According to WHO, defines it as development of physical, psychological, vocational, social and educational potential consistent with his/her physiological impairment conducive to the environmental limitation.

Aims of Cardiac Rehabilitation

• To restore him to self reliance in daily active life.
• To restore him to formal work activities
• To prepare him for another full time employment compatible with his working capacities. Sheltered workshop.

Warning Signs & Symptoms of Cardiac Rehabilitation

1. Dyspnea.
2. Pulse rate–rate should come back to resting level in 2–3 minutes after ending the exercise.
3. Pulse ratio–Pulse is taken before the exercise then on completion. Pulse is counted for 2 consecutive minutes. The pulse after exercise is divided by resting pulse to give pulse ratio e.g. pulse before exercise = 80.
4. Chest pain–Patients must be educated to report chest pain and to rest immediately on any onset of retrosternal sensation or tightness in chest.
5. Fatigue–If patient is doing the ex. every day, and at same patient feels tired before completion of exercise, he should stop exercise at that point and rest.
6. Dizziness–Any onset of dizziness or faintness must be reported & Patient should rest.
7. Cramps–If patient is developing cramps in any of the muscles during the exercise, exercise should be stopped for the day.
8. Abnormal ECG recording–If any abnormality presents, exercise should be stopped on that day and progressed slowly.
9. Abnormal BP.
10. Decreased urinary output.
11. Signs of CV insufficiency.

Phase–I of Cardiac Rehabilitation
This begins when the patient is admitted to the hospital and ends on discharge, which is usually 7 to 10 days.

Aims

• To prevent accumulation of secretion in the lungs.
• To prevent Deep Vein Thrombosis.
• To prevent bed sores.
• To teach and encourage relaxation.
• To train postural awareness strengthening trunk and leg muscles.

Day 1 to 2

• Humidification, Vibration, Postural drainage and Breathing exercise.
• Passive exercises –ankle/toe exercises–Active movements limited to 5 repetitions. Positioning of the patient to prevent bed sores.
• Activities allowed are bed side commode, self feeding, partial self care and mostly bed rest and supported sitting.

Day 3 to 4

• Continue all of above, number of repetitions can be increased to 10.
• SLR (straight leg raising) can be started– repeat 5 times.
• Sitting in a chair 5–10 minutes.
• Partial self–care, taking bath in sitting, position by sitting on a high stool.
• Isometric activities can be started.
• SLR repetition can be increased to 10.
• Walking 5–10 minutes.
• Sitting and self feeding in a chair.

Days 5 to 6

Trunk Mobility Exercises
• Same as all of the above.
• Trunk mobility exercises.
• No. of repetition can be increased.
• Walking 50 to 100 meters.
• Activities allowed, self dressing and assisted showering.

Days 7 to 9

• All of the above, walking 200 meters.
• Climbing 2 steps.
• Patient in chair most of the day and allowed to shower himself.

Day 10

• All of above, walk up one flight of steps.
• Before discharge, Exercise Tolerance Tests as below are performed which help us to give a home exercise program to the patient.
• 12 minutes walk test–Ask the patient to relax completely, take his resting pulse, BP, RR. Ask the patient to walk comfortably at his own normal pace for 12 minutes in the corridor. Monitor the no. of pauses. Grading used is:
• Grade I–test cannot be completed.
• Grade II–can complete the test with more than 3 pauses.
• Grade III–can complete the test with 3 pauses.
• Grade IV–can complete without pause.
• Grade V–complete with 5 kgs extra weight.
Take BP, pulse, RR and after 3 minutes of test to check recovery. Progression is by increasing the destination or the speed in the given time.

Phase–II
It begins when patient is discharged from hospital and continues for 6 weeks to 6 months depending upon facilities and patient's condition. This phase covers supervised home exercises or supervised monitored exercises in an out patient cardiac rehab. center.

It is continuation program of Phase–I until a re–evaluation by physician is competed 6–8 weeks Post MI following which a new exercise program is prescribed. During phase–II patients programs are restricted to low level to less restricted moderate level training program.

Duration of walking/cycling begins with 10–20 minutes and progresses to 50–60 minutes within 6 weeks. Each exercise session is divided into warm up and cool down period. Warm up and cool down lasts for at least 5 minutes, at a heart rate of 12–18 minutes with a freq. of 2 times /day, 5–6 times/week. Mostly walking and stationary cycling is given. Occupational and recreational exercise are recommended.

Phase–III
Aims
• To further increase exercise tolerance.
• To maintain or improve confidence.
• To provide support and encouragement.
• To help decrease risk factors and thereby decrease recurrence.
Exercises intensity is based on patients medical and physical status. Duration is 15–60 minutes depending upon time and intensity. Warm up and cool–down periods should be crucial, i.e. 5–10 minutes. Physical examination as a part of daily activity should be carried out. Exercises are given at 60% of maximum heart rate achieved during stress test. Stress test is done regularly, (after 3 months) and exercises are progressively increased.