29th September 2022 is celebrated as World Heart day. This day is observed to cater to and manage the needs of the increasing number of patients who have undergone cardiac surgery. Cardiac rehabilitation is a treatment process that is found to be effective for patients suffering from a heart attack, coronary artery disease, heart failure, angina, or heart surgery. Cardiac Rehab is a complex intervention that includes Physical activity, Exercise training, and Cardiovascular risk management to improve the well-being and functional capacity of patients with heart disease. The treatment involves various healthcare professionals including healthcare providers, nurses, and rehabilitation specialists. A physiotherapist is one healthcare professional who works with the patient during cardiac rehab and designs an exercise program for the patient. These exercise programs are personalized according to the patient's needs. In this blog, we will guide you through what are the potential benefits and goals at each stage that you can aim for, as you move through the recovery phase of your cardiac condition.
CARDIAC REHABILITATION USUALLY PROGRESSES THROUGH THESE 4 PHASES:
Phase I starts when the patient is still in the hospital. Rehabilitation exercises and regimens are recommended and supervised by the experts at the hospital.
Phase II is when the patient is discharged from the hospital, cardiac rehabilitation usually involves outpatient care.
Phase III starts when the patients are prescribed to continue the cardiac rehab exercises and regimens on their own at home.
Phase IV starts when the patient continues to follow the guidance on exercise and lifestyle. The patient proceeds independently with the current exercise training. He/she should receive regular check-ups to make sure that he/she is effectively managing the heart condition and thus avoiding any flare-ups.
Phase I or clinical cardiac rehab:
Patients with acute heart conditions, such as those recovering from a heart attack or heart surgery, may be referred to a cardiac rehab team while still in the hospital. Phase I cardiac rehab starts in the hospital, and the physiotherapist helps to recover basic functional mobility. The patient is taught to learn techniques to monitor the activity. This phase likely lasts between 2 and 5 days, depending on the patient's physical condition. The physiotherapist designs and carefully monitors the progress and limits the exercise program to get the patient back on his/her feet again. This initially involves just sitting up in bed, standing, and testing the range of motion, before moving to short walks around the hospital wing.
Phase II or outpatient cardiac rehab:
Once the patient leaves the hospital, he/she can engage in phase 2 cardiac rehabilitation in an outpatient physiotherapy clinic. Though the patient must still be having difficulty with functional mobility. The physiotherapist will closely work with the patient to ensure a smooth transition into outpatient rehab. The patient is monitored through lifestyle changes and as he/she begins to progress with the exercise regime.
Phase III Post-cardiac rehab:
Phase III cardiac rehabilitation is the next step in the physiotherapy rehab program. Phase III cardiac rehab involves more intensive exercises and activities while simultaneously monitoring vital signs, such as blood pressure and heart rate, which should remain stable while workloads are increased to ensure a safe transition into phase III cardiac rehabilitation.
Physiotherapy Evaluation
The physiotherapist conducts the initial evaluation of phase 3 cardiac rehab, by asking the patient to perform various tests and measures to assess the functional ability. During the initial evaluation in phase 3 cardiac rehab, the physiotherapist may also choose to perform a specific outcome measure to provide an objective measure of functional mobility. Outcomes measures are also used during phase 3 cardiac rehab including the timed up-and-go test and the 6-minute walk test.
During phase III of cardiac rehab, the physiotherapist aims to help the patient become more independent and informed. The patient learns how to self-monitor his heart rate and exertion levels during exercise.
Phase 3 cardiac rehabilitation mostly involves exercises. The physiotherapist prescribes specific exercises to improve the overall tolerance and endurance level for the activity. The exercises include working on a stationary bike, treadmill walking, flexibility, and upper and lower body strength exercises. Before starting phase III, the physiotherapist should ensure that the patient is fully capable of monitoring his/her exercise and activity intensity. These techniques may include checking the heart rate, using the Borg scale, or using a heart rate monitor to assess exercise intensity while working out. The therapist also teaches the patient simple talk test to monitor their activity level.
As the patient progresses through phase 3 cardiac rehab, the physiotherapist will prescribe more independent exercises and activities. Usually, the patient spends 3 to 4 weeks participating in phase 3 cardiac rehabilitation This is done to prepare the patient for phase 4 cardiac rehabilitation, independent exercise, and lifestyle modifications. The physiotherapist will ensure that the progress is safe through the program with the ultimate goal to move on to independent exercises in phase 4 cardiac rehabilitation.
Phase IV or Maintenance:
After the completion of the previous three stages of cardiac rehabilitation, the patient is well aware of the heart condition and how best to manage it. Independent exercise and conditioning are essential to maintain optimal health and prevent the possibility of future cardiac problems. While phase IV is an independent maintenance phase, the physiotherapist helps to make changes in the ongoing exercise routine to help achieve physical fitness and wellness. Phase 4 essentially continues for the rest of their life.
By working closely with the concerned physiotherapist and participating fully in the four phases of cardiac rehabilitation, the patient can increase the chances of returning to optimal health quickly and safely.
