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Cardiac rehabilitation has many benefits

By Brenda Anderson, cardiac rehabilitation manager, NHS Grampian

Cardiac rehabilitation is defined as: “The sum of activities that is required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they (people) may by their own efforts preserve or resume when lost, as normal a place as possible in the community.” (Scottish Intercollegiate Guidelines Network 2002)

Phases of cardiac rehabilitation
♥ Phase 1 – inpatient education and preparation for discharge
♥ Phase II – post discharge support and guidance
♥ Phase III – 8 week comprehensive programme including exercise, education and relaxation training
♥ Phase IV – long-term maintenance including secondary prevention and exercise

Exercise – the good news
Taking part in exercise has many benefits. It helps to lower blood pressure, weight and cholesterol levels, reduces the risk of a stroke and type 2 diabetes and lowers the risk of osteoporosis (bone thinning).  It also relieves stress, helping you to relax. It improves your mental and physical well-being and helps reduce fatigue and make you feel more energetic. It also keeps your joints more mobile and flexible.

But it is very important to increase your physical activity gradually.  This means both the amount of time you spend doing it, and how intense the activity is.

People with chronic conditions often have good and bad days. When they feel well they are tempted to do lots of activities and household chores, then usually the day after they are more tired and have to rest a great deal. This can cause fitness levels to deteriorate. So you should try to avoid this cycle by doing a little activity every day and gradually increase the amount you do. Your fitness will gradually improve, you will use less oxygen and the workload of your heart will decrease.

Remember to warm up and cool down each time you do any physical activity.  Begin slowly for the first few minutes and build up gradually, making your warm up last for 15 minutes.

When you come to the end of your activity, make sure you don’t stop suddenly.  You should cool down for a minimum of 10 minutes but you may need longer than this.

What type of exercise?
Aerobic exercise that gets your big muscle groups working is most beneficial. This includes walking, cycling, climbing steps, swimming and circuits (cardiac work mixed with other exercises).

Over time it helps to reduce your heart rate and blood pressure, reducing the workload on the heart.  If you prefer you can start with interval training, which is short, frequent bouts of exercise lasting between five and ten minutes and periods of rest in between. Or you could do three minutes of step-ups and then one minute of easy walking.

How frequent and intense?
To achieve maximum benefit, you should work for 20 to 30 minutes, three or four times a week. Each session needs to include a warm up, conditioning session and a cool down.

It is useful to refer to the Rating of Perceived Exertion (RPE) scale from six to 20. Six involves no exertion and 20 is maximum exertion. You should aim for 12 or 13 which is when activity feels moderate to hard. You are warm and perhaps a little breathless but you feel you can continue exercising.

You can also use a heart rate monitor to see how hard your heart is working and avoid doing too much.  But be aware of how intense the exercise feels to you as it can be more important than a heart rate monitor reading and can be more reliable as heart rate varies between individuals.  Your maximum heart rate is 220 (226 for women) minus your age.

If you have heart problems it is recommended that you never exercise to more than 80 per cent of your maximum heart rate but some people will be advised to have a lower limit.  Ask your doctor about this.

External factors
Exercising when it is very hot or very cold should be avoided as it puts the heart under greater stress.  Always have water with you and take regular sips so you avoid becoming dehydrated. 

If you are using any exercise equipment make sure it is safe for purpose (you are not likely to fall or get injured using it) and appropriate for your abilities. It should also be well maintained.

Try to avoid rapid changes in posture such as bending very low or getting up too quickly from the floor to a standing position as it can lower blood pressure and make you feel dizzy and lightheaded.

Some people prefer to exercise on their own, but joining a group session offers social benefits too.

Tiredness or changes in medication can sometimes affect your ability to exercise. Drugs may affect your heart rate and blood pressure response and give you more symptoms. Remember to listen to your body and slow down if you are finding it difficult.  If you are feeling unwell stop.

Anyone with a heart condition can benefit from supervised cardiac rehabilitation. As well as getting the benefits of exercise, your confidence to do exercise will increase. You are taught how to increase exercise safely and work at a level that is beneficial for your heart within its particular capabilities.

Cardiac rehabilitation has also been shown to reduce anxiety and depression, and improve quality of life.

 



The Cardiomyopathy Association's Registered Charity Number is 803262.
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