Education, counseling, and behavioral interventions are important elements of cardiac rehabilitation. In this guideline, "education" is defined as systematic instruction, and "counseling" is defined as providing advice, supporl, and consultation. "Behavioral interventions" refer to systematic instruction in techniques to modify health-related behaviors. Patients with cardiovascular
disease have to learn to manage their illness and prevent or retard progression or induce regression of atherosclerosis. This management focuses on techniques of lifestyle changes, guided by health professionals.
A multifactotial risk-reduction model developed by the Stanford Coronary Risk Intervention Project showed that individualized changes in lifestyle and medical treatment reduced the risks of disease progression and coronary events in patients with coronary heart disease. The risk-reduction goals, which were consistent with national guidelines, encompassed body weight, blood pressure,lipid levels, nutrition, and physical activity . Over a four-year follow-up period, patients assigned to this model of care, as compared with patients who received usual care, had a 30 per cent reduction in saturated-fat intake, a four per cent reduction in the body-mass index, a 22 per cent reduction in LDL cholesterol levels, a 12 per cent increase in HDL cholesterol levels, and a 20 per cent improvement in exercise capacity. The rate of disease progression,assessed by angiographic evaluation of coronary lesions, was reduced in the intervention group, and the lesions were more likely to regress in this group.
The rates of major clinical cardiac events and hospitalization were also significantly decreased in the intervention group. The following general scheme is followed:
Inpatient
Smoking cessation and prevention; Assessment of physical activity, Outpatient referral.
Outpatient
Evaluation: Medical history; Risk factors; Stress testing; Vocational counseling.prescribed Exercise: On site or at home; Aerobic training; Resistance exercise.
Modification of Risk Factors: Education; Nutritional counseling; Exercise;
Medication.
Specification of Long Term Goals: Physical; Vocational; Psychological; Clinical.Safety, Intensity Level and Frequency of Exercise lkaining
The level and frequency and type of exercise should be determined for each individual patient by the team taking into consideration the risk stratification,stress testing, age, physical disabilities and other factors.The safety of cardiac rehabilitation exercise training is inferred from aggregate analysis of clinical 'experience. None of the more than three dozen randomized controlled trials of cardiac rehabilitation exercise training in patients with CHD,involving over 4,500 patients, described an increase in morbidity or mortality in rehabilitation compared with control patient groups. littensity Level
Studies have reported statistically significant irnpl-ovement in exercise tolerance after exercise training compared with baseline. The use of beta-blocking diugs inn patients following myocardial infarction did not impair improvement in exercise tolerance following cardiac rehabilitation exercise training.
Exercise rehabilitation decreases angina pectoris in patients with coronary disease and decreases symptoms of heart failure in patients with left ventricular systolic dysfunction. Exercise training is recommended as an integral component of the symptomatic management of these patients.Don't over do it: You should start slow and progress gradu'dly. If you are injured you should rest until you are recovered. Know the difference belween injured and sore. Inability to finish, nausea, and trouble sleeping are all signs of over doing it.
Have fun: Choose something that you enjoy. Emphasize the 'want' rather than the 'should' when you exercise.Find a friend: Exercising by yourself will work, but the combined motivation of a friend will prevent you from skipping as many days.Make it important: Make exercise a priority rather than m extra. If you include it as part of your daily schedule it will get done. Do it at the same time every day.
Guidelines for Safe Exercise
Frequency - 3-5 times a week.
disease have to learn to manage their illness and prevent or retard progression or induce regression of atherosclerosis. This management focuses on techniques of lifestyle changes, guided by health professionals.
A multifactotial risk-reduction model developed by the Stanford Coronary Risk Intervention Project showed that individualized changes in lifestyle and medical treatment reduced the risks of disease progression and coronary events in patients with coronary heart disease. The risk-reduction goals, which were consistent with national guidelines, encompassed body weight, blood pressure,lipid levels, nutrition, and physical activity . Over a four-year follow-up period, patients assigned to this model of care, as compared with patients who received usual care, had a 30 per cent reduction in saturated-fat intake, a four per cent reduction in the body-mass index, a 22 per cent reduction in LDL cholesterol levels, a 12 per cent increase in HDL cholesterol levels, and a 20 per cent improvement in exercise capacity. The rate of disease progression,assessed by angiographic evaluation of coronary lesions, was reduced in the intervention group, and the lesions were more likely to regress in this group.
The rates of major clinical cardiac events and hospitalization were also significantly decreased in the intervention group. The following general scheme is followed:
Inpatient
Smoking cessation and prevention; Assessment of physical activity, Outpatient referral.
Outpatient
Evaluation: Medical history; Risk factors; Stress testing; Vocational counseling.prescribed Exercise: On site or at home; Aerobic training; Resistance exercise.
Modification of Risk Factors: Education; Nutritional counseling; Exercise;
Medication.
Specification of Long Term Goals: Physical; Vocational; Psychological; Clinical.Safety, Intensity Level and Frequency of Exercise lkaining
The level and frequency and type of exercise should be determined for each individual patient by the team taking into consideration the risk stratification,stress testing, age, physical disabilities and other factors.The safety of cardiac rehabilitation exercise training is inferred from aggregate analysis of clinical 'experience. None of the more than three dozen randomized controlled trials of cardiac rehabilitation exercise training in patients with CHD,involving over 4,500 patients, described an increase in morbidity or mortality in rehabilitation compared with control patient groups. littensity Level
Studies have reported statistically significant irnpl-ovement in exercise tolerance after exercise training compared with baseline. The use of beta-blocking diugs inn patients following myocardial infarction did not impair improvement in exercise tolerance following cardiac rehabilitation exercise training.
Exercise rehabilitation decreases angina pectoris in patients with coronary disease and decreases symptoms of heart failure in patients with left ventricular systolic dysfunction. Exercise training is recommended as an integral component of the symptomatic management of these patients.Don't over do it: You should start slow and progress gradu'dly. If you are injured you should rest until you are recovered. Know the difference belween injured and sore. Inability to finish, nausea, and trouble sleeping are all signs of over doing it.
Have fun: Choose something that you enjoy. Emphasize the 'want' rather than the 'should' when you exercise.Find a friend: Exercising by yourself will work, but the combined motivation of a friend will prevent you from skipping as many days.Make it important: Make exercise a priority rather than m extra. If you include it as part of your daily schedule it will get done. Do it at the same time every day.
Guidelines for Safe Exercise
Frequency - 3-5 times a week.
- Duration - 20-60 minutes.
- Intensity (how hard) - within what has been prescribed for you. This is usually based on ypur prescribed target heart rate. Please note that this does not apply to persons on heart rate lowering'drugs like beta-bloclters and some calcium channel blockers lilte diltiazem.
Calculating Your Target Heart Rate
- age = MHR (maximum heail rate)
1) 220 2) MHR x 0.6 = (this is the low end of your target HR)
3) MHR x 0.8 = (this is the upper end of your target HR)
Example: If you are 40 years old, your MHR is 220 - 40 = 180.
- age = MHR (maximum heail rate)
1) 220 2) MHR x 0.6 = (this is the low end of your target HR)
3) MHR x 0.8 = (this is the upper end of your target HR)
Example: If you are 40 years old, your MHR is 220 - 40 = 180.
180*0.6=208
180*0.8=144
Therefore, your Targel Heart Rate is between 108 and 144 beats per minute.
Prescribed Grades of Exercise
1)Age less than 65 and not overweight
Moderate intensity aerobic; 75-85 per cent maximal heart rate; Walking,jogging, cycling; 3-4 days a week; 30-45 min-continuous or interval.
2)Age >65 years
Low intensity aerobic and resistance; 65-75 per cent of maximal heart rate;Walking, cycling; 3-4 days per week; 30 ~ n j n (can be intennittent).
3)Overweight
Moderate-high intensity aerobic; 65-80 per cent heart rate; Walking; 5-6days per week; 45-60 minutes.
4)Age >65, physically disabled or overweight
Optirnise: Use resistance exercise where feasible (Table ).
Frequency
For many low-risk coronary patients, particularly those following myocardial revascularization proceclures, rehabilitation often begins shortly after discharge from the hospital; many enter immediately what has traditionally been considered a Phase I11 program, that is, without intervening supel-vision in a Phase I1 component.
Prescribed Grades of Exercise
1)Age less than 65 and not overweight
Moderate intensity aerobic; 75-85 per cent maximal heart rate; Walking,jogging, cycling; 3-4 days a week; 30-45 min-continuous or interval.
2)Age >65 years
Low intensity aerobic and resistance; 65-75 per cent of maximal heart rate;Walking, cycling; 3-4 days per week; 30 ~ n j n (can be intennittent).
3)Overweight
Moderate-high intensity aerobic; 65-80 per cent heart rate; Walking; 5-6days per week; 45-60 minutes.
4)Age >65, physically disabled or overweight
Optirnise: Use resistance exercise where feasible (Table ).
Frequency
For many low-risk coronary patients, particularly those following myocardial revascularization proceclures, rehabilitation often begins shortly after discharge from the hospital; many enter immediately what has traditionally been considered a Phase I11 program, that is, without intervening supel-vision in a Phase I1 component.
Approximately 70 per cent of culrent survivors of myocardial infarction under age 70 years and many patients following uncomplicated myocardial evascularization procedures are at low risk for proximate cslrdiovascular events following discharge from the hospital (free of nlyocardial ischemia a1 exercise testing, significant ventsiciilar arrhythmia, and/or significant left venlricular systolic dysfunction).For these carefully selected low-risk patients, bolh medically directed home exercise and supeiviscd exercise training have resulted in comparable improvements in functional cc,lpcily, without reported complications of home exercise training. These alternate approaches (horne-based programs) to rehabilitative care include planned corninunication ancl management by rehabilitation nurses and other specially trained personnel.
At the opposite end of the disease severity spectl-uin are elderly coronary patients; those with significant comorbidity; high-risk patients with continuing ischemia, compensated heart failure, or serious arrhythmias; those with complications of myocardial infarction or CABG; and those with severe angina pectoris. These patients require closer surveillance of their exercise training for extended time periods The requirements, duration, and complexily of exercise surveillance are based on the patients clinical and risk factor status, as well as the patient's needs for exercise training.
The optimal approach combines a home-based walking program with intermittent monitored exercise sessions at the cardiac-rehabilitation center,exercise counseling, and periodic reassessment of risk factors. Older patients and those with severe deconditioning who may need inore complex regimens ofCardiovascular Surgery and Cardiac Rehabilita-ti0.n interval and resistance training benefit from on-site supervision of exercise. As with weight-loss programs, a detailed exercise diary of home-based exercise increases compliance.
The frequency of exercise training in the 35 mdomized controlled trials varied between two and seven times per week. The most common frequency was three times per week The weekly frequency of exercise did not relate to aimprovement in exercise tolerance.
At the opposite end of the disease severity spectl-uin are elderly coronary patients; those with significant comorbidity; high-risk patients with continuing ischemia, compensated heart failure, or serious arrhythmias; those with complications of myocardial infarction or CABG; and those with severe angina pectoris. These patients require closer surveillance of their exercise training for extended time periods The requirements, duration, and complexily of exercise surveillance are based on the patients clinical and risk factor status, as well as the patient's needs for exercise training.
The optimal approach combines a home-based walking program with intermittent monitored exercise sessions at the cardiac-rehabilitation center,exercise counseling, and periodic reassessment of risk factors. Older patients and those with severe deconditioning who may need inore complex regimens ofCardiovascular Surgery and Cardiac Rehabilita-ti0.n interval and resistance training benefit from on-site supervision of exercise. As with weight-loss programs, a detailed exercise diary of home-based exercise increases compliance.
The frequency of exercise training in the 35 mdomized controlled trials varied between two and seven times per week. The most common frequency was three times per week The weekly frequency of exercise did not relate to aimprovement in exercise tolerance.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.