What is cardiac rehabilitation and who should get it?

At a Glance:

What is Cardiac Rehabilitation (CR/cardiac rehab)?

Cardiac rehabilitation, also known as cardiac rehab, is an organized approach for improving the quality of life, preventing and reducing the recurrence of cardiac events in persons suffering from heart diseases.

Cardiac rehabilitation program aims to improve the physical, emotional and functional life of such persons. The steps are provided for early recovery from the cardiac events and strategies are designed for the prevention of such events.

The process of cardiac rehabilitation is coordinated by an integrated multidisciplinary team of professionals comprising of cardiac specialist, general physicians and other health professionals including trained nurse, dietary consultant, physiotherapist, occupational therapist, psychologist, and pharmacist who work towards the person’s well-being.

The cardiac rehabilitation program is designed as per the needs of an individual and combines cardiac health education, cardiovascular risk reduction, stress management and cardiac exercises for optimum health of the person. Cardiac rehabilitation programs are recommended by the various medical associations like the American Health Association, American College of Cardiology and Cardiology society of India

Who needs cardiac rehabilitation and what are its benefits? 

Cardiac rehabilitation assists the person with cardiac diseases in leading a quality life with a low risk of recurrence. Some of the cardiac diseases in which an individual is recommended to undergo cardiac rehabilitation include:

• Angina
• Angioplasty
• myocardial infarction 
• Bypass surgery
• Cardiomyopathy
• Congenital heart disease
• Coronary artery disease
• Heart attack
• Heart failure
• Heart transplant
• Peripheral artery disease
• Repair or replacement of the heart valve
• Revascularization procedures.

Age is generally no bar for cardiac rehab as the rehab program is designed keeping in consideration all the factors relating to an individual including age.

Participation in a cardiac rehab program is one of the best support a person can get for his/her cardiac health. Some of the benefits of cardiac rehabilitation are:

• Better control over individual’s health.
• Reduced risk of future cardiac events.
• Early recovery from heart diseases as well as cardiac surgeries.
• Reduced mortality i.e chances of early death due to cardiac diseases.
• Improved exercise capacity, psychological well-being, and quality of life.
• Reduced risk of sudden death and helps to control cardiac symptoms.
• Reduced risk of recurrent hospitalization.
• Managed cardiovascular risk profile including cholesterol level, blood glucose, triglyceride level, and blood pressure.

Comprehensive cardiac rehabilitation is monitored and supervised for approximately three months but this not the end. It is a long-term maintenance program which requires a lifelong commitment in order to obtain maximum benefit. Individuals, after undergoing a rehabilitation program, can successfully develop their own exercise regimen, whether at home or at the gym.

However, after cardiac rehab, individuals must incorporate habits that are essential for cardiac health such as avoiding smoking and managing the body weight to achieve maximum benefit.

Furthermore, individuals are also able to manage stress. They also learn facts, sign, and symptoms of cardiovascular diseases and how to deal with them. Most important of all, the quality of life is improves, and individuals feel psychologically, emotionally and mentally fit than before.

What to expect during cardiac rehabilitation? 

The aim of cardiac rehab is not only to improve the health and quality of life of the patients but also to bring confidence in them to self-manage by equipping them with the necessary skills.

According to the British Association of Cardiovascular Prevention and Rehabilitation (BACPR), various core components constitute cardiac rehabilitation. These components include:

Health behaviour change and education: Health behaviour change is monitored, milestones are assessed, and further goal setting is done. Various misconceptions related to heart disease causes are to be addressed as these may lead to distress and irritability.

Lifestyle risk factor management: Lifestyle risk factors are identified, and individuals have the opportunity to discuss these risk factors. Exercise, a healthy diet, managing obesity and avoiding smoking are linked with healthy cardiac health and counselling is provided about these factors.

Psychosocial health: Stress management and good emotional health help in achieving the aim of cardiac rehab.

Medical risk factor management: Medical risk factor for cardiovascular events like blood pressure and levels of lipids and glucose are monitored as per best practice standards by the skilled, qualified and competent staff.

Cardioprotective therapies: Cardioprotective therapy includes cardioprotective medications such as beta blockers, calcium-channel blockers or anticoagulants and implantable devices.

Long term management: Long term management goals are identified during the program and the individuals are supported to develop self-management skills to achieve those goals. 

Audit and evaluation: Audit and evaluation of the cardiac rehabilitation program are done to evaluate the progress. It also helps in making changes in the program on the basis of clinical outcome for individual persons.

What type of exercises are included in a cardiac rehab plan?

Exercise in the cardiac rehabilitation program is planned as per the specific needs and health status of the individual and is divided into three phases: 

Warm-up exercise: Warm-up exercise is required to gradually increase cardiac blood circulation and heart rate. The heart will gradually adapt to the exercise regimen and the risk of angina and arrhythmia is significantly reduced. It also helps in stretching muscles which reduces the risk of injury. Warm-up exercise is generally done for 15 minutes, equally divided between pulse raising activities, stretching activities and movement activities. Warm up exercise includes walking, low-level cycling, upper back stretch, chest stretch, calf stretch, and hamstring stretch. 

Main Exercise: The main exercise is done for about 15-40 minutes. The exercise is designed on a case-to-case basis. Types of exercise include treadmill exercise, aerobics, and swimming. Other exercises include marching on the spot, step ups, forward arm reaches and shadow boxing. 

Cooldown exercise: Cooldown exercise helps the body to regain its resting state. Sudden stopping of exercise may lead to hypotension which may cause symptoms such as dizziness. It also helps in maintaining a constant slowing of heartbeat and rhythmic contractions of the heart. During the cool down phase, the speed of exercise should be gradually lowered until the body attains a resting state. The time period for cool down exercise is about 10-15 minutes.

Warm-up and cool down exercises are critical in an exercise regimen and should not be missed.

What are the phases of cardiac rehabilitation?

There are three phases of cardiac rehabilitation and the phases are categorized on the basis of the time period after cardiac events.

Cardiac rehabilitation phases are: 

Phase I: In-hospital patient

This phase of cardiac rehab starts as soon as the patient has started recovering after treatment for heart disease. The cardiac rehabilitation team provides information regarding cardiovascular risk factors and specific signs and symptoms of cardio diseases. Individuals are also provided with information regarding a healthy diet and routine weight checks. 

Phase II: Post-discharge early phase

This phase starts with monitoring the response of a person towards exercise such as heart rate, blood pressure, and other cardiovascular parameters. Any changes required in the exercise regimen are done in this phase. 

Phase III: Post-discharge late phase

This phase is also known as the maintenance phase. The exercise done by the individuals are not monitored but they are supervised by competent and qualified staff. The person remains in the rehabilitation center as recommended by the cardiologist. After completing phase III, a person may go home with exercise instructions given by the supervision staff.

For how long does CR last? 

The time period of cardiac rehabilitation varies from person to person and is generally advised by the cardiologists depending upon the severity of the disease. Generally, the cardiac rehab program may continue for about 3 months. The frequency of visiting the rehabilitation center decreases with time as the person becomes well versed with the guidelines to follow during exercise. Intensive programs are also designed for some individuals which last for two to three weeks.

What are the complications of cardiac rehabilitation? 

Most complications of cardiac rehabilitation are caused due to poor assessment of exercise regimen. Some of the risks are:

• Myocardial infarction
• Ventricular fibrillation
• Intracranial hemorrhage
• Dyspnea
• Hypertension
• Angina pectoris
• Death in extreme cases. During in-patient cardiac rehabilitation, the complications are immediately managed thus the chances of death are rare.

Cardiac rehabilitation is contraindicated in individuals with conditions like:

• Unstable angina
• Advanced heart failure
• Pulmonary embolism
• Myocarditis
• Ventricular arrhythmia

Is cardiac rehab done at all medical centers or is it done at specialized cardiac rehab locations? 

Cardiac rehab is an integrated multidisciplinary approach which requires the coordinated efforts of several healthcare professionals to provide optimum benefit to the patients.

Special cardiac rehabilitation centers are necessary as it requires sophisticated equipment for exercise, monitoring cardiovascular parameters  and also needs facilities for sudden cardiac complications.

Yashoda Heart Institute is a state-of-the-art facility that provides comprehensive, multi-disciplinary programmes for the prevention, diagnosis, and treatment of Cardiological and Cardiothoracic conditions. The institute is renowned for following scientifically evidenced, non-invasive, interventional and surgical practices and comprehensive emergency services. The hospital houses top class facilities like

• Minimally Invasive Cardiac Lab
• Two flat panel Cath Labs
• Cardiac OT
• Non-Invasive Cardiac Lab
• Non-Invasive Cardiac Scan on a 64-Slice CT Machine
• 12- Bedded Critical Care Unit- by an Intensivist, a critical care expert
• ICCU with a consistent 1:1 nurse to bed ratio
• Latest Electrophysiology laboratory with 3D mapping facility
• Advanced Siemens patented HD PET CT

Further, a highly expert and trained multidisciplinary team consisting of experts like cardiologists, physicians, physiotherapists, and nutritionists are available for planning, executing and supervising the cardiac rehab program at the Institute.

What are the factors that affect the cost of cardiac rehab? 

Hospital care for cardiovascular diseases varies from person to person as it depends on many factors like length of hospital stay, a need of investigations, medications and underlying medical condition of the person. Various researches conclude that cardiac rehabilitation is not only clinically effective, but it is also cost-effective in the long run. Some of the factors that affect cardiac rehab cost are:

• Type of cardiovascular event for which rehab is required
• Period of cardiac rehabilitation
• Need for advanced monitoring machines
• Sophisticated exercising equipment
• The frequency of visit to a cardiac rehabilitation center

Conclusion:

Cardiac diseases cause a deep impact on the physical, mental and emotional health of a person. The person experiences limitations in every aspect of his life. Cardiac rehab is the medically supervised, patient-centric and customized program to reverse or manage these limitations. The program is generally scheduled for three months and the person becomes well informed about the cardiac diseases, its symptoms and learns to cope with them. Individuals undergo monitored exercise regimen and the risk of recurrence of disease is significantly reduced. Overall the quality of life is improved, and the person develops a healthy routine through cardiac rehabilitation.

Track and improve your health after a heart attack, cardiac procedure or surgery. With cardiac rehab, you are not only fit but also at a reduced risk of developing subsequent heart events in the future. 
This facility is available at Yashoda Hospitals, Secunderabad. For more details, please call 9866467677 or 9985680912

References:

• Centers for Disease Prevention and Control. How Cardiac Rehabilitation Can Help Heal Your Heart. Available at:  https://www.cdc.gov/features/cardiac-rehabilitation/index.htmlAccessed on January 22, 2019
• Mayo Clinic. Cardiac Rehabilitation. Available at: https://www.mayoclinic.org/tests-procedures/cardiac-rehabilitation/about/pac-20385192. Accessed on January 22, 2019
• National Heart Foundation of Australia. Recommended Framework for cardiac rehabilitation. Available at: https://www.heartfoundation.org.au/images/uploads/publications/Recommended-framework.pdf. Accessedon January 22, 2019
• American Heart Association. Cardiac Rehabilitation. Available at: https://www.heart.org/-/media/data-import/downloadables/cardiac-rehab-pdf ucm_497590.pdf?la=en& hash=65 AB0201B95133D33F3BBB3F5E4709744393358A. Accessed on January 22, 2019
• Oxford University Hospitals. Cardiac rehabilitation exercise programme. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/091011cardiacrehableys.pdf. Accessed on January 22, 2019
• European Society of Cardiology. Cardiac rehabilitation: Evidence for action. Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Cardiac-rehabilitation-Evidence-for-Action. Accessed on January 22, 2019