Cardiac Rehabilitation

The WHO defines cardiac rehabilitation as:

The rehabilitation of cardiac patients is the sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and socialbconditions, so that they may, by their own efforts, preserve or resume when lost, as normal a place as possible in the community. Rehabilitation cannot be regarded as an isolated form of therapy, but must be integrated with the whole treatment, of which it forms only one facet.

(WHO 1993)

Typically, patients following an acute MI and coronary artery by-pass graft (CABG) surgery have been referred for cardiac rehabilitation. The National Service Framework recommends that cardiac rehabilitation should be available to people manifesting CHD in various forms. Many more groups are now included in both comprehensive and exercise-based rehabilitation.

Post-revascularisation

The number of patients receiving percutaneous transluminous coronary angioplasty (PTCA) and stenting are increasing. Education for lifestyle modification and exercise training is proven to be beneficial on physiological

and psychosocial risk factors.

Stable angina

Cardiac rehabilitation improves the management of symptoms and exercise training assists in raising the angina threshold so patients are able to do more before they experience angina.

Chronic heart failure

With the advances in the management of CHD, the number of patients presenting with chronic heart failure are increasing. Exercise-based cardiac rehabilitation is beneficial in improving exercise capacity, reduction of symptoms and improving quality of life. Patients with mild-to-moderate heart failure show the largest improvements.

Valve surgery

Supervised exercise training in comprehensive cardiac rehabilitation is beneficial in improving functional capacity, reducing symptoms and improving the quality of life in this patient group.

Congenital heart disease

This group includes young people and children. Supervised exercises improve exercise capacity and psychological function in this patient group.

Implanted cardioverter-defibrillators

The number of patients with implanted cardioverterdefibrillators in a cardiac rehabilitation programme may be small; however, comprehensive cardiac rehabilitation is safe and improves exercise ability and psychological well-being significantly.

COMPONENTS OF CARDIAC REHABILITATION

• Risk factor assessment and modification.

• Education.

• Exercise.

• Psychosocial support.

Cardiac rehabilitation team

The cardiac rehabilitation package individualised for each patient requires expertise and skills from a multidisciplinary collaborative team of professionals. The team includes a cardiologist and staff from nursing, physiotherapy, dietetics, pharmacy, occupational therapy and psychology with training in cardiac rehabilitation. Continuation of care in the community involves the primary healthcare team that is the general practitioner and cardiac nurse, phase IV exercise specialist and a link from a local cardiac patient support group

The role of the physiotherapist

Physiotherapists have the knowledge, assessment skills and clinical reasoning, combined with evidence-based approach to treatment, to undertake the rehabilitation management of patients with multi-pathology problems. Physiotherapists are also trained to run group sessions and classes. Hence, the role of the physiotherapist within the multi-disciplinary team should focus on exercise prescription, training and education in phases I–III. The modification in exercise prescription needs to be discussed with medical and nursing team members. In a group setting where exercise is delivered to CHD patients, teamwork and liaison with other team members who are aware of patients’ clinical and psychosocial issues is essential.