CardiacRehabilitationNikkiGardiner

ClinicalleadforCardiac&PulmonaryRehabilitation

12th November2016

CardiacRehabilitation– Theevidence…

• Cardiacrehabilitation(CR)isaprofessionallysupervised,menu-basedprogrammeincorporatinganumberofcomponentswhich,takentogether,ensurethatpeoplewhohaveacardiaccondition,eventortreatmentareabletorecoverandgetbackto‘everydaylife’asquicklyandfullyaspossible.

• CRhelpstoreducethechanceoffuturecardiaceventsandmortality

• CRservicehasthepotentialtoreduceunplannedcardiacreadmissionsby28-56%,(Lam,2011).

• TheNationalAuditofCardiacRehabilitation(NACR)overallcurrentuptakeforCardiacRehabilitationis47%withanaimofreaching65%(BHF,2015).

• TheBACPR-NACRCertificationprogrammewaslaunchedinJune2015andhasstartedtocertifyprogrammeswithanaimtocertifyatleast25programmesperyear.

CardiacRehabilitation

StagesofCardiacRehabilitation

BenefitsofCardiacRehabilitation• Reducesthechanceoffuturecardiaceventsandmortality

• Reducesre-admissionstohospitalwithchestpain

• Identifiessafeandcomfortablelevelsofexercise

• Understandingmedications

• Helpstoreduceanxietyanddepression

• Improveonoverallqualityoflife

• Increasesconfidence/returningtohealthylifestyle

Leicester- Individualisedcare• HospitalBasedProgramme– LGH,GGH,LRIandNational

CentreofSportsandExerciseMedicine(NCSEM)

• CommunityBasedProgramme– LeisureCentre'saroundthecounty(directreferral)

Web-basedCRprogramme

Whathappensnext?

Referraltocommunityexercisesessions

ReferraltootherHealthProfessionals

SupportGroups

Exercise

Whyexercise?• Lowersrestingbloodpressure

&heartrate• Lowerscholesterollevels• Helpsreduceweight• Reducesstress• Promotesasenseofwell

being• ImprovescontrolofdiabetesOverallregularEXERCISEreducesyourriskoffurthercardiacevents.

• Helpstoimprovemusclestrengthandmusclemass

• Helpstoimprovedailyactivities

• Preservebonedensity

TypesofexerciseAerobic– Aimfor30minutesx5week

WalkingCyclingDancingSwimmingClassesGym

Strength– Aimfor2-3timesweek

UsinghandheldweightsUsinggymweightsmachines

BeSafe!• Alwayswarmupbeforetheaerobicexerciseandcooldownafter.

– Helpstopreventinjuryandmusclesorenessaswellas– Getsyourheartintoasteadystatepriortodemandinglotsofextraoxygenforittopumparound

yourbody

• Ifyoufeelanysuddenpain,dizzinessorextremeshortnessofbreath,thenstopexercisingandseekhelp.

• Ifyouhavehadavirusorarefeelingparticularlyunwellandtireddonotforceyourselftoexercise– yourbodyisalreadyusingmoreupmoreenergy.– Takesometimeofftogetbetter.– Whenre-startingremembertobuildyourselfupsteadilyagain.

• Neverexerciseifyouhavebeendrinkingalcoholorhavejusteatenaheavymeal.

• Avoidexerciseinveryhotorverycoldweather.

3phasesofexercise

• Warmup

• Conditioningphase

• Cooldown

Howtomonitoryourself?RateofPerceivedExertion(RPE)

6 Noexertionatall7 Extremelylight89 Verylight1011 Light1213 SomewhatHard1415 Hard1617 VeryHard1819 Extremelyhard20 MaximalExertion

Howtostart…Step1 3-5minutes4– 6timesperdayStep2 5-10minutes3– 4timesperdayStep3 10-15minutes2– 3timesperdayStep4 15-20minutes1– 2timesperdayStep5 20-30minutes4– 6daysperweekStep6 morethan30minutes5daysperweek

Usethescaleofperceivedexertiontohelpyouwithyourprogression

Makinglifestylechanges• Workingtogether

• Understandingyourcondition

• Havingrealisticgoals

• Takingaction/responsibility

• Addressingbarrierstochange

Prioritisinggoals• Whichonefirst?

• Ithastobeimportanttoyou

• Rateimportanceofyourgoals(scale1-10)

• Howconfidentdoyoufeelaboutmakingthechanges?(scale1-10)

• Usingagoalsettingchart.

Future

• EducationofSCADtoHealthcareprofessionals-developCRprogrammes

• PromotionofreferraltoCRspecialistteam

• AddressingpatientswithadiagnosisofSCAD- IndividualisedcarewithinCR(self-management/web-based).