Role Of Physiotherapy in Cardiac Rehabilitation



David Kennard

Physiotherapist

Member, Heart Support Australia


The role of physiotherapists in cardiac rehabilitation begins pre-operatively. A physiotherapist will often do a pre-operative education session. This will involve education on the surgery – the procedure, the possible complications, post operation expectations and the post-operative exercises (such as early walking, deep breathing exercises for the lungs and sternal care in bypass patients).


Post-Operative Care

This involves 3 distinct stages – immediate post-operative care to hospital discharge, cardiopulmonary rehabilitation and finally, on-going physiotherapy care.


1. Immediate Post Operative Physiotherapy

A physiotherapist will come and access a patient within 24 hours of the surgery. This involves getting the patient to sit up, undertake a small walk, deep breathing exercises and coughing, plus education on looking after the sternum for bypass patients.

The physiotherapist will come on numerous occasions to check the patients lungs, mobilise the patient and undertake stairs ready for hospital discharge.


2. Cardiopulmonary Rehabilitation

Once the patient has been discharged from the hospital, patients will be enrolled in a Cardiopulmonary Rehabilitation Program. This program is run in small classes (6-10) and involves an individualised exercise program and group education sessions covering topics such as, nutrition, medications, exercising, alcohol consumption, mental health and the roles of other care team professionals (pyschologists, doctors, dieticians etc). The aim of the program is to:

· Help patients resume normal activity

· Help patients regain confidence

· Help improve fitness

· Help identify and control risk factors

Personally, I found this program fantastic. I found the exercise sessions extremely helpful to know what I was allowed to do. I gained a lot of confidence. I also knew that once I’d done the exercises in the class that I could then add them to my daily home routine. The education was very valuable in helping to make small adjustments to my diet and life choices.


3. On-going Physiotherapy

One of my saving graces after surgery was seeing a physiotherapist at a private practice. One week after surgery I woke with sever midback pain. I was unable to sit, stand up or walk without considerable pain. I could not comfortably move my head. So I attended a physiotherapist who treated my midback and alleviated the pain.

While attending sessions like this, I have hear people talk about hip and back pain that limits their ability to exercise. I’ve also heard people mention a sense of feeling lost after being discharged from the Cardiopulmonary Rehabilitation Program. That they are not quite sure what to continue to do to rehabilitate themselves.

Physiotherapists can play a role in helping patients with pain. We can offer advice on exercises to reduce the pain, but also alternative exercises to continue your heart rehabilitation. For example, the use of a pool rather than walking if people have hip pain. The role of a physiotherapist can be:

· Follow up and check on sternal stability

· Treat any injuries or pain issues patients may have. This could be from the surgery or an injury that has arisen from being more active. Physiotherapists can then advise on exercises to help the injury recuperate, but also modify your heart rehabilitation program.

· Help give advice and progress the patients home based rehabilitation program. I personally feel that once the cardiopulmonary rehabilitation program finishes there is not much guidance. Seeking advice from a physiotherapist or exercise physiologist can help guide the program and keep patients on track, keep patients focused, help maintain confidence, maintain and improve physical fitness and reduce secondary complications (like hip pain).

· Set up an individualised gym program incorporating aerobic and weight (resistance) training. The best exercise program would be 30 minutes aerobic exercises 5 times per week and weight training 2 times per week.


Effects of Aerobic Exercises on the Heart

· Lowers BP

· Reduces the risk of diabetes by helping the muscles process glycogen

· Maintains healthy body weight

· Reduces inflammation in the body

· Improves the muscles ability to remove oxygen out of the blood. This reduces the need for the heart to pump more blood to the muscles.

· Reduces stress hormones

· Slows HR

· Increases HDLs

Effects of Weight (Resistance) Training

· Increases independence in Activities of Daily Living

· Increases muscle strength

· Increases muscle endurance

· Reduces the risk of falls

· Reduces Rate of Perceived Excursion (RPE)

· Reduces Pericardial adipose tissue by 32%

· Reduces the risk of high BP, insulin sensitivity and dyslipidemia


View the presentation for more information here


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