Cardiac rehabilitation is a structured program of ex-ercise and education run by a team of experts in heartdisease and aimed at improving the patient’s qualityof life while extending the length of life. This is accomplished through electrocardiographic monitor-ing, clinical observation, and assessment of signs andsymptoms. Supervised cardiac rehabilitation results inearly-problem detection, leading to improvements inmedical care. Early detection and resolution of med-ical problems help to prevent cardiac complicationsthat would require extended outpatient and inpatienttreatments.
What are the goals of a cardiac rehabilitation program?
The goals of a cardiac rehabilitation program shouldinclude:
● Detecting signs and symptoms of heart disease at rest
● Assuring safety during physical activity by monitor-ing ECG, heart rate, blood pressure, and sympto-matic responses to exercise
● Improving adherence to the exercise, diet, smokingcessation, and stress reduction prescriptions
● Increasing exercise tolerance
● Decreasing symptoms of disease
● Decreasing mortality
● Reducing negative emotional effects of disease
● Enhancing self-confidence to achieve or resume anactive lifestyle
What are the components of acardiac rehabilitation program?
All cardiac rehabilitation programs should be super-vised by a cardiac physician, managed by heart careprofessionals, and offer a standard group of services.A good cardiac rehabilitation program focuses on theneeds of the individual; therefore, although the over-all program may have a wide variety of standard programs, each patient’s program will have differentemphases and different components.
Behavioral factors, such as poor compliance with nutri-tional and pharmacological treatment regimens, fre-quently contribute to exacerbations of CHF in theelderly. In part, noncompliance may be due to the difficult-to-follow medication schedules prescribed byhealth care providers. It is estimated that 20 to 58 per-cent of patients with CHF are noncompliant withmedications
.Noncompliance is a major cause of unnecessary hospi-talization. Of patients hospitalized with heart failure,27 percent were rehospitalized within 90 days due todietary and/or medication noncompliance. Readmis-sion rates for patients 65 years and older with CHF ap-proach 50 percent. Factors that may contribute includesocial isolation, poor compliance with medications, andpoor diet. Programs providing case management forCHF have been effective. An effective rehabilitationprogram will address these issues.
According to the American Heart Association, theprinciples of cardiac rehabilitation include:
● A thorough medical evaluation, with an emphasis onmaximizing the benefits of existing medications
● A supervised program of aerobic and resistancetraining exercises
● Education and programs on how to change the pa-tient’s lifestyle to better manage acquired risk fac-tors, such as:
● High blood pressure
● High blood cholesterol
● Physical inactivity
● A diet high in salt, calories, and fat
● Stress management programs
● Counseling for depression
● Nutritional counseling
● Lending emotional support
● Providing vocational guidance to enable the patientto return to work
● Supplying information on physical limitations
What does a cardiac rehabilitation program accomplish?
Cardiac rehabilitation produces physiological, meta-bolic, and psychological benefits. The most importantbeneficial health outcomes are a reduction in mortality,improvement in the number of cardiac events, im-provement in symptoms, increased exercise tolerance,improvement in blood lipids, increased smoking cessa-tion, and improved psychosocial outcomes.Cardiac rehabilitation also reduces hospitalizations andincreases productivity of those who successfully complete them. This saves the patient and the health caresystem money.
What do I ask my doctor aboutcardiac rehabilitation?
Despite the known benefits of cardiac rehabilitation(rehab), only 15 percent of qualified patients partici-pate in a program. Reasons for this include a lack ofphysician referral (especially among women and theelderly), poor patient motivation, logistical or lack ofhealth insurance benefits and other financial con-straints, or a combination of these factors.
Although you may have CHF and therefore shouldbenefit from a rehab program, there may be good rea-sons that your doctor may not recommend cardiacrehab, such as other medical conditions that make ex-ercise more dangerous than normal or that there are norehabilitation programs in your area.
If a full-scale cardiac rehabilitation program is un-available in your area or not right for you, there are alternatives. For example, although not everyone can participate in a monitored exercise program, al-most everyone with heart disease or risk factors for heart disease would benefit from some form of risk factor assessment, activity counseling, and healtheducation.
Home exercise training programs are beneficial in cer-tain low-risk patient groups. They offer the advantagesof convenience and low cost but lack the valuable elements of professional supervision, education, andgroup interaction.
Discuss with your doctor your interest in cardiac reha-bilitation. He or she should be able to tell you about theavailability of rehabilitation programs in your area andmake a referral for you.
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