Cardiac Rehabilitation and Exercise Flashcards
Define Cardiac Rehabilitation.
The co-ordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease.
Describe any evidence about the benefits of cardiac rehab.
The Cochrane review of exercise-based rehabilitation for CHD concluded that exercise-based CR is effective in reducing cardiac deaths, reducing cardiac risk factors, and in enhancing psychosocial factors.
What patient groups are included In CR ?
- MI
- Angioplasty (and Stent)
- Coronary Artery Bypass Graft
- Stable/Stabilised Angina
- Valve Repair
- Congenital Repairs
- Transplant
- Heart Failure
- Arrhythmias
Describe the phases of cardiac rehabilitation.
PHASE 1
“during the inpatient stage or after a step change in the patient’s
cardiac condition”
PHASE 2
“early post discharge period. Support can be provided by home visiting, telephone contact”
PHASE 3
Outpatient program, typified by exercise class
PHASE 4
Long term, community based exercise
Identify the physiological benefits of cardiac rehab.
- Improvement in functional capacity
- Improved cardiovascular efficiency
- Reduction in atherogenic and thrombotic risk factors.
- Improvement in coronary blood flow, reduced myocardial ischaemia, and severity of atherosclerosis.
- Reduction in risk of cardiovascular disease mortality.
Identify the psychological benefits of cardiac rehab.
- Reduced anxiety and depression (test through phq4)
- Enhanced mood
- Enhanced self-efficacy
- Restoration of self-confidence
- Decreased illness behaviour
- Increased social interaction
- Resumption of chores/hobbies
- Resumption of sexual activity
- Return to work/vacation
Describe the main components of the initial assessment of a patient before cardiac rehab?
(Individual Assessment with the Cardiac Rehab Physio)
•Setting goals to increase and maintain in CR
•Risk assessment using the AACVPR guidelines (HR, BP, Shuttlewalk test and monitor HR during test)
•Risk stratification (“process of separating patient populations into high-risk, low-risk”)
What is the cycle of change ? How is it relevant to cardiac rehab ?
Not interested (in rehab) → Thinking about it → Planning it → Doing it → Had enough → Give up or start again
Hence motivational interview techniques can be useful in that regard.
What are the barriers to exercise for cardiac patients ?
- Bad weather (home programe to overcome that)
- Too tired
- Not in the mood (less intense exercise can improve mood)
- Don’t know how to
- Can’t afford it
- Fear
- Don’t have time
Describe how goals should be set as part of cardiac rehab, giving an example of a good goal.
Goals should be SMART •Specific •Measurable •Achievable •Realistic •Time based
Eg I want to be able to walk up the hill to my daughters, without stopping, by the time I have done 6 exercise classes.
Distinguish between activity and exercise.
- Activity is sporadic in nature and inconsistent in intensity. E.g. climbing the stairs.
- Exercise is purposeful and sustained e.g. going for a walk.
Describe a typical exercise session for cardiac rehab.
Warm Up
- 15 minutes
- Aim is to prepare the muscular, nervous, cardiac, respiratory and vascular systems for the main work out
- Includes stretching (to ensure full range of movements available), joint mobility exercises walking around gym, activities for to warm up different muscle groups.
- Increasing size of movement as get on (gradual pulse raising)
- Should be 9-11 on Borg Scale
Conditioning Phase
- 20 minute duration
- Should be designed to produce a training effect (e.g. walk to brisk walk, breaststroke to crawl etc.)
- Circuit based exercises
- Comfortably short of breath, (i.e. 13-14 on Borg Scale, still able to talk)
Cool Down
- 10 minute duration
- Pulse lowering exercises, which aim to reduce the heart rate and blood pressure gradually
Throughout the exercises, told to keep moving feet to increase veinous return (to prevent light-headedness and dizziness)
What are the FITT principles ?
Way to monitor exercise. • Frequency • Intensity • Time • Type
How is the state of exertion of patients monitored during exercises ?
-Pulse (but not always ideal, some drugs interfere with that)
-Self-monitoring of changes in breathing (through SING ? TALK ? GASP ?). More specifically,
Sing: Good level to start off with or for warm up.
Talk: Slightly short of breath but able to chat is a good level for moderate exercise.
Gasp: If you cannot talk fluently, you are working too hard.
Describe the BORG scale.
Scale measuring perceived level of exertion, from 6 to 20.
6- No exertion at all (lying totally still) 7- Extremely light (able to whistle) 8- 9- Very light 10- (able to sing) 11- Light 12- 13- Somewhat hard (able to talk) 14- 15- Hard/heavy 16- 17- Very hard (able to gasp) 18- 19- Extremely hard 20- Maximal exertion
