EXERCISE & CARDIAC REHABILITATION

CARDIAC REHABILITATION PHASE IV

By Martin Feaver, MA, BACR Phase IV

The process of cardiac rehabilitation aims to help the individual resume a full and active life as soon as possible following a cardiac event together with reducing the risks of possible further events.

It employs a multidisciplinary, profession- al team to educate and advise patients during their recovery on their treatment and possible lifestyle changes that will help prevent further cardiac events. Cardiac rehabilitation is an active process with patients assuming responsibility for their own health.

Phase IV cardiac rehabilitation is the long-term, or lifetime, stage of the reha- bilitation process. Although there is an emphasis on exercise during this stage, the need to continue advising, educating and supporting clients is as important as it has been in the previous stages. Phase IV exercise classes are generally operated

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in leisure centres or similar facilities - although some classes take place in hos- pitals - and use the skills of a suitably qualified instructor. With the move away from the hospital/medical environment patients become clients which is an important psychological shift in the reha- bilitation process.

Exercise is delivered individually and in classes. Class activities usually involve supervised circuit training with adapta- tions to meet specific medical or individ- ual needs ie. arthritis and osteoporosis.

Indicators ● Post-myocardial infarction ● Post-coronary artery by- pass graft

● Post-angioplasty ● Post-heart transplant ● Post-valve replacement ● Stable angina

Individual exercise prescriptions are designed to enable independent exercise at home (this is covered in more detail later in the patient leaflet). Although Phase IV is generally delivered through specialist classes it can also be delivered through personal training and mainstream exercise classes. A specific requirement however, is that the instructor is qualified in Phase IV cardiac rehabilitation.

The format for circuit training comprises of aerobic and muscular strength and endurance exercise stations. The time an

Contraindicators (require further medical investigation) ● Unstable angina ● A resting systolic blood pressure higher than 180mmHg or a resting diastolic blood pressure higher than 100mmHg

● A significant drop in blood pressure during exercise ● Unstable or acute heart failure ● Febrile illness - until the client’s fever subsides

Table 1: Indicators and contraindicators for inclusion suitability in a Phase IV rehabilitation programme (2,5)