World Heart Day | Maintaining Your Heart Health by Physiotherapy

29th September 2022 is celebrated as World Heart day. This day is observed to cater and manage the needs of the increasing number of patients who have undergone cardiac surgery. Cardiac rehabilitation is a treatment process that is found to be effective for patients suffering from a heart attack, coronary artery disease, heart failure, angina, or heart surgery. Cardiac Rehab is a complex intervention that includes Physical activity, Exercise training, and Cardiovascular risk management to improve the well-being and functional capacity of patients with heart disease. The treatment involves various healthcare professionals including healthcare providers, nurses, and rehabilitation specialists. A physiotherapist is one healthcare professional who works with the patient during cardiac rehab and designs an exercise program for the patient. These exercise programs are personalized according to the patient's needs. In this blog, we will guide you through what are the potential benefits and goals at each stage that you can aim for, as you move through the recovery phase of your cardiac condition.

CARDIAC REHABILITATION USUALLY PROGRESSES THROUGH THESE 4 PHASES:

Phase I starts when the patient is still in the hospital. Rehabilitation exercises and regimens are recommended and supervised by the experts at the hospital.

Phase II is when the patient is discharged from the hospital, cardiac rehabilitation usually involves outpatient care.

Phase III starts when the patients are prescribed to continue the cardiac rehab exercises and regimens on their own at home.

Phase IV starts when the patient continues to follow the guidance on exercise and lifestyle. The patient proceeds independently with the current exercise training. He/she should receive regular check-ups to make sure that he/she is effectively managing the heart condition and thus avoiding any flare-ups.

Phase I or clinical cardiac rehab:

Patients with acute heart conditions, such as those recovering from a heart attack or heart surgery, may be referred to a cardiac rehab team while still in the hospital. Phase I cardiac rehab starts in the hospital, and the physiotherapist helps to recover basic functional mobility. The patient is taught to learn techniques to monitor the activity. This phase likely lasts between 2 and 5 days, depending on the patient's physical condition. The physiotherapist designs and carefully monitors the progress and limits the exercise program to get the patient back on his/her feet again. This initially involves just sitting up in bed, standing, and testing the range of motion, before moving to short walks around the hospital wing.

 

Phase II or outpatient cardiac rehab:

Once the patient leaves the hospital, he/she can engage in phase 2 cardiac rehabilitation in an outpatient physiotherapy clinic.  Though the patient must still be having difficulty with functional mobility.  The physiotherapist will closely work with the patient to ensure a smooth transition into outpatient rehab. The patient is monitored through lifestyle changes and as he/she begins to progress with the exercise regime.

 

Phase III Post-cardiac rehab:

Phase III cardiac rehabilitation is the next step in the physiotherapy rehab program. Phase III cardiac rehab involves more intensive exercises and activities while simultaneously monitoring vital signs, such as blood pressure and heart rate, which should remain stable while workloads are increased to ensure a safe transition into phase III cardiac rehabilitation.

 

Physiotherapy Evaluation

The physiotherapist conducts the initial evaluation of phase 3 cardiac rehab, by asking the patient to perform various tests and measures to assess the functional ability.  During the initial evaluation in phase 3 cardiac rehab, the physiotherapist may also choose to perform a specific outcome measure to provide an objective measure of functional mobility. Outcomes measures are also used during phase 3 cardiac rehab including the timed up-and-go test and the 6-minute walk test.

During phase III of cardiac rehab, the physiotherapist aims to help the patient become more independent and informed. The patient learns how to self-monitor his heart rate and exertion levels during exercise.

Phase 3 cardiac rehabilitation mostly involves exercises. The physiotherapist prescribes specific exercises to improve the overall tolerance and endurance level for the activity. The exercises include working on a stationary bike, treadmill walking, flexibility, and upper and lower body strength exercises. Before starting phase III, the physiotherapist should ensure that the patient is fully capable of monitoring his/her exercise and activity intensity. These techniques may include checking the heart rate, using the Borg scale, or using a heart rate monitor to assess exercise intensity while working out. The therapist also teaches the patient simple talk test to monitor their activity level.

As the patient progresses through phase 3 cardiac rehab, the physiotherapist will prescribe more independent exercises and activities. Usually, the patient spends 3 to 4 weeks participating in phase 3 cardiac rehabilitation This is done to prepare the patient for phase 4 cardiac rehabilitation, independent exercise, and lifestyle modifications. The physiotherapist will ensure that the progress is safe through the program with the ultimate goal to move on to independent exercises in phase 4 cardiac rehabilitation.

 

Phase IV or Maintenance:

After the completion of the previous three stages of cardiac rehabilitation, the patient is well aware of the heart condition and how best to manage it. Independent exercise and conditioning are essential to maintain optimal health and prevent the possibility of future cardiac problems. While phase IV is an independent maintenance phase, the physiotherapist helps to make changes in the ongoing exercise routine to help achieve physical fitness and wellness. Phase 4 essentially continues for the rest of their life.

By working closely with the concerned physiotherapist and participating fully in the four phases of cardiac rehabilitation, the patient can increase the chances of returning to optimal health quickly and safely.

 

10 Best Aerobic Exercises for Cardiovascular Fitness

Physical inactivity is identified as the fourth leading risk factor for global mortality.  Inactivity is found to be a significant risk factor for many health conditions like Coronary Heart disease, Stroke, Diabetes, and Cancer. Regular physical activity is proven to help prevent and manage such non-communicable diseases, says one of the recommendations of WHO. These activities can include doing some easy aerobic exercises at your place. In this blog, we will be discussing aerobic exercises and their benefits.

 

Aerobic exercises

Aerobic exercises or cardiovascular exercises are some of the finest physical exercises that make the heart pump faster and supply more oxygen-carrying blood to the whole body with every beat. The lungs adapt to take in more oxygen, making the muscles more efficient by using it. These exercises usually involve the whole body and use oxygen which is involved in the cellular reactions that provide the body with the energy necessary to perform the activity. The cells throughout the body increase the number and size of the mitochondria ( powerhouses of the cell), which uses oxygen to create energy that can fuel important reactions throughout the body, Mitochondria is a part of the body's cells that turn oxygen into energy which each cell uses to function.

 

Benefits

Aerobic exercises help build strength in major muscle groups, keep the blood pumping, and also, help strengthen the heart and lungs. Other benefits of aerobic exercises are:

 

• Help lower the cholesterol.
• Reduces the risk of a heart attack.
• Reduces the risk of type 2 diabetes.
• Reduces the risk of certain cancers breast, colon, etc.
• Helps increase bone density for patients with osteoarthritis or other rheumatic conditions.
• Reduces pain and swelling due to arthritis.
• Improves immune function.
• Lowers blood pressure.
• Helps in weight loss.
• Build endurance and stamina.
• Tones the muscles and improves posture.
• Improves balance.
• Helps decrease anxiety.
• Alleviates symptoms of depression.
• Improves balance.
• Improved mood.
• Helps manage stress through sleep and mood-regulating benefits.
• Lowers the risk of dementia and may improve cognition.

 

Aerobic exercises

Aerobics exercises can be done anywhere and do not require equipment. To prevent injuries, do warm-up before and cool-down exercises after the workout. For moderate-intensity aerobic exercise aim for 150 minutes a week and vigorous exercises for 75 minutes. Given below are some examples of aerobic exercises.

 

Running/jogging: Start slowly with alternate walking and running for 1 minute at a time.  Initially do short sessions twice a week, and then progress to 20–60 minutes, 2 or 3 times per week, as the strength increases.

 

Walking: Walking is the best aerobic exercise because it is easy to do and can be done anywhere. Do brisk walking for 10-minutes before and after work and at lunchtime or simply take long walks. Monitor the steps, you can set a target of 10,000 steps per day and work out your goal by adding 500 steps daily for half an hour to one hour thrice a week.

 

Dancing: Dancing can be done while listening to your favorite music in the private room. It can be done for 30 minutes or for an hour, 2 or 3 times per week.

 

Jump rope: Start with a goal of a 15-minute workout thrice a week. Progress by increasing the no of jumps and the time thus making it more difficult.

 

Stairsteps: Stand upright in front of the stairs, don't lean on the handles. Then place the foot on the step up and then place it back down. Look forward while using the muscles. Start at a slow pace, and then increase the speed thus increasing the intensity of the exercise. Then slow back.  Do it for 20–60 minutes, 3 times per week.

 

Swimming: Swimming is a great no-impact workout. Start with laps using one stroke, add more like the breaststroke, the backstroke, or advanced one i.e. butterfly swimming for 10–30 minutes thrice a week increasing the duration by 5 minutes each week, take rest between laps. Don't swim alone or without a lifeguard.

 

Stationary bike: Adjust the bike to the proper height. Start with a slow pace for 5–10 minutes (warm-up), and then increase the pace for an hour thrice a week until it is a bit challenging.

 

Jump squat: Stand straight with the feet apart at shoulder's width. Move into the squat position. Use a jumping motion, to move up and out of the squat position. Upon landing, immediately move into a squat position and repeat.

 

Cardio kickboxing: This is a high-impact workout combining aerobics with martial arts and boxing. After a warm-up, punch and kick, proceed to the core workout or strengthening moves for an hour, thrice a week.

 

Flutter kicks: Lie down flat on the back and place the hands under the lower back for support. Lift both the feet up off the ground and then bring one up to form a right angle with the rest of the body. Bring it back down while moving the other leg to form a right angle with the body. Keep moving the legs up and down, don’t let them rest on the ground.

 

Perform balance and stretching activities to enhance muscle strengthening and flexibility exercises thrice a week. In case of any health issue consult your physiotherapist before beginning any exercise program.