Cardiac rehabilitation

Cardiac rehabilitation is a comprehensive exercise, education, and behavioralmodification program for patients with heart disease. It is designed to control symptoms, improve exercise tolerance, and improve their overall quality of life. Heart attack survivors, bypass and angioplasty patients, and individuals with angina, congestive heart failure, and heart transplants are all candidates for a cardiac rehabilitation program.

A cardiac rehabilitation program is designed and supervised by a specializedteam of doctors, nurses, and other healthcare professionals. Members of the cardiac rehabilitation team may include a dietician or nutritionist, physicaltherapist, exercise physiologist, psychologist, vocational counselor, occupational therapist, and social worker. The program usually begins in a hospitalsetting and continues after the patient is discharged over a period of 6-12 months.

The elements of a cardiac rehabilitation program vary by individual clinicalneed, and each program is carefully constructed for the patient by his or herrehabilitation team.

Exercise programs generally start out slowly, with simple range-of-motion armand leg exercises. Walking and stair climbing soon follow. Blood pressure iscarefully monitored before and after exercise sessions, and patients are taught how to measure their heart rate and recognize symptoms of cardiac distress. Patients with advanced heart disease may require continuous electrocardiogramy (ECG) monitoring during their exercise sessions. After release from thehospital, the patient works with his cardiac team to create an individual exercise plan.

Cardiac patients will also work with a nutritionist or dietician to develop alow-fat, low-cholesterol diet plan. Patients with high blood pressure may beput on a salt-restricted diet and instructed to limit their alcohol intake.Weight loss may also be a goal with overweight cardiac patients.

A psychologist or social worker can help cardiac patients with issues that may be contributing to their heart condition, such as stress, anxiety, and depression. Counseling and relaxation training can help patients deal with thesefeelings. In addition, vocational counselors can assist cardiac patients in setting practical goals to return to work.

Encouraging patients to kick the smoking habit is an important part of cardiac rehabilitation. Cardiac patients who smoke are twice as likely to have a heart attack in the following 5 years than non-smoking patients. A smoking cessation program usually includes patient education and behavioral counseling. Nicotine replacement therapy, which uses nicotine patches, nose spray, or gumto wean patients off of cigarettes, is often part of the program. Antidepressants and anti-anxiety medication may also be helpful in some cases.

Patients require ongoing support from their healthcare team, family, and friends to continue the progress they make during the rehabilitation period. Thepatient and family should be fully educated on the physical limitations of the patient, his recommended diet and exercise plan, his emotional status, andthe lifestyle changes required to improve the patient's overall health.

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