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.

Dementia | Top 10 Exercises for Patients with Alzheimer’s Disease

World Alzheimer’s Day is observed on the 24th of September every year, to raise awareness about Alzheimer’s disease. This day is viewed as an opportunity to find new ways of fighting the effects of this disease and regulate the increasing number of Alzheimer’s cases all over the world. Alzheimer's disease or Dementia is a progressive brain disease, that affects the brain cell and leads to loss of body function, behavior changes, and memory loss. Usually, ignorance about the early symptoms can lead to the worsening of the situation. Studies have shown that exercises are beneficial for people suffering from Alzheimer’s disease. Exercising not only improves strength and endurance but also improves cardiovascular fitness. Physiotherapists play an important role in recommending exercises for patients with Alzheimer’s disease and tailoring routines to meet the needs of each patient. Listed below are a few exercises that can be recommended for an individual suffering from Alzheimer’s disease.

Exercising helps in the maintenance of Motor skills, Communication skills, balance, strength, and Physical functioning.

Sideway Walking:

• Stand with the feet together and knees slightly bent.
• Step sideways in a controlled manner and move one foot to the side first.
• Then move the other foot to join it.
• Avoid dropping the hips while stepping.
• Perform 10 steps from each side of the room to the other.

 

Cross Leg Walking:

• Cross the right foot over the left.
• Bring the left foot to join it.
• Attempt 5 cross-steps on each side.
• Place the fingers against a wall for stability.
• The smaller the step, the more the patient can work on the balance.

 

Heel-to-Toe Walk:

• Stand upright and place the right heel on the floor directly in front of the left toe.
• Then repeat the same with the left heel.
• Make sure and keep looking forward at all times.
• Place the fingers against a wall for stability.
• Try to perform at least 5 steps.
• As the patient progresses, move away from the wall.

 

Retracing the Steps:

• Just before sleeping, the patient recalls everything, what he/she did that day from the moment he/she woke up.
• If necessary the other person can help him/her remember but should be asked to repeat what he/she said and ask him/her questions related to the same, like, what color clothes he/she was wearing? Who came to visit him/her? What did he/she eat?
• The exercises should be preferably carried out in chronological order and in as much detail as possible.
  
  
  Using the opposite hand:
  Encourage the patient to use his/her less dominant hand more frequently, e.g. if he/she is right-handed, ask him/her to brush the teeth, brush the hair, pick up cutlery, or hold an object with the left hand. These exercises will stimulate the opposite side of the brain, which can result in rapid expansion in the parts of the cerebral cortex that are responsible for processing tactile information, and thus can improve mental health.

 

Ride a Stationary Bike:

Simple and repetitive movements are ideal for people with Alzheimer’s disease. In addition to improving movement, riding on a stationary bike also improves cardiovascular fitness.

 

Lifting Weights:

Strengthening training is an important exercise to include in a regular routine as lifting weights has also been found to be beneficial for cognitive improvements. Individuals with Alzheimer’s disease should lift weights only under the supervision of a physiotherapist.

 

Touching and Recognizing:

Our sense of touch passes above certain processes in the brain, triggering feelings and memories. Put some objects in a bag and ask the patient to touch and identify the objects without looking at them. Our brain usually needs to see the object so that it can distinguish between them, using touch to identify subtle differences increases stimulation in areas of the brain that process tactile information, strengthening synapses in the brain.

 

Scrabble:

• Engage the mind in framing a new word every time the opponent sets a new target.
• Scrabble requires logical thinking.
• Demands the right strategy on putting a new word and where to put it for more points.
• So, Scrabble is an awesome brain exercise for Alzheimer's patients.

Chess:

• Chess is effective for cognitive functioning
• It is one of the best brain exercises for mental exercise.
• Playing chess with someone can also help people with Alzheimer's disease.

 

Physiotherapy can’t reverse the effects of Alzheimer’s disease, but it can help slow its onset. Physiotherapists are experts who work to ensure that the patient can continue to live an active life for as long as possible.

 

Top 10 Exercises and Stretches for Rotator Cuff Injury

A rotator cuff is a versatile group of muscles in the shoulder joint. Repetitive overhead movements, throwing movements, or reaching tasks at work can irritate the rotator cuff tendons. To prevent the risk of injury to these muscles, weekly strengthening and neuromuscular exercises are advisable. This can be done by doing the correct exercises at the correct time. That is why it's always best to consult a Physiotherapist before attempting any exercises. The physiotherapist provides a tailored treatment plan for a quick recovery. In this blog, we have mentioned a few exercises for individuals suffering from rotator cuff injury.

 

Rotator Cuff Muscles

The rotator cuff is made of four different muscles supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles originate from the shoulder blade on the back and wrap around to the top of the shoulder. The shoulder joint is a very shallow, strong, and stable joint.  The physiotherapist takes the assessment first and then prescribes an appropriate exercise, depending on the severity of the rotator cuff injury.

Below are examples of rotator cuff exercises that will not only help you keep your hard-earned gains, but also promote your recovery as well. These exercises could be attempted at various stages through the rehab program, as guided by your Physiotherapist.

 

Shoulder Flexion and Extension with a stick:

For flexion:

• Stand and hold the stick in front.
• Keep the elbows fully extended.
• Raise both hands to the point where slight pain is felt.
• Lower the stick down, repeat this exercise and lower it down slowly again.
• Repeat the exercise for 10-15 repetitions in a single session.

For extension:

• Stand and hold the stick behind your back.
• Take the stick back up to the pain-free range and then bring it back to the starting position.
• Repeat this exercise 15 to 20 times, initially slight pain may be felt but do it 10 to 15 times in a session.

 

Isometric External Rotation:

• Resist pushing the arm inwards/outwards.
• Hold each direction for 30-40 seconds.
• Slight pain is felt initially.
• Repeat this exercise3 times, once to twice, daily, depending on the pain.

 

Internal and External strengthening Exercises:

For Internal rotation:

• Use a resistance band, and stand on the end of it with the foot on the opposite side of the injured shoulder.
• Start the movement near the hip on the opposite side, keep the elbow straight, and pull the band across the body.
• This movement looks as if drawing a sword.
• Repeat this exercise 8-12 times 3-4 times per week as pain allows.
• Slight pain should be felt during this exercise.

For External rotation:

• Hook a large theraband to a sturdy structure.
• Stand in front of it and hold the band with the affected arm.
• Tuck the same arm beside the body and bend the elbow to 90 degrees.
• While working on the right shoulder, turn the entire body clockwise. Turn counter-clockwise if it's the left shoulder.
• Stop turning when the bent elbow forms a 90-degree angle with the resistance band.
• Pull the band away, while keeping the arm tucked beside the body and the elbow bent to 90 degrees
• Once the resistance band is taut, slowly return the arm to the starting position.
• Repeat 10 times.

 

Pendulum Exercise:

• Hold onto a table or a chair with a good arm and bend forward using the hips.
• Relax and let the injured arm hang freely.
• Use the lower body to build momentum, shifting forward and back or side to side.
• Let the upper arm bone gently swing with the body.
• Do this exercise for 10 repetitions.

 

Crossover arm stretch:

• Gently pull the injured arm across the chest as far as possible.
• A slight stretch is felt at the back of the affected arm and shoulder blades.
• Hold the stretch for 30 seconds, and repeat the same 3 times.

 

Anterior capsule rotator cuff stretching using towel:

• Use a towel or a bedsheet to stretch the muscles on the front side of the shoulder.
• Put the hand on the painful side of the back and hold the bottom end of the towel.
• With the normal hand, grab the upper end of the towel and stretch the muscles on the front side of the shoulder.

 

 Shoulder Taps:

• Begin in a push-up position with the elbows straight.
• Make sure that the hands are in line with the shoulder and keep the back straight.
• Lift one hand and tap the shoulder on the opposite side.
• Repeat with the other side.
• Doing both sides counts as 1 repetition.
• Repeat 10 times.

 

Push-ups:

• Get on all fours with the hands a little wider than the shoulders.
• Keep the head and spine in line, with the elbows straight.
• Lower the whole body until the chest is close to the floor.
• Pause for a few seconds, and push yourself up, back to the initial position.
• Repeat 10 times.

 

Doorway Stretch:

• Stand in the middle of a door.
• Place the hands at the side of the door, forming the letter T (to stretch the upper part) or the letter V (for the middle-lower part).
• In that position, bend the elbows 90 degrees.
• Then, lean forward and push yourself into the door.
• A slight stretch should be felt on the chest and shoulders.
• Hold this position for 30 seconds and repeat the same exercise 3 times.

 

Band Pulls Apart:

• Stand with the head and neck in good alignment.
• Hold a resistance band shoulder-width apart, with the palms facing upward.
• Lift the hands to shoulder height and pull the band apart while squeezing the shoulder blade.
• Return to the starting position and repeat this exercise 10 times.

Avoid any exercise that causes you pain. Get yourself first assessed by the physiotherapist. Secondly, take rest until the pain eases, or else modify the exercise by doing it in such a way that you can avoid doing that activity.