CLINICAL CONDITIONS EXERCISE AND THE CARDIAC REHABILITATION OF POST-MI PATIENTS

There are two fundamental objectives in rehabilitating a patient who has suffered a heart attack. The first is to restore the patient to the best possible physical and psychological health, and where appropriate, employment. The second is to reduce as far as possible the risk of a recurrence of cardiac illness.

Exercise is the centrepiece of most cardiac rehabilitation programmes because it helps significantly in achieving both these aims. However, it is important that exercise education is supported by information on subjects such as the nature and causes of heart disease, how to monitor risk factors, dietary advice, stress management and relaxation training.

Exercise in cardiac

rehabilitation The exercise programme should be preceded by an electrocardiogram-based (ECG) exercise test with the patient on

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the usual medication. This helps to detect any residual ischaemia (indicated by angina), determines the fitness level of the patient, appropriate heart rates for training, the presence of exercise- induced arrythmias (electrical heart irregularities) and blood pressure response.

ECG-based exercise tests are strongly advised for any patients who are at risk of, or already have, a heart condition as this is the only way exercise-induced arrythmias can be properly identified. Exercise advice should not be given to patients with heart risks without these tests.

There are four phases of cardiac rehabilitation:

Phase 1 – The coronary care unit. A positive approach to future activity from the staff is critical. This should be supported by early mobilisation and education about risk factors.

Phase 2 – The first few weeks at home. On discharge the patient should be given clear instructions for appropriate activities at home and how to gradually increase exertion. It is important that patients always have a point of contact for questions eg. a hospital telephone helpline or cardiac liaison nurse.

Phase 3 – The formal exercise-based comprehensive rehabilitation programme. This usually starts at three to six weeks after the attack and lasts between six weeks and a year.

Phase 4 – Long term exercise. This does not necessarily need to be supervised but periodic monitoring of symptoms, risk factors and medication by the GP is advised.