cardiac physiotherapy

CardioVascular Diseases – Improving Heart Health via Cardiac Rehab Program

India is one of the most populous countries in the world. The present health scenario suggests that our country is undergoing an epidemiological transition. The epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD). Estimates indicate that NCDs account for 53% of total deaths in India & Cardiovascular diseases (CVD) mortality tops the list of NCD deaths with 45% of deaths accounted by CVD.#1

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programs as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME (cardiac surgery).

CARDIOVASCULAR DISEASES

Cardiovascular diseases (CVDs) are a class of diseases that involves heart or blood vessels.

Common CVDs include-

  • Ischaemic Heart Disease (IHD)
  • Hypertensive Heart Disease (HHD)
  • Rheumatic Heart Disease (RHD)
  • Cardiomyopathies
  • Congenital Heart Disease (CHD)
  • Peripheral Artery Disease (PAD)

The underlying mechanism varies for the above mentioned diseases; the most common cause being atherosclerosis.

RISK FACTORS FOR CVDs

  • Hypertension
  • Smoking
  • Excessive alcohol intake
  • Diabetes
  • Obesity
  • High blood cholesterol
  • Poor diet
  • LACK OF EXERCISE & SEDENTARY LIFE STYLE

However it is estimated that 90% of CVDs are preventable.

Also most of the CVD patients can help lower their risk of future heart problems if they make changes to improve their health.

CARDIAC REHABILITATION

What is Cardiac Rehabilitation?

Cardiac Rehabilitation (Cardiac Rehab) is a professionally supervised program to help people recover from heart attacks, heart surgeries, percutaneous coronary intervention procedures such as stenting & angioplasties.

Cardiac Rehab program usually provide education & counselling services to help heart patients increase physical fitness, reduce cardiac symptoms & improve health.

BENEFITS OF CARDIAC REHAB

  • Reduction in all cause mortality rate by 20-30% (as per AHA)
  • Reduced cardiac symptoms (angina, dyspnea, fatigue)
  • Improved adherence & preventive medication
  • Increased exercise performance
  • Improved quality of life.

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programmes as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME.

What kind of services does the Cardiac Rehab Program offer?

(Read more details at http://reliva.in/knowledge_center/cardiac-rehab–staying-heart-healthy )

  • Appropriate recommendations are made for medical examination, physical activity & exercises,  based on the risk stratification process as per the American College of Sports Medicine (ACSM) that assigns participants into 3 categories-
  • Low Risk
  • Moderate risk
  • High Risk
  • A comprehensive health fitness evaluation typically includes the following before the planning & prescription of the Cardiac Rehab program
  • Resting Heart rate, BP, Height, Weight, BMI, ECG
  • Cardiorespiratory Fitness (if required) – TMT
  • Muscular Strength – RM method
  • Flexibility
  • An exercising training program is best designed to meet the individual’s health & physical fitness goals.

COMPONENTS OF EXERCISE TRAINING

  • Cardiovascular (aerobic) fitness
  • Muscular strength & endurance
  • Flexibility

Exercises that improve neuromuscular fitness such as balance & agility are also recommended by ACSM particularly for older adults & highly deconditioned persons.

ACSM also recommends loading exercises (i.e. weight bearing & resistance exercises) to maintain bone health.

A single exercise session includes the following-

Cardiac Rehab in Progress at Reliva
Cardiac Rehab in Progress at Reliva
  • Warm –up – at least 5 to 10 minutes of low <40% to moderate intensity cardiovascular & muscular endurance activities.
  • Stretching – at least 10 minutes of stretching exercises performed after warm up or cool down phase
  • Conditioning – this phase includes aerobic/resistance &/or sports related exercises
  • Cool Down – at least 5-10 minutes of low (<40% to moderate 40% -<60%)intensity of cardiovascular & muscular endurance activities.

Cardiac rehabilitation takes place as

  • In-patient Rehabilitation Programs
  • Outpatient exercise Programs

Outpatient cardiac rehab programs should begin as soon as hospital dismissal.

Most patients are capable of beginning a supervised exercise program with 1-2 weeks of leaving the hospital.

SUMMARY OF THE ACTUAL CARDIAC REHAB PROGRAM

  • While actual training program for each patient would differ, an indicative plan would be as follows:
COMPONENTSACTIVITIESRECOMMENDED TIME
Warm upStretching/low level calisthenics10 minutes
Aerobic ConditioningTreadmill (Mod Bruce/Bruce protocols or other protocols as indicative), cycle ergometer, cross trainer, stair stepping20-30 minutes as tolerated
Muscular ConditioningWeight training15-30 minutes as tolerated
Cool DownSlow walking/ stretching5-10 minutes
  • An indicative exercise prescription would be as follows (FITT Priciple) :
Frequency3-5 days/week
IntensityRPE- 11-16/ 20-80% using Heart rate Reserve
TimeApprox 60 minutes
TypeTreadmill/elliptical/ Cycle ergometer/Cross trainer/stair climber
Resistance Training8-10 exercises (1 set per exercise of 8-12 reps) that conditions the major musle groups atleast 2 days per week
Initial level of FitnessHigh = higher work loadLow =  lower work load

 

Having the essence of the details about Cardiac rehabilitation, it is important to take up these best benefitting programs seriously by moving out of the cages of ignorance & myths about CVD’s.

The larger group of hospitals do provide the cardiac rehab services but they reach out to the very few.

Its time we start giving importance to clinic based Cardiac Rehab programs who plan for the Outpatient Exercise programs for cardiac patients.

ReLiva Physiotherapy & Rehab Clinic in Navi Mumbai has taken an initiative towards providing this utmost care to the cardiac patients by providing clinically monitored & supervised Cardiac Rehab Outpatient programs.

We believe in “Exercise is Medicine”. (Read what our Cardiac Rehab patients have to say about us by clicking here.)

Like all medicines, ‘Effective Dosage” of exercise is important for achieving the desired results. “More” is not better. For cardiac patients, more exercise could be as or more dangerous as consuming higher dosage of medication than prescribed.

“Less” would not deliver desired & long term outcomes. Patients’ cardiovascular capabilities may remain suboptimal; thus impacting the quality of life & overall health.

Monitoring while cardiac rehab
Monitoring while cardiac rehab

“ Effective dosage” changes as physical capacity & capabilities change. Hence regular monitoring is critical to evaluate & arrive at “effective Dosage” at different stages of Cardiac rehab.

Read about Contribution of progress in a patient due to Cardiac Rehab Program : Patient at ReLivaTM in the next post by clicking here.

With these advances in Cardiac rehab, this program can become recognized as a cornerstone in a comprehensive management of cardiac patients.

More awareness is the prime necessity to optimize the effectiveness of the cardiac rehab program.

With such initiatives together we can definitely contribute towards a better life for the Cardiac patients.

Contributed by Dr. Anuradha Purohit – Mandlekar (PT). She is BPT, MPT(Cardio-thoracic), MIAP, American Health Association (AHA) certified specialist at ReLiva Physiotherapy & Rehab and pioneers the Cardiac Rehab Program.

#1- (ref – 2013, Vol.2, No.2,ISSN 2319-4154,Health Sciences E-Journal)

physiotherapy after surgery

Recovering After Surgery With Physiotherapy

Physiotherapy post surgery in the hospital and at Home

Physiotherapy after surgery is an integral part of treatment for patients who are or have been hospitalized as prolonged immobilization puts patients at risk for complications such as deconditioning, muscle weakness, myopathy and neuropathy, respiratory infections, and contractures. It is important for such patients to consider physiotherapy at home as an integral part of the recovery process.

The main aim of a physiotherapist is to assist your return to normal activities of daily living after hospitalisation. Physiotherapists typically help with many aspects of your treatment while in the intensive care unit (ICU) and will continue working with you when you transfer to a general ward until you leave hospital to go home. Even at home, in many cases a physiotherapy home care program can significantly aid the recovery of patient. ReLiva Physiotherapy's home care program is designed and our physiotherapists understand the requirements for post surgical/ post ICU patients

Our home visit physiotherapist will assess and treat neurological, musculoskeletal and cardiorespiratory complications of the patients and help them in recovery. The physiotherapist is involved in specific patient positioning, suctioning, mobilization, ambulation, strengthening and balance exercises, passive range of motion exercises and airway clearance techniques.

As per Dr Farhad Kapadia, Consultant Physician, M.D, M.R.C.P, D.A (U.K.), E.D.I.C, FRCP: "Physiotherapy may be our best tool in getting the patient rapidly functional after a critical illness, and it needs to become an integral aspect of intensive care"

Benefits of physiotherapy:

  • Enables the patients to recover from the episodes of hospital as early as possible
  • Prevent post op complications
  • Teach the patient how to manage their own recovery post discharge
  • Facilitate safe and early discharge by reducing the length of stay in the hospital
  • Improves the quality of life

Physiotherapy helps in:

  • Improve the cardiovascular endurance
  • Improved performance of daily tasks
  • Improves the strength and endurance of the muscles
  • Improves the lung capacity
  • Makes the patient mobile and independent
  • Improves the airway clearance
  • Early mobilization of ventilated patients by a physiotherapist reduces mortality, and results in improved physical function and mobility

Physiotherapy post surgery:

The main aim is to return to the normal activities as early as possible.

Routine post operative physiotherapy intervention comprises of breathing exercises, circulatory exercises and early mobilisation to prevent complications and education in home management cardiovascular fitness, limiting restrictions due to medical procedure and

Positioning: To prevent complications like bedsores, congestion in the lungs, change of positions after regular intervals become important.

Chest PT:

  • Breathing exercises are important for the patient to reduce the chest infections and improve the air entry in the lungs. It also helps complete expansion of the thorax in order to have an effective breathing. Breathing exercises includes deep breathing exercises, segmental breathing exercises, thoracic expansion exercises, pursed lip breathing exercises and active cycle of breathing techniques.
  • Coughing huffing techniques where the patient is taught how to do forceful expiration by supporting the wound to get rid of the accumulated sputum actively
  • Airway clearance: physiotherapists help to clear the excess sputum by different techniques like positioning the patient, postural drainage, suctioning and use of different expiratory devices

Limb PT:

  • It is important to maintain blood circulation following surgery to reduce the risk of deep vein thrombosis due to immobility. Hence mobility exercises are important.
  • Also, it helps to improve and maintain the joint mobility and muscle strength which eventually gets deconditioned due to illness

Mobilisation:

  • Early mobilisation is a key factor in reducing post operative complications, enabling a quick recovery and timely discharge from hospital. Patient is assisted to get out of bed by physiotherapist on the day of your operation or the following day depending upon the type of the surgery. The final goal is to increase patients mobility making them independent and training stair climbing if required.

The above mentioned treatment principles were the general ones. But the treatments differs in different surgeries viz; orthopedic surgeries, abdominal surgeries, cardiothoracic surgeries, vascular surgeries, neuro surgeries.

To determine the treatment needs,the physiotherapist assesses the patients physical function including:

  • Pain, swelling, joint range of motion, muscle strength, muscle coordination, mobility status, balance, respiratory status and cardiovascular fitness in ortho surgeries
  • Pain, discrepancies in balance, coordination, muscle weakness and fatigue, work of breathing, and loss of range of movement, loss of cardiovascular fitness and mobility status in abdominal and cardiovascular surgeries
  • Pain, muscle tone, consciousness, orientation, work of breathing, balance and coordination, sitting and standing ability, synergy patterns, gait in neuro surgeries.

If you or your loved ones, have been recently discharged from the hospital after a long stay, the patient needs to continue supervised physiotherapy treatment to ensure complete recovery in the long term basis. Please feel free to give us a call and speak to our physiotherapists should you require any assistance.

recovery from knee pain

Dreams come true!

Painful knees are a very common occurrence among the elderly and so was with Mr Narayanaswamy. He continued to live with painful knees which eventually hampered his everyday activity. There was chronic pain and despite medication his walking and general movement began to decline. He continued to console himself that the reduced activity and stamina was owing to his increasing age.

But after a prolonged period of about two years, by when he was bed-ridden and almost totally inactive – he underwent total knee replacement as advised by his doctor.

After an initial rehab of knee replacement, an average person usually reports significant improvement in walking and other movements. Unfortunately Mr Narayanaswamy was not showing any signs of recovery. Instead he consistently suffered from fever and weight loss. Eventually a TB infection was diagnosed that had affected the TKR implant too. So a revision surgery had to be performed on him shortly, thereafter.

It is at this stage that I got to meet Mr S. Narayanaswamy – who had gone through so much in the last two years. Not just being physically weak he was feeling mentally drained too. He recalls “After I came from the hospital, I was very low on physical as well as mental strength. I was depressed also.  Even the slightest of movement made me breathless.

I was to be his home visit Physiotherapist from ReLiva. On his initial assessment, I realized that it was not just his stamina, he was even having difficulty balancing himself while standing. He had been bed-ridden and completely inactive for more than a year.

As a physiotherapist, I identified that his immediate goal was to improve his balance, regain strength and thereafter build up his stamina. All of these eventually will help him regain self-confidence.

Together we worked hard day-in and day-out. I would visit him regularly at his place and work on his goals through a combination of therapy and exercises. Gradually he showed signs of recovery and began to stand properly on his own. We systematically progressed to the next set of exercises. Now I had prescribed him several movements to be done on his own during the rest of the day. The committed and sincere person that he was, he would do those home exercises diligently on most occasions. We were moving from one strength to another.

It was at the end of another session of physiotherapy when he broke the news with a beaming smile that he was thinking of visiting his daughter abroad!

We had come a long way. Here was a man who was completely bed-ridden for a year and a half and could not even speak on the telephone for more than a minute and NOW – he wanted to travel overseas! He was daring to dream and together we shall have to make his dream come true! We now worked towards a deadline when he could walk independently to take this long journey on his own.

After another bout of intense physiotherapy, he reported, “my energy level has gone up, I have regained my emotional strength, there is no depression, no breathlessness! I am walking properly and climbing stairs.”

Last, I saw him the day before he was to take his flight and he walked on his own with his walking stick. We did some strengthening exercises which he would continue doing on his own while he was away. He told me that “I am a happy individual now. I am back to life!” … what he didn’t realise was : What a happy and delighted therapist he was leaving behind in me watching his dream come true!

As shared by Dr Shrutika Parab (PT). Dr Shrutika is a home visit physiotherapist with ReLiva Physiotherapy. She is immensely popular among her clients for her enthusiastic and positive approach. You can contact her directly at ReLiva (+91 9920991584) or email to her at contact@reliva.in.

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