Importance of Cardiac Rehabilitation

Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease relate to men. 

According to the World Health Organization statistics 23% of women and 18% of men will die within one year of a first recognized heart attack. 22-32% of women and 15-27% of men who survive heart attacks will die within five years.  

12-25% of women and 7-22% of men who survive heart attacks will be diagnosed with heart failure within five years.  

Women are less likely than men to receive appropriate treatment after a heart attack. Cardiac rehabilitation is a medically supervised program for people who have had a heart attack, heart failure, heart valve surgery, coronary artery bypass grafting or percutaneous coronary intervention. Cardiac rehab involves adopting heart-healthy lifestyle changes to address risk factors for cardiovascular disease. To help you adopt lifestyle changes, this program includes physical training, education on heart-healthy living, and counseling to reduce stress. These measures will help you return to an active life. Cardiac rehab can improve your health and quality of life, reduce the need for medicine that treats heart or chest pain, reduce the chance of you returning to hospital or an emergency room for a heart problem, prevent future heart problems and even help you live longer.  

The cardiac rehab team comprises doctors, physical and occupational therapists, nurses, exercise specialists, dietitians or nutritionists, and mental health specialists. Sometimes a case manager will help track your health issues. Your cardiac rehab team will design a program to meet your needs. Before starting your programme, the rehab team will take your medical history, do a physical exam and perform tests. Possible tests include an electrocardiogram (EKG), cardiac imaging tests and a treadmill or stationary bike exercise test. You also may have tests to measure your cholesterol and blood sugar levels. During cardiac rehab, you will learn to exercise safely and increase your physical activity. The length of time that you spend in cardiac rehab depends on your condition. Cardiac rehab can include programmes at home and at rehab facilities. Your rehab team will keep a close watch on how exercise affects your heart and how you are progressing, before gradually releasing you from supervision to continue cardiac rehab on your own. The healthier lifestyle you’ve learned-including eating a balanced diet, exercising regularly, and not smoking-can then become a way of life for you.  
During this time you may also see your doctor regularly to treat other medical conditions, including high cholesterol and high blood pressure.  

The benefits of cardiac rehabilitation

• Strengthening and conditioning of your heart and lungs  
• Controlling weight and improving cholesterol levels, including HDL, LDL, triglycerides and total cholesterol  
• Understanding your medications, the signs and symptoms of heart disease and when to seek medical attention  
• Increasing self-confidence  
• Laying the groundwork for the development of a healthier lifestyle  
• Reducing your symptoms and chances of experiencing another cardiac event  
• Early return to work and activities of daily living  
• Developing healthy habits and stress reduction skills, as well as relaxation techniques  
• Providing emotional support for you and your family  

Cardiac Rehabilitation Through Education
This education will help you understand heart condition and ways in which to reduce the risk for you having future heart problems. The rehabilitation team will help you develop a realistic plan to identify and reduce heart disease risk factors. You will participate in nutrition and stress management sessions. The more you know about what contributes and leads to the development of heart disease and the steps you can take toward building a healthier heart, the more you can help reduce your risk of developing a cardiovascular condition. Learning stress-reduction techniques, ways to eat healthy and making other behavioleral changes can also help you prevent future problems.  The heart-healthy lifestyle changes in cardiac rehab have few risks. Very rarely, physical activity during rehab can cause serious problems, such as injuries to your muscles and bones, or possibly life-threatening heart rhythm problems. If serious problems occur during the supervised sessions, the rehab team will immediately stop the physical activity, administer appropriate treatment and contact your cardiologist  
Heart-healthy eating  
Heart-healthy eating involves consuming vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish, lean meats, poultry, eggs, nuts, seeds, soy products, legumes and vegetable oils (except coconut and palm oils). Also, it limits sodium, saturated and Tran’s fats, added sugars and alcohol. 

 
Food to eat  
The following foods are the foundation of a heart-healthy diet.  

• Vegetables such as greens (spinach, collard greens, kale), broccoli, cabbage, and carrots  
• Fruits such as apples, bananas, oranges, pears, grapes, and prunes  
• Whole grains such as plain oatmeal, brown rice, and whole-grain bread or tortillas  
• Fat-free or low-fat dairy foods such as milk, cheese, or yogurt  

Protein-rich foods:  

• Fish high in omega-3 fatty acids, such as salmon, tuna, trout, about 8 ounces a week  
• Lean meats such as 95 percent lean ground beef or pork tenderloin  
• Poultry such as skinless chicken  
• Eggs  
• Nuts, seeds, and soy products  
• Legumes such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans  
• Oils and foods containing high levels of monounsaturated and polyunsaturated fats that can help lower blood cholesterol levels and the risk of cardiovascular disease. 

Some sources of these oils are:  

• Canola, corn, olive, safflower, sesame, sunflower, and soybean oils  
• Nuts such as walnuts, almonds, and pine nuts  
• Nut and seed butters  
• Salmon and trout  
• Seeds such as sesame, sunflower, pumpkin, or flax Avocados  

Smoking increases the risk
Smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for the blood to clot. Smoking also increases the risk of recurrent coronary heart disease after bypass surgery.  

Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50.  

Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.  

Smoking decreases HDL (good) cholesterol. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk for heart disease. You will thank yourself one day for quitting smoking. The health benefits start almost immediately and within a few years of quitting smoking your risk of stroke and coronary artery disease is similar to those of non-smokers. We can help with resources and tools for the healthiest decision you make to quit smoking.  

Physiotherapy and cardiac rehabilitation
The physiotherapist has a central role in the physical and educational components of CR programs. Physiotherapists Prescribe individualized exercise programmes that contribute to the education programs on lifestyle  

Also take a note of the following: 

• Changes, such as smoking cessation.  
• CR programs are delivered in public facilities and in the community and home settings. 
• CR Programs, in which a physiotherapist is centrally involved, are highly effective for improving the Individual’s health outcomes.

Impact on Patient Experience  
The involvement of the physiotherapist in the delivery of CR programs improves patient compliance and results in better health outcomes for participants.  

• CR programs can be delivered at home or in a facility and both delivery models are equally effective at improving health outcomes.  
• Physiotherapy in CR provides tailored care that leads to improvements in physical and psychosocial function and high patient satisfaction  

CR programmes that include physiotherapy are an effective low-risk intervention that emphasizes exercise, education and lifestyle modifications. CR increases physical activity in patients following cardiac events and encourages the adoption of healthy behaviours leading to a reduction in the rate of hospitalization, subsequent cardiovascular events and mortality. Physiotherapists support the transition from hospital to on-going community services.