Cardiac Rehabilitation and Its Phases

Cardiac Rehabilitation

The most alarming predictions made for the new millennium is that of cardiovascular diseases (CVD) topping the list of death and disability. These accounts for 2, 08,000 deaths, that is 36% of the annual total, every year (coronary heart disease statistics, 2007). CVD rates in urban areas in India are now 4-fold higher than in the USA which were same in 1968 (Enas EA. 2000 ). According to World health organization (WHO) by 2010 CVD’s are estimated to be the leading cause of death in developing countries (World health statistics 2007). Thus, the need of comprehensive program was felt for the patients with heart disease. Cardiac Rehabilitation (CR) was hence recognized as an essential component in the care of patients with CVD. There have been scientific evidences over the past 3 decades of the benefits of CR services (Oldridge, Guyatt , Fischer and Rimm 1988, Witt , Jacobson , Weston et al 2005 ).

The WHO’s (1993) most recent definitions of CR read as follows :

” The rehabilitation of a cardiac patient is the sum of activities required to influence favorably the underlying cause of the death , as well as the best possible physical , mental , and social condition , so that they may , by their own efforts preserve or resume when lost , as normal a place as possible in the community. Rehabilitation cannot be regarded as an isolated form of therapy but must be integrated with the whole treatment of which it forms only one facet.”


·         Phase I : The Acute stage

·         This is the hospital phase which begins with a referral from patient’s physician after he is medically stable to the time of discharge which is usually about 7 to 10 days.

·         It contains educational sessions , correction of cardiac misconceptions and counseling for the patient and their relatives, also the use of hospital anxiety and depression scale(HADS) is also suggested.(Zigmond and Snaith , 1983)

·         This phase is directed to prevent pulmonary complications post surgery also ambulation and self- care evaluation.

·         Phase II : The sub acute stage

·         This varies from 5 to 12 weeks after infarction or surgery.

·         It begins with completion of the low-level treadmill test and ends at the completion of catheterization and the maximal treadmill test.

·         This phase includes aerobic exercise, flexibility exercise and strength training to maintain the cardiovascular endurance.

·         Phase III : Long term follow-up

·         This is a high level phase which includes high level aerobic exercises performed only when formal reevaluations in the form of exercise test shows no inappropriate ventricular function and are medically stable too.

·         This phase ends when the exercise program attains maintenance level of the patient.

·         Educational and psychological support is given to the patient and advices to reduce risk factors also vocational rehabilitation is given to the patient to assist return to work.

·         Phase IV : Lifetime follow through

In this phase patient is expected to carry out his exercise program independently which can be done at any fitness centre, club or at home.