PHASES OF CR
PHASES OF CARDIAC REHABILITATION
Cardiac rehabilitation services are divided into 3 phases, as follows:
Ø Phase 1 - Initiated while the patient is still in the hospital
Ø Phase 2 - A supervised ambulatory outpatient program spanning 3-6 months
Ø Phase 3 - A lifetime maintenance phase in which physical fitness and additional risk-factor reduction are emphasized
PHASE 1 : IN - HOSPITAL PHASE
This program begins while patients are still in the hospital.
Phase 1 includes a visit by a member of the cardiac rehabilitation team, education regarding the disease and the recovery process, personal encouragement, and inclusion of family members in classroom group meetings.
Some older patients may serve as volunteers and share their experiences about learning to live with heart disease.
Team members include cardiac nurses, exercise specialists, physical therapists, occupational therapists, dietitians, and social workers.
In the coronary care unit, assisted range-of-motion exercises can be initiated within the first 24-48 hours.
Low-risk patients should be encouraged to sit in a bedside chair and to begin performing self-care activities (eg, shaving, oral hygiene, sponge bathing).
On transfer to the step-down unit, patients should, at the beginning, try to sit up, stand, and walk in their room. Subsequently, they should start to walk in the hallway at least twice daily either for certain specific distances or as tolerated without being unduly pushed or held back. Standing heart rate and blood pressure should be obtained followed by 5 minutes of warm-up or stretching. Walking, often with assistance, is resumed, with a target heart rate of less than 20 beats above the resting heart rate and an RPE of less than 14. Starting with 5-10 minutes of walking each day, exercise time gradually can be increased to up to 30 minutes daily.
Team members including the nurse educator, dietitian, exercise rehabilitation trainer, and physician should incorporate in the discharge planning an appropriate emphasis on secondary prevention through risk factor modification and therapeutic lifestyle changes (TLC), such as aspirin and beta-blocker use in all patients, angiotensin converting enzyme (ACE) inhibitor use in patients with left ventricular ejection fraction of less than 40%, smoking cessation, lipid management, weight management, and stress management. They must also ensure that phase 1 patients get referred to appropriate local, convenient, and comprehensive phase 2 programs.
PHASE 1.5 : POST - DISCHARGE PHASE
This phase begins after the patient returns home from the hospital.
Better understanding of how to keep the heart healthy and strong is emphasized. Team members work with patients and family members.
Team members check the patient's medical status and continuing recovery; they should offer reassurance as the patient regains health and strength.
This phase of recovery includes low-level exercise and physical activity, as well as instruction regarding changes for the resumption of an active and satisfying lifestyle.
Risk reduction strategies are emphasized again.
After 2-6 weeks of recovery at home, the patient is ready to start phase 2 of his/her cardiac rehabilitation.
PHASE 2 : SUPERVISED EXERCISE
Patients who have completed hospitalization and 2-6 weeks of recovery at home can begin phase 2 of their cardiac rehabilitation program.
The physician and cardiac rehabilitation staff members formulate the level of exercise necessary to meet an individual patient's needs.
Exercise treatments usually are scheduled 3 times a week at the rehabilitation facility.
Constant medical supervision is provided; this includes supervision by a nurse and an exercise specialist, as well as the use of exercise ECGs.
In addition to exercise, counseling, and education about stress management, smoking cessation, nutrition, and weight loss also are incorporated into this phase.
Phase 2 may last 3-6 months.
PHASE 3 : MAINTENANCE PHASE
Phase 3 of cardiac rehabilitation is a maintenance program designed to continue for the patient's lifetime. The exercise sessions usually are scheduled 3 times a week.
Activities consist of the type of exercises the patient enjoys, such as walking, bicycling, or jogging. A registered nurse supervises these classes.
ECG monitoring usually is not necessary.
The main goal of phase 3 is to promote habits that lead to a healthy and satisfying lifestyle.
Phase 3 programs do not usually require medical or nursing supervision. In fact, most patients participate in "phase 3" equivalent exercises at the exercise facilities in the community (eg, YMCA, YWCA).