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 The epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD).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 (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)
- 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
- Excessive alcohol intake
- 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.
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.
What kind of services does the Cardiac Rehab Program offer?
(Read more details at)
- 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
- 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
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-
- 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:
|Warm up||Stretching/low level calisthenics||10 minutes|
|Aerobic Conditioning||Treadmill (Mod Bruce/Bruce protocols or other protocols as indicative), cycle ergometer, cross trainer, stair stepping||20-30 minutes as tolerated|
|Muscular Conditioning||Weight training||15-30 minutes as tolerated|
|Cool Down||Slow walking/ stretching||5-10 minutes|
- An indicative exercise prescription would be as follows (FITT Priciple) :
|Intensity||RPE- 11-16/ 20-80% using Heart rate Reserve|
|Time||Approx 60 minutes|
|Type||Treadmill/elliptical/ Cycle ergometer/Cross trainer/stair climber|
|Resistance Training||8-10 exercises (1 set per exercise of 8-12 reps) that conditions the major musle groups atleast 2 days per week|
|Initial level of Fitness||High = 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.
“ 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)