Exercise and Cardiac Rehabilitation by bestt571

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									Exercise and Cardiac

        Siobhan Doyle
Clinical Lead Physiotherapist
• Benefits of exercise
• Recent studies
• Components of exercise class
• Health and Safety recommendations
• Physical inactivity is estimated to cause 22%
  of ischaemic heart disease
• The risk of developing cardiovascular disease
  is 1.5 times greater in people who do not
  follow minimum physical activity
Physical activity:
•    improves glucose metabolism
•    reduces body fat
•    lowers blood pressure
•    improves musculoskeletal strength
•    controls body weight
•    reduces symptoms of depression
• A Cochrane review in 2004 concluded that
  exercise only cardiac rehabilitation reduced
  all cause mortality by 27% and cardiac
  mortality by 31%

• The Canadian Co-ordinating Office for Health
  Technology Assessment reported reductions
  of all cause mortality of 24% and cardiac
  mortality of 23%.

• A study by Witt et al in 2004 found that not
  only was participation in cardiac rehab
  associated with decreased mortality after MI
  but also with lower risk of recurrent MI
  Assessment before exercise
• Clinical risk stratification is suitable for low to
  moderate risk patients undergoing low to
  moderate intensity exercise
• Exercise testing and echocardiography are
  recommended for high risk patients and/or
  high intensity exercise
• Functional exercice capacity should be
  evaluated before and on completion of
  exercise testing.
       Exercise content

•   warm-up
•   conditioning phase
•   cool down
•   relaxation
• Graduated low intensity exercise
• Short dynamic stretches

• increase myocardial blood supply
• Increase soft tissue flexibility
• Mobilise joints
        Conditioning phase
• Frequency: supervised exercise should be
  twice weekly for a minimum of 8 weeks. In
  addition patients should be given a home
  exercise programme

• Intensity: low to moderate intensity exercise
  is most suitable to meet the needs of a broad
  range of patient groups. Individual patients
  should be prescribed target heart rate ranges
  and/or Borg RPE based on assessment and
  risk stratification
• Time: Optimum training effect is achieved
  with 20-30 minutes of continuous aerobic

  – Progression of conditioning phase depends on
    initial functional exercise capacity, age and health
  – More deconditioned patients may benefit more
    from interval type training
• Type: Aerobic type activities have been
  found to be most beneficial.
   - Exercises should include simple repetitive
  movements of large muscle groups

• Exercise intensity should be monitored and
  modified using the Borg RPE scale and/or
  heart rate monitoring

 -Limitations exist when each of these
 methods is used individually.
               Cool down

• Exercise should be followed by a cool down
  period which includes low intensity exercise
  and short stretches.

• Patients should be supervised for up to 15
  minutes following exercise
        Resistance training

Cardiac patients may require resistance
training to facilitate a return to physically
demanding activities
This is only appropriate for low-moderate risk
patients and should not be introduced until 4-
6 weeks of supervised aerobic exercise have
been completed
                Phase 4

• PHASE 4 is a community based activity which
  follows immediately after the completion of
  the phase 3 programme.
  The key aim is long term compliance to
  exercise and thus the programme must be
  enjoyable and convenient.
                   Phase 4

• Regular supervised training sessions are
  provided and exercise prescription is
  individualised for additional unsupervised
  physical activity.
• In the case of deterioration of functional
  capacity a referral can be made back to the
  primary care team.
       Health and safety for
          phase 3 and 4
• Fever and acute systemic illness
• Unresolved/unstable angina
• Resting blood pressure systolic >180 mmHg,
  diastolic > 100mmHg
• Significant unexplained drop in BP
• Tachycardia > 100bpm
• New or recurrent symptoms of
  breathlessness, palpitations or dizziness
• Swelling of ankles or significant lethargy
           Health and safety

• Prior to exercise patients should be inducted
  in to the safe use of all equipment
• All staff should be trained in basic life support
  and updated regularly
• Appropriate resuscitation equipment including
  a defibrillator, should be available at every
  supervised exercise session. At least 1 staff
  member should be trained to advanced life
          Health and safety

• Protocols for the management of medical
  emergencies must be available
• Rapid access to emergency services must be
  available e.g. crash team or ambulance
• Equipment must be maintained
• Venue must be suitable – adequate space,
  temperature, ventilation and humidity
• Drinking water must be available
          Health and safety

Staffing levels
• Phase 3 - Current guidelines recommend two
  trained staff should be present at all times
  during exercise training with a staff ratio of
  not more than 5:1
• Phase 4 – In the absence of guidelines for
  staffing levels for phase 4, recommendations
  for phase 3 should be followed.
• There is a perception that exercise training
  for cardiac patients is dangerous but if these
  safety issues are implemented, available data
  suggests that cardiac rehabilitation
  programmes result in very few complications.
  The incidence of death is one per 1.3 million
  exercise hours.

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