Cardiac Rehabilitation Flashcards
(33 cards)
What were the concerns about early mobilization after cardiac events?
Arrhythmias, ischemia, aneurysm formation
Why was it traditional to limit mobility following cardiac events?
To avoid complications and promote healing
What are the potential consequences of prolonged bed rest after cardiac events?
Decline in functional capacity, prolonged hospital stay, increased morbidity, and mortality
What is the definition of cardiac rehabilitation?
The coordinated sum of activities required to influence favorably the underlying cause of cardiovascular disease and provide optimal physical, mental, and social conditions for patients’ optimal functioning.
What are some components of cardiac rehabilitation?
Structured exercise, education, psychological support, social support, lifestyle advice, and risk factor management.
Which patient groups can benefit from cardiac rehabilitation?
Post MI (Myocardial Infarction), CABG (Coronary Artery Bypass Graft), PCI (Percutaneous Coronary Intervention), Stable CAD (Coronary Artery Disease), Chronic heart failure, GUCH (Grown-Up Congenital Heart) patients, patients with complex devices, cardiac transplants, and those who have undergone valve/other surgeries.
What are the goals of cardiac rehabilitation?
- Reduce the risk of adverse cardiac events such as death, MI, and rehospitalization.
Improve cardiac symptoms.
Curtail the physiological and psychosocial effects of heart disease.
Reintegrate patients into the community with good functional status.
What are some benefits of cardiac rehabilitation?
- Reduced mortality.
Reduced adverse cardiac events (e.g., MI).
Reduced rehospitalizations.
Higher smoking cessation rates.
Improved functional status.
Weight reduction.
Lower blood pressure and lipids.
Better diabetic control.
What does the evidence show regarding exercise training in cardiac rehabilitation?
Meta-analyses have shown that exercise training in patients following MI can lead to a reduced risk of cardiovascular death, reduced need for hospital readmission, improved functional capacity, and reduced overall and cardiovascular mortality in patients with stable IHD (Ischemic Heart Disease).
What are some considerations regarding cause and effect in cardiac rehabilitation?
- Observational data is available, but prospective randomized studies are limited.
Patient self-selection may influence outcomes, with potentially fitter, more motivated, and better-compliant patients participating.
Reporting bias can affect the interpretation of results.
However, cardiac rehabilitation has been associated with better health outcomes.
What are the lipid targets in cardiac rehabilitation?
Target total cholesterol <4 mmol/L and LDL <2 mmol/L.
How does exercise training impact lipid levels?
Exercise training is associated with reductions in total cholesterol, LDL-cholesterol, and triglyceride levels, as well as an increase in HDL cholesterol. It also improves compliance with medication, including statins.
What are the blood pressure targets in cardiac rehabilitation?
The target blood pressure is <140/90 mmHg (ideally <130/85 mmHg).
How does long-term exercise training impact hypertension?
Long-term exercise training is associated with a reduction of approximately 10-20 mmHg in systolic blood pressure. It is recommended to combine exercise with lifestyle modifications such as weight loss, reduced salt intake, reduced alcohol intake, and improved compliance with medication, including ACE inhibitors.
What are the effects of exercise training on diabetes?
Exercise training is associated with improved glucose tolerance, lower serum insulin levels, increased cellular insulin sensitivity, reduced triglyceride levels, and reduced body fat levels. It also improves compliance with diet and medication, such as Metformin and insulin.
What are the six core components of cardiac rehabilitation according to BACPR (British Association for Cardiovascular Prevention and Rehabilitation)?
Health behavior change and education
Lifestyle risk factor management
Physical activity and exercise
Healthy eating and body composition
Tobacco cessation and relapse prevention
Psychosocial health and medical risk management, including long-term strategies, audit, and evaluation.
What activities are typically involved in Phase 1 of cardiac rehabilitation?
In-hospital activities include clinical assessment, education, reassurance, addressing risk factors, mobilization in/around the ward, and discharge planning. It usually takes place during the first week after admission.
What does Phase 2 of cardiac rehabilitation involve?
Phase 2 occurs immediately post-discharge and typically lasts from week 2 to week 6. It includes a personal exercise program, stress management, reinforcement of health education, and daily exercises in and around the home. Patients have telephone contact with the rehabilitation team and may receive home visits if required.
What are the characteristics of Phase 3 in cardiac rehabilitation?
Phase 3 takes place in a community setting such as a local leisure center or gym, starting around week 6 and lasting up to 6 months. It involves an assessment of exercise capacity, an individualized exercise program, multi-modality exercises (steady-state/intervals/circuits), a health education program, and psycho-social support. The exercise program is ideally based on a symptom-limited exercise stress test.
What is the focus of Phase 4 in cardiac rehabilitation?
Phase 4 is the lifelong maintenance phase of cardiac rehabilitation. It involves unsupervised exercise and encourages at least 2.5 hours of moderate-intensity aerobic exercise per week, spread across at least 5 days. The exercise should consist of bouts of at least 10 minutes and should be performed at a moderate intensity (around 60-70% of maximum heart rate). This phase can be conducted in various settings, such as a local gym.
What is the recommended Borg Level for perceived exertion during activity in cardiac rehabilitation?
Aim for Borg Level 4-6 activity.
What are some benefits of patient education in cardiac rehabilitation?
Patient education helps patients cope with their illness, improve their health-related quality of life, and improve compliance with lifestyle interventions, medication, investigations, and non-drug treatments.
What are the targets for weight optimization in cardiac rehabilitation?
Assess diet, target BMI of 18.5-25 kg/m2, target waist measurement of <94 cm for men and <80 cm for women. This involves reducing calorie intake, saturated fat, and salt, and following a reduced-calorie diet. Exercise is also important.
How can smoking cessation be achieved in cardiac rehabilitation?
Smoking cessation strategies include quitting smoking altogether, participating in the NHS smoking cessation program, considering hypnosis, and using drugs such as nicotine replacement therapy.
