India has the dubious reputation of being the heart disease and diabetes capital of the world. Heart attack, arrythmia, angina pain, coronary artery disease, cardiomyopathy, heart failure feature as common cardiovascular disease. Hypertension or high blood pressure is the other most common risk factor for heart disease (disease of cardiovascular system). Cardiac rehabilitation program works as treatment as well as prevention tool for heart disease.
Studies suggest that the epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD) such as heart attacks and stroke, cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes. 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).
What is Cardiovascular Disease?
Cardiovascular disease (CVD) is a class of diseases that involve heart or blood vessels. Common CVDs include-
- Ischemic 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.
Related Reading: Stroke Treatment & Recovery
What are the Risk Factors for CVDs?
Population with the following is known to be at a higher risk of Cardiovascular Diseases:
- Hypertension
- Smoking
- Excessive alcohol intake
- Diabetes
- Obesity
- High blood cholesterol
- Poor diet
- Lack of exercise and sedentary lifestyle
However, it is estimated that up to 90% of CVDs are preventable2,3.
Also most of the CVD patients can help lower their risk of future heart problems if they make changes to improve their health.
Related Reading: Cardiac Rehab – Staying Heart Healthy
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.
Why Cardiac rehabilitation?
Heart disease can be a life changing event. But it can also be a positive life-changing event. If appropriate care is taken, most people not only recover from their event (angina or heart attack), but go on to improve their quality of life to a higher level than before. After a heart event, post-care and rehabilitation is a vital part of the process. A structured cardiac rehabilitation program is crucial to get the patient on the path to recovery, and to prevent further illness.
It wouldn’t be wrong to say that your treatment is incomplete without cardiac rehabilitation
Leading cardiology associations such as the American Heart Association, have classified Cardiac Rehabilitation as a Class I recommendation, on par with other life saving measures such as a daily aspirin dose. Extensive research shows that patients who underwent cardiac rehabilitation, showed a 20% reduction in total death and 26% in cardiac (heart) deaths when compared with those on usual medical care.
At Reliva, we believe in Exercise as Medicine. Read what our Cardiac Rehab patients have to say about us by clicking here.
What are the benefits of Cardiac Rehab?
The goals of cardiac rehabilitation are:
- To help the person get back to his or her normal routine, as quickly as possible
- To institute lifestyle changes and regular monitoring to reduce future risk of cardiac events like heart attack.
- To improve the psychological well-being of the cardiac patient.
The successful completion of these goals helps attain the following benefits, overall.
- Reduced cardiac symptoms (angina, dyspnea, fatigue)
- Improved adherence & preventive medication
- Increased exercise performance
- Improved quality of life.
- Reduction in all cause mortality rate by 20-30% (as per AHA)
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 Rehabilitation Program offer?
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.
What are the components of Exercise training in Cardiac Rehabilitation?
- Cardiovascular (aerobic) fitness
- Muscular strength & endurance
- Flexibility
Exercises that improve neuro-muscular 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:
| COMPONENTS | ACTIVITIES | RECOMMENDED TIME |
| 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 Principle) :
| Frequency | 3-5 days/week |
| 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.
It is 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 Mumbai 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
“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.
Related Reading: Cardiac Rehab Program : Patient Story of Recovery & Confidence
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 (PT). She is BPT, MPT(Cardio-thoracic), MIAP, American Health Association (AHA) certified specialist at ReLiva Physiotherapy & Rehab and pioneers the Cardiac Rehab Program.
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Scientific References:
1] ref – 2013, Vol.2, No.2,ISSN 2319-4154, Health Sciences E-Journal
2] McGill HC, McMahan CA, Gidding SS (March 2008). “Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study”. Circulation. 117 (9): 1216–27. doi: 10.1161/CIRCULATIONAHA.107.717033. PMID 18316498.
3] O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. (August 2016). “Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study”. Lancet. 388 (10046): 761–75. doi:10.1016/S0140-6736(16)30506-2. PMID 27431356.
