An evaluation of current exercise procedure in Phase 3 Cardiac Rehabilitation.
Since its formation in 1992 the British Association for Cardiac Rehabilitation has had a major influence on the care and education of patients recovering from cardiovascular health problems. Cardiac Rehabilitation is a rapidly expanding speciality in the United Kingdom; it establishes guidelines for practitioners and maintains ongoing scientific research within its field. Patients with cardiac disease, along with a team of highly trained health professionals are encouraged and supported to achieve and maintain optimal physical and psychological health. Cardiac rehabilitation is implemented via exercise training, behavioural change, education and psychology support. This is to facilitate a return to normal living and encourage patients into lifestyle changes to prevent future complications.
Cardiac Rehabilitation is structured into four phases throughout a patient’s recovery. Each phase is designed to be beneficial dependent on the stage of recovery. Phase one occurs when a patient is still in hospital, having been admitted to a Coronary Care Unit (CCU) or directly to a medical surgical wing. The main issues assed in phase one include: reassurance, information, risk factor assessment, risk satisfaction, education, mobilization, discharge planning and the involvement and support of the family (Leon, 1997). Phase two is conducted post discharge and occurs within 4-6 weeks. During this time patients can feel isolated and insecure. Psychological distress and poor social support are powerful predictors following any cardiac treatment. Phase 2 is implemented to provide support by home visiting, telephone calls, and by supervised use of the heart manual or certain behavioural programs. Phase 3 is also post-discharge, and consists of an 8 week program split into four levels. Phase 3 is a structured exercise training program conducted alongside continued education and psychological support and advice. Phase 3 is usually conducted safely and effectively in the community. Phase 4 is about the long-term maintenance of patients. The two main goals include; long-term maintenance of individual goals, monitoring of patient status as well as continued follow-ups of general progress. Cardiac Support groups have also been set up to help patients maintain physical activity and lifestyle changes (Coats, McGee, stokes, and Thompson, 1995).
Phase 3 of Cardiac Rehabilitation is structured on exercise and education in the community. Research has indicated that community based rehabilitation is feasible; however whether it is cost effective would require trials of adequate size (Wolfe, Tilling, & Rudd, 2000). The rational for exercise training for cardiovascular disease includes; exercise tolerance, especially for patients who have receded functional capacity. Improved skeletal muscle strength and endurance is also visible along with the relief of myocardial ischemia symptoms (Frankin, Gordon, & Timmis, 1992). Regular aerobic physical activity increases exercise capacity and furthermore, plays a role in both primary and secondary prevention of cardiovascular disease (Morris & Froelicher, 1991). Improved psychological well-being and the increased survival rate are favourable outcomes, especially when exercise is used in conjunction with education and behaviour modification. Before any exercise is performed medical screening and assessment is undertaken. Risk stratification, exercise prescription, supervision and monitoring are key elements of program safety (Camp, 1995). The effects of exercise training differ in cardiac patients when compared to a healthy adult. Research suggests that increases in VO2 peak are between 10% and 55% in myocardial infarction patients and 15-65% in coronary artery bypass graft patients (Coats, McGee, stokes, and Thompson, 1995; Carr & Shepherd, 2003).
The issue of intensity within phase 3 is critical, especially due