CARDIAC
REHABILITATION
Dr. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy
OBJECTIVE

Define different phases during implementation of
exercise program in cardiac rehabilitation.

Demonstrate exercise prescription in each phase.
PHASES OF CARDIAC REHABILITATION
PHASE I hospital activity
PHASE II immediate post discharge
PHASE III supervised out patients exercise program
PHASE IV transition to long term community ex’s
PHASE I

Graduated mobilization is initiated in the first 24-48 hours
post cardiac event

The patient is allowed to perform his morning care and to
feed himself

Start to participate in exercise program initially, supine,
sitting and standing

Monitoring patient heart rates, blood pressure, resting
electrocardiographic(ECG) and heart and breath sounds
may also be auscultated in selected patients
PHASE II

May last from 2 to 6 weeks.

It involves a closely supervised and carefully monitored
exercise

Exercise prescription should be individualized and based on
medical history, physical examination and recent exercise
stress testing results

Three main components of an exercise training program

Frequency: minimum frequency for exercising is 3 times
weekly

Time: usually need 30 -60 minutes for each session

Intensity: from 13-15 RPE in the Borg scale
PHASE III

Last up to 6-12weeks.

Required minimum equipment monitoring.

Competitive environments.

Aerobic, strengthening and endurance training.

Frequency :1-2 times per week at supervised
rehabilitation, Twice weekly independent home exercise,
The remaining days Walking.

Timing: increase time to 20-30 minutes

Intensity: THR
PHASE IV

Medically and psychologically stable

Improvement functional capacity ( 5 METs)

Exercise safe, effective and individual.

Lifestyle changes and risk factor modification

Monitor his own HR or use RPE

Recognize warning signs and symptoms
Mission of Cardiac Rehab
To restore and maintain an individual’s
optimal physiological, psychological,
social and vocational status.
Goals of Cardiac Rehab

Identify, modify, and manage risk factors to
reduce disability/morbidity and mortality

Improve functional capacity

Alleviate/lessen activity related symptoms

Educate patients about the management of
heart disease

Improve quality of life
Core Program Components
 Risk
factor management
 Baseline
and ongoing patient assessment
 Exercise/activity
training
What is Cardiac Rehabilitation?
 Medically
 Lifestyle
supervised
modification
 Monitored
progressive exercise/activity

Inpatient-Outpatient-Maintenance (Phase I, II, III)

Individualized, typically 3x/week, up to 12 weeks
 Physician
Referral Required
Patient Benefits:

Improved functional capacity

Increased knowledge of heart disease

Improved adherence to positive lifestyle changes

Better compliance with medical regime

Increased self-esteem and confidence

Reduced subsequent morbidity and mortality r/t CAD
Risk Factors
Tobacco
 Smoking
 50%
and Chew
decreased risk of CHD 1 year after cessation
Hypertension
 90%
 35
middle-aged Americans will develop HTN
million office visits/yr for HTN
Risk Factors
Hyperlipidemia
 105,000,000
 10%
reduction in TC = 30% reduction in incidence of CAD
Physical
 $76
>
people with a tot chol > 200
Inactivity
billion
60% of Americans don’t get sufficient exercise
Risk Factors
Obesity
 More
than 50% women and 60% men are overweight or
obese
 Nearly 300,000 American adults die of causes related to
obesity
Diabetes
 58%
reduction by lifestyle intervention
 75% of people w/DM die of CAD or vascular disease
Cardiac Rehab Professionals
Partners in Patient Care:

Medical Director

Referring Physician

Registered Nurses

Physiotherapist

Exercise Physiologists

Dieticians/Nutritionists

Social Services/Psychosocial

Pharmacists