What is cardiac and respiratory rehabilitation?
Cardiac and respiratory rehabilitation (or cardiopulmonary rehabilitation) is a multidisciplinary program that involves nutritional counseling, education, strengthening the heart and lungs, smoking cessation, stress management, and various other lifestyle changes. In many patients, Cardiac and pulmonary diseases coexist, increasing the rate of disability, morbidity, and death. Rehabilitation focuses on improving the quality of life of the patient to maintain a healthy and longer life.
Multidisciplinary Team members
A Health care team member needs to have appropriate training, skills, and respect for their work. The multidisciplinary team member includes:
- Cardiologist / physician
- Respiratory therapist
- Clinical nurse specialist
- Clinical nutritionist
- Physiotherapist
- smoking cessation counselor
- Pharmacist
- Social worker
- psychologist
Indications of Cardiac Rehabilitation
Patients with the following cardiac condition are eligible for cardiac rehabilitation:
- Congestive heart failure(CHF)
- Ischaemic Heart Disease
- Myocardial Infarction
- Heart valve replacement
- Coronary artery bypass graft(CABG)
- Cardiac stent or angioplasty
- Heart attack
- Post heart transplant
Goals of Cardiac Rehabilitation
Individuals who have suffered from any of the above listed cardiac diseases are very prone to having a low-quality lifestyle, and that is when cardiac rehabilitation comes in. The goals are as follow:
- To improve cardiac function
- To enhance the quality of life
- To reduce cardiac-related hospital admissions
- To relieve or manage stress
- Smoking cessation, Weight reduction
- Restore self-confidence and patient education
- reduce the risk of sudden death and reinfarction
- increase work capacity
Indications of Respiratory Rehabilitation
Patients who are having any of the following chronic lung diseases can benefit from Respiratory Rehabilitation:
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Sarcoidosis
- Cystic fibrosis
- Ankylosing spondylitis
- Bronchiectasis
Goals of Respiratory Rehabilitation
- To improve the quality of life
- To reduce the risk of future lung problems
- To let the patient learn proper oxygen and medication usage
- Patient education
Phases of Cardiac and Respiratory Rehabilitation
In many patients, Cardiac and pulmonary diseases coexist, increasing the rate of disability, morbidity, and death. Cardiopulmonary rehabilitation is a multidisciplinary approach, and it consists of the following phases:
Phase 1: Inpatient program
This phase begins soon after a cardiac event, after the stabilization of the patient. The emphasis is on low-level exercise and education for the patient and the family. The member of the rehab team visits the patient to discuss lifestyle modification and encourage the patient.
Phase 2: Outpatient hospital-based program
This phase begins approximately 2 weeks after discharge. The healthcare team includes dieticians, social workers, pharmacists, clinicians, and others. This phase focuses on monitored exercise, nutritional counseling, psychosocial counseling, and patient education on lifestyle management and exercise.
Phase 3: Maintenance Phase
It is a community based/clinic exercise and education program in which physical fitness and additional risk factor reduction are emphasized.
Phase 4: Community Phase
This phase is a continuation of phase 3 but without supervision. Patients continue to apply what they have learned.
What is involved in respiratory rehabilitation?
When a patient is suffering from a chronic respiratory disease, everyday activities such as running, walking, or climbing becomes a bit hectic and that is why respiratory rehabilitation is crucial for them. Respiratory rehabilitation involves the following exercises and interventions:
- Exercise: Exercise is the key to any pulmonary rehab. Exercise includes upper body workout, lower body workout, aerobic, breathing exercises, breathing techniques, and strength training. Exercise creates increased tolerance to shortness of breath, better physical capability, and better quality of life.
- Emotional support: people with severe respiratory diseases are more prone to having depression, anxiety, and other mental health issues. Emotional support helps them cope up with the feelings of apprehension.
- Education: Educating the patient about the disease, risk factors, complications, and prevention is important to prevent future relapse. Clinicians guide the patient regarding the correct use of medications, inhalers, and other facilities.
- Lifestyle management: A healthy lifestyle is important for everyone but for patients suffering from any chronic pulmonary disease, it is crucial. The lifestyle modifications might include:
- Quitting smoking
- Healthy diet
- Regular exercise
- Breathing and relaxation techniques
- Avoiding extreme heat, cold or high altitudes
- Living in a less pollutant area
What is involved in cardiac rehabilitation?
Cardiac rehabilitation is a supervised program that includes:
- Education: one on one education or group education sessions
- Pharmacological therapy: This includes interventions such as lipid-lowering, blood pressure management, glucose control.
- Heart-healthy diet: This includes meals that are low in salt and rich in whole grains, vegetables, fruits, and fish.
- Exercise and cardioprotective therapies: exercise gets your heart pumping and it promotes good overall health. The exercise program is done under supervision and it also includes cycling, jogging, rowing,
- weight loss: There is a very strong correlation between obesity and cardiovascular diseases. Obesity leads to decreased blood flow through veins and arteries and that is why weight loss is really important in a cardiac rehab program.
- Lifestyle risk factor management: Building healthier habits, doing exercise, quitting smoking, and eating a heart-healthy diet is the best lifestyle management one can do.
Risks of cardiorespiratory Rehabilitation
Cardiorespiratory rehabilitation is not suitable for every individual who has had heart or lung disease. The healthcare team evaluates the risks and assesses the overall health, medical, and social history of the patient before opting for a rehabilitation program. It’s very rare for people to suffer injuries such as strained muscles or sprains while doing exercise as a part of their rehabilitation program.
Results of cardiac rehabilitation
Cardiac rehabilitation is a long-term, effort-based program and the patients need to continue the advised exercises and habits for a long time. Consistency is the key for any rehabilitation. Counseling and education regarding diet, lifestyle, and exercise must go on for a longer time. To get the most advantages from cardiovascular rehabilitation patients have to be consistent and active.
Over the long term patients may:
- Learn heart-healthy behaviors, exercise, and diet.
- Gain strength
- Decrease the risk of relapse and other heart diseases
- Cut bad habits such as smoking, alcoholism, etc.
Cardiorespiratory is a long-term plan of care that is based on a patient’s motivation. The more dedicated, consistent, and positive you are towards your rehabilitation, the better you’ll do.
REFERENCES
- Wenger NK. Current status of cardiac rehabilitation. Journal of the American College of Cardiology. 2008 Apr 29;51(17):1619-31.
- Adams KJ, Barnard KL, Swank AM, Mann E, Kushnick MR, Denny DM. Combined high-intensity strength and aerobic training in diverse phase II cardiac rehabilitation patients. Journal of Cardiopulmonary Rehabilitation and Prevention. 1999 Jul 1;19(4):209-15.
- Lavie CJ, Milani RV. Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. The American journal of cardiology. 1995 Jul 15;76(3):177-9.
- McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews. 2015(2).
- Dugmore LD, Tipson RJ, Phillips MH, Flint EJ, Stentiford NH, Bone MF, Littler WA. Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12-month cardiac exercise rehabilitation program. Heart. 1999 Apr 1;81(4):359-66.