals.

Description

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 six to 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 five 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.

Aftercare

Long-term maintenance is a critical feature of cardiac rehabilitation. Patients require support from their healthcare team, family, and friends to continue the lifestyle changes they implemented during the rehabilitation period.

Risks

The risks of another heart attack during cardiac rehabilitation are slight, and greatly reduced by careful, continuous monitoring of the physical status of the patient.

Normal results

The outcome of the cardiac rehabilitation program depends on a number of variables, including patient follow-through, type and degree of heart disease, and the availability of an adequate support network for the patient. Patients who successfully complete the program will ideally reach an age-appropriate level of physical activity and be able to return to the workforce and/or other daily activities.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

Key terms

Angina — Chest pain.
Bypass surgery — A surgical procedure that grafts blood vessels onto arteries to reroute the blood flow around blockages in the arteries (arteriosclerosis).

cardiac rehabilitation

Etymology: Gk, kardia, heart; L, re + habilitas, ability
a supervised program of progressive exercise, psychological support, education, and training to enable a patient to resume the activities of daily living on an independent basis following a myocardial infarction. The patient may require special training to adapt to a new occupation and life-style.

car·di·ac re·ha·bil·i·ta·tion

(kahr'dē-ak rē'hă-bil'i-tā'shŭn)
A systematic program of exercise and nutritional, behavioral, and vocational counseling to optimize the recovery and physiologic capacity of the patient with cardiovascular disease.

cardiac rehabilitation

a structured, planned programme, originally restricted to patients following myocardial infarction, designed to achieve and maintain the maximum degree of physical and psychological independence of which they are capable. Now extended to include all patients with any cardiovascular disease. The programme is exercise based, with a gradual increase in activity individually tailored to suit clinical status and level of symptoms. Educational (risk factor modification) and nutritional sessions are included for both patient and spouse/partner and the psychosocial aspects such as return to work, resumption of sexual intercourse, etc. are covered.
References in periodicals archive ?
Exercise books or videos should be used at home for patients who are unable to attend cardiac rehabilitation centers, so they do not reduce their number of sessions.
Lead coronary heart disease nurse Julie Wratten, who is part of the cardiac rehabilitation programme, said: "I would like to thank Stuart and Denis for all the incredible work they have put into raising the money to buy these bikes.
This edition, revised from the 2004 edition, deals more firmly with the disparity between the clear evidence that cardiac rehabilitation and secondary prevention decrease mortality and morbidity after a cardiac event, and the low level of it actually being used.
Moreover, the authors do not describe how and when they determined that a cardiac rehabilitation program participant was eligible to return to work.
The primary health care setting has been identified as having the ability to improve cardiac rehabilitation care participation rates (Cupples et al.
9, 2013 /PRNewswire/ -- Zynx Health(TM), the market leader in providing evidence-based clinical decision support (CDS) solutions, today announced the availability of the Cardiac Rehabilitation module in ZynxCare, the category leader of the Clinical Decision Support - Order Sets and Care Plans market segment in the 2012 Best in KLAS Awards.
It is recognised by the British Heart Foundation and is run by the members themselves, who have all been through South Tyneside NHS Foundation Trust's respected cardiac rehabilitation programme.
Though standard for years, cardiac rehabilitation has been ineffective.
In spite of this evidence, only 20 to 30 per cent of patients are referred to a cardiac rehabilitation program after hospital discharge, a phenomenon observed in many countries.
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.
And though cardiac rehabilitation, which has a strong counseling component, has been successful in treating patients following bypass surgery, mental health counselors are rarely used in cardiac rehabilitation settings despite the six-fold increase in depression post-surgery.
David and Jane Freeman, of Ryton on Dunsmore, organised a party and asked their guests to donate money for the cardiac rehabilitation ward at Rugby's St Cross Hospital.