13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Empowering Clients with Heart Disease through a Cardiac Rehabilitation
Programme
Authors: Valerie Flattery & Cardiac Rehabilitation Team
Cardiac Rehabilitation Department, University College Hospital Galway, Ireland,
Phone: +35391544997.
Cardiac Rehabilitation has been defined by World Health Organisation as a programme
that favourably influences the underlying cause of the disease and ensures that an
individuals physical, mental and social conditions are addressed so that they may resume
their place in the life of the community. Cardiac Rehabilitation is an integrated
component of the client’s whole treatment process. (1). A multidisciplinary team has
been functioning at University College Hospital Galway, Ireland since 2001.
The team members are:
 Cardiac Rehabilitation Nurse
 Community Liaison Nurse
 Physiotherapist
 Dietician
 Occupational Therapist
 Medical Social Worker
 Cardiologists
The programme is directed by the Consultant Cardiologists. The Cardiac Rehabilitation
Team liaises with the Cardiac Technicians and other members of the Cardiology
Department.since January 2001 delivering an eight week programme of Cardiac
Rehabilitation.
The Aims of Cardiac Rehabilitation at University College Hospital Galway
To educate the client about their heart
disease and to teach skills to cope with and
overcome their condition
To improve the quality of life of the client
“They say too much information is a bad
thing- not so”
“Overall course very worthwhile and
enjoyable”
To bridge the gap between hospital and
home
“I was a little ‘at sea’ on first being
discharged but the course gave me great
confidence”
To assist and empower the client to return to
optimal physiological; psychological and
social status so they can return to previous
life roles
“ Would have found it difficult to resume
full activity without the additional
knowledge”
To build self confidence to encourage
“All my questions were answered which
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
lifestyle changes as appropriate
was a great help to me and made me feel
very secure”
The eight week structured Cardiac Rehabilitation Programme consists of exercise and
educational sessions. The topics covered in the informational sessions include: risk
factors; heart disease; nutrition; medication; stress management; activity guidelines; work
issues; emotional aspect of illness. Family members are encouraged to take an active part
in the client’s rehabilitation. All members of the multidisciplinary team are involved in
delivering the educational component. The exercise sessions are planned and supervised
by the Cardiac Rehabilitation Nurse and Physiotherapist.
The Role of the Cardiac Rehabilitation Nurse Specialist
 Co-ordinates the 8 week programme
 Assesses clients risk factors; signs and symptoms and sets goals with clients
 Works in partnership with Physiotherapist during exercise classes in monitoring
clients exercise tolerance
 Organises fasting lipid profiles; fasting glucose and liver profiles. Analyses results
and takes appropriate action
 Helps to empower client to take responsibility for risk factor management and
facilitates shared care between primary and hospital care
 Facilitates group session on Lifestyle Changes and Risk Factor Modification
 Evaluates clients goals post rehab and percentage attendance at programme which
indicates motivation
 Ensures clients have follow-up appointments
The Role of the Physiotherapist in Cardiac Rehabilitation
The physiotherapist’s role in the cardiac rehabilitation programme involves instructing
the clients in the correct way to use the exercise equipment, as well directing them as to
the duration and intensity they should be exercising at during the classes and at home.
An education session on exercise is also given which aims to educate the client about the
role exercise has to play in the their physiological development and how to develop a
structured exercise programme for themselves.
The Role of the Occupational Therapist in Cardiac Rehabilitation
“Building Healthier Hearts”- the report of the Cardiovascular Health Strategy Group
identified Occupational Therapists as one of the health professionals required to deal with
the multi-factorial complexities of cardiac patients. In the cardiac rehabilitation
programme Occupational Therapy intervention can contribute towards the general aims
of the programme by enhancing and maintaining the physiological and psychosocial
status of the patient through:
 Improving tolerance for functional activities
 Improving functional independence
 Reducing stress, anxiety and depression
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings

Preparing patients physically and psychologically for return to home, activities of
daily living, work and leisure.
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Canadian Occupational Performance Measure (COPM)
The Canadian Occupational Performance Measure (COPM) is an individualised clientcentred measure designed by Occupational Therapists to detect changes in a client’s selfperception on occupational performance over time. It is designed to be used as an
outcome measure. This measure identifies occupational performance as being in the areas
of self care; productivity and leisure. It is a semi- structured interview to identify
problems. These are rated and rescored post the Cardiac Rehabilitation programme. The
COPM was used with all 144 clients brought onto the 8 week Cardiac Rehabilitation
programme. 85 of these individuals scored performance deficit areas, and 60 of these
clients were rescored post the 8 week programme. Some of these results are as follows:
Hospital Anxiety & Depression Scale
The Hospital Anxiety and Depression Scale (HAD) has been proven to be a reliable, valid
and widely used instrument for detailing states of anxiety and depression for clients
attending a general medical setting. (2). The score range for anxiety and depression is 021 with a score of ‹ 7 for non- cases; 8- 10 for possible cases and › 11 for definite cases.
A score of › 8 for either anxiety or depression is considered clinically significant.
In 2004 103 clients had the HAD completed. The data above is for the clients with
clinically significant scores. Following the 8 week programme, 3 clients continued to
The Role of the Social Worker In Cardiac Rehabilitation
The Social Worker in Cardiac Rehabilitation assists patients and their families adjust to
new circumstances brought on by heart disease, through counselling and groupwork.
Issues addressed often include loss; identity; role change; anxiety and depression. During
the 8 week Cardiac Rehabilitation programme the Social Worker facilitates groups on the
emotional aspects of heart disease; partners and friends group and co facilitates stress
management with the Occupational Therapist as well as meeting with patients
individually as necessitated.
Stress Management
The Occupational Therapy and Social Work services to Cardiac Rehabilitation carried out
a patient satisfaction survey on Phase III Cardiac Rehabilitation patients attending the
stress management sessions from July- October 2004. The results were tabulated and
analysed.
“I have a better awareness and am trying to identify what stresses me”
“It has been good to see other people have the same problems as yourself”

70% of participants said they felt their questions were answered excellently and
20% very well

90% of participants felt the sessions were of the right length
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
The Role of the Dietician in Cardiac Rehabilitation
The dietician has an important role to play in the primary and secondary prevention of
CHD. Secondary prevention is regarded to be of greatest importance. The interventions
during the 8 week programme include a group talk and guided supermarket tour. This talk
focuses on the more practical side of the healthy heart diet such as label reading and
cooking methods. The aim of the tour is to assist clients with the practical aspects of their
dietary change by demonstrating healthy eating choices at the point of purchase.
Client comments on Supermarket Tour:
“Finding out that there could be variety in the diet and not as restricted as I thought”
“Learnt how to look for and read ingredient labels”
The Future?
 In the future we hope to further develop our service to clients who are unable to
participate in the current Cardiac Rehabilitation Programme, for example, heart
failure clients.
 Relaxation techniques are described as a valid treatment modality that can be
taught in Cardiac Rehabilitation. (3). The physical effects of relaxation include:
decrease in blood pressure; decrease in heart rate and decrease in arrhythmias. In
a 5 year study by van Dixhoorn et al (1999), clients after MI who enrolled in a
Cardiac Rehabilitation Programme with relaxation therapy had considerably less
cardiac events and rehospitalisations than clients who had exercise training only.
These results suggest that the inclusion of relaxation therapy improves the longterm outcomes of Cardiac Rehabilitation.(4).
Conclusion:
“The entire process was professional; fun; hard work; caring; educational and I am
sorry it is over”
(1) Chua, T.P. & Lipkin, D.P. (1993). Cardiac Rehabilitation. British Medical Journal.
306: 731- 732.
(2) Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale.
Acute Psychiatry Scand. 67: 361- 370
(3) Van Dixhoorn, J., Duivervoorden, H.A, Pool, J. (1989). Physical Training and
Relaxation Therapy in Cardiac Rehabilitation Assessed Through a Composite Criteria for
Training Outcome. American Heart Journal. 188 (3); 545- 552
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
(4) Van Dixhoorn, J., Duivervoorden, H.A. (1999). Effect of Relaxation Therapy on
Cardiac Events after Myocardial Infarction: a 5 Year Follow-up Study. Journal of
Cardiopulmonary Rehabilitation. 19: 178- 185
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