Cardiopulmonary rehabilitation
Encyclopedia
Cardiac Rehabilitation (CR) is a branch of rehabilitation medicine
dealing with optimizing physical function in patients with cardiac disease. CR services are generally provided in an outpatient setting as comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. While the "glue" of cardiac rehabilitation is exercise, programs are evolving to become comprehensive prevention centers where all aspects of preventive cardiology
care are delivered. This includes nutritional therapies, weight loss
programs, management of lipid
abnormalities with diet and medication, blood pressure
control, diabetes management and stress management
.
Patients typically enter cardiac rehabilitation in the weeks following an acute coronary event such as a myocardial infarction
(heart attack), coronary bypass surgery, coronary stent
placement or replacement of a heart valve
. Participation typically begins with an intake evaluation that includes measurement of cardiac risk factors such as lipid
measures, blood pressure
, body weight and smoking status. An exercise stress test
is usually performed both to determine that exercise is safe and to allow for the development of an exercise prescription. Short and long-term risk factor goals are established and patients are closely monitored by a "case-manager" who may be a cardiac-trained nurse, a physical therapist or an exercise physiologist.
Participation in cardiac rehabilitation is associated with a 25% decrease in overall mortality
over 3 years so when one is asked "is it safe for patients with cardiac disease to exercise ?" an appropriate response would be "it is not safe for cardiac patients NOT to exercise" (after appropriate medical evaluation).
Cardiac Rehabilitation services are significantly underused in the United States, with only 19-29% of patients with eligible cardiac diagnoses participating. Underuse is related to many factors, including a geographical lack of an available program and low referral rates by physicians, who often focus more attention on better reimbursed cardiac interventional procedures than on long-term lifestyle treatments. With a contemporary focus on the cost-effectiveness of medical interventions, CR programs are well-positioned to assume a more prominent role in the long-term care of patients with coronary heart disease. CR exercise and prevention programs are supported by scientific statements from the American Heart Association
and the American College of Cardiology
.
Cardiac rehabilitation is carried out in three to four phases. Phase 1 is in-hospital and involves nutritional, psychological and physical advice under the guidance of a cardiac rehabilitation consultant. Phase 2 of rehabilitation is the crucial early outpatient phase, where the patient undertakes long-term behavioral change by incorporating exercise and healthy nutrition into their lives. Medications are also prescribed to meet risk factor goals. Phases 3 and 4 cardiac rehabilitation are long-term maintenance programs that should not be minimized, as benefits are maintained only with long-term adherence.
Physical medicine and rehabilitation
Physical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...
dealing with optimizing physical function in patients with cardiac disease. CR services are generally provided in an outpatient setting as comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. While the "glue" of cardiac rehabilitation is exercise, programs are evolving to become comprehensive prevention centers where all aspects of preventive cardiology
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
care are delivered. This includes nutritional therapies, weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
programs, management of lipid
Lipid
Lipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...
abnormalities with diet and medication, blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
control, diabetes management and stress management
Stress management
Stress management is the alteration of stress and especially chronic stress often for the purpose of improving everyday functioning.Stress produces numerous symptoms which vary according to persons, situations, and severity. These can include physical health decline as well as depression. According...
.
Patients typically enter cardiac rehabilitation in the weeks following an acute coronary event such as a myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
(heart attack), coronary bypass surgery, coronary stent
Coronary stent
A coronary stent is a tube placed in the coronary arteries that supply the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention...
placement or replacement of a heart valve
Heart valve
A heart valve normally allows blood flow in only one direction through the heart. The four valves commonly represented in a mammalian heart determine the pathway of blood flow through the heart...
. Participation typically begins with an intake evaluation that includes measurement of cardiac risk factors such as lipid
Lipid
Lipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...
measures, blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, body weight and smoking status. An exercise stress test
Cardiac stress test
Cardiac stress test is a test used in medicine and cardiology to measure the heart's ability to respond to external stress in a controlled clinical environment....
is usually performed both to determine that exercise is safe and to allow for the development of an exercise prescription. Short and long-term risk factor goals are established and patients are closely monitored by a "case-manager" who may be a cardiac-trained nurse, a physical therapist or an exercise physiologist.
Participation in cardiac rehabilitation is associated with a 25% decrease in overall mortality
Mortality
Mortality is the condition of being mortal, or susceptible to death; the opposite of immortality.It may also refer to:* Mortality rate, a measure of the number of deaths in a given population...
over 3 years so when one is asked "is it safe for patients with cardiac disease to exercise ?" an appropriate response would be "it is not safe for cardiac patients NOT to exercise" (after appropriate medical evaluation).
Cardiac Rehabilitation services are significantly underused in the United States, with only 19-29% of patients with eligible cardiac diagnoses participating. Underuse is related to many factors, including a geographical lack of an available program and low referral rates by physicians, who often focus more attention on better reimbursed cardiac interventional procedures than on long-term lifestyle treatments. With a contemporary focus on the cost-effectiveness of medical interventions, CR programs are well-positioned to assume a more prominent role in the long-term care of patients with coronary heart disease. CR exercise and prevention programs are supported by scientific statements from the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
and the American College of Cardiology
American College of Cardiology
The American College of Cardiology is a nonprofit medical association established in 1949 to advocate for quality cardiovascular care through education, research promotion, development and application of standards and guidelines, and to influence health care policy...
.
Cardiac rehabilitation is carried out in three to four phases. Phase 1 is in-hospital and involves nutritional, psychological and physical advice under the guidance of a cardiac rehabilitation consultant. Phase 2 of rehabilitation is the crucial early outpatient phase, where the patient undertakes long-term behavioral change by incorporating exercise and healthy nutrition into their lives. Medications are also prescribed to meet risk factor goals. Phases 3 and 4 cardiac rehabilitation are long-term maintenance programs that should not be minimized, as benefits are maintained only with long-term adherence.