Introduction

What Is Cardiac Rehabilitation?

Cardiac rehabilitation is patient-oriented and interprofessional prevention and intervention programme for patients with cardiovascular diseases such as:

• Congenital Heart Disease
• Acute Coronary Syndrome
• Myocardial Infarction
• Heart failure
• After coronary artery bypass surgery
• After heart transplantation

There are four phases of rehabilitation based on British Association of Cardiac Rehabilitation. Physiotherapist participate in all phases of rehabilitation from providing chest physiotherapy treatment, to ambulating the patients, to designing home asked exercise training programme after patients discharge.

Phase I: Hospital inpatient period

Phase II: Immediate post-discharge

Phase III: Intermediate post-discharge

Phase IV: Long-term maintenance

The Five Core Components of Cardiovascular Disease Prevention and Rehabilitation by BACPR are:

Physiotherapy treatment contributes mainly in components such as, long term strategies, lifestyle risk factor management and health behaviour change and education in cardiovascular rehabilitation.

Physiotherapists play an important role in the multidisciplinary team delivering cardiac rehabilitation by providing:

• Skillful cardiovascular assessment
• Exercise prescription
• Rehabilitation management
• Risk factor monitoring & management

Rehabilitation management includes airway clearance techniques, functional training for activities of daily living (ADL), functional training for work and therapeutic exercise.

Exercise training and patient education are the essential components in comprehensive cardiac rehabilitation to reduce complications of cardiovascular disease, prevent deconditioning of health, promote physical activity, and a lifestyle risk factor management.

A capable physiotherapist should be able to prescribe exercise according to the FITT principle to increase the specificity of exercise training for in individual.

F = Frequency/volume of training

I = Intensity of training

T = Type of training

T = Time/duration of training

Physiotherapist will provide education on smoking cessation, self monitoring techniques, diets, lifestyle modifications and workplace modifications as long term maintenance.

Walking Program for Cardiac Rehabilitation with FITT principle

F = Frequency

• 3-5 times per week

I = Intensity

• Moderate Intensity: Aim for 50-70% of maximum heart rate (HRmax). For many individuals, this means a brisk walk where you can talk but not sing comfortably. Alternatively, use the Borg RPE scale to aim for a moderate intensity level of 12-14.

T = Time

• Start with 20 minutes per session, gradually increasing to 30-60 minutes as endurance

T = Type

• Aerobic Exercise: Walking

Sample Walking Session

1.    Warm-Up (5 minutes):

• Begin with a slow, comfortable walk to gradually increase your heart rate and warm up your

2.    Main Exercise (20-30 minutes):

• Walk at a brisk pace where you can maintain a conversation but feel slightly Aim to reach the target intensity level.

3.    Cool-Down (5 minutes):

• Slow down your pace to a comfortable level and gradually bring your heart rate back to its resting Stretch major muscle groups (e.g., calves, hamstrings) if needed.

Progression

• Weeks 1-2: Start with 20 minutes of walking, 3 times per week
• Weeks 3-4: Increase to 30 minutes per session, 4 times per week
• Weeks 5-6: Aim for 40-60 minutes per session, 5 times per week, adjusting intensity as needed based on your comfort and fitness

Notes

• Monitor Your Heart Rate: Use a heart rate monitor or check your pulse manually to ensure you’re within the desired intensity
• Adjust Based on Feedback: Pay attention to how you feel during and after If you experience any discomfort or unusual symptoms, stop and consult a healthcare provider.
• Safety: Always follow the specific recommendations and guidelines provided by your cardiac rehabilitation

Stationary Cycling Program for Cardiac Rehabilitation with FITT Principle

F = Frequency

• 3-5 times per week

I = Intensity

• Moderate Intensity: Aim for 50-70% of maximum heart rate (HRmax) or use a rate of perceived exertion (RPE) of 12-14. This means you should be able to talk but not sing

T = Time

• Start with 15-20 minutes per session, gradually increasing to 30-45 minutes as fitness

T = Type

• Aerobic Exercise: Stationary cycling

Sample Stationary Cycling

1.    Warm-Up (5 minutes):

• Begin with low resistance and a slow pace to gradually increase your heart rate and prepare your muscles for

2.    Main Exercise (15-30 minutes):

• Increase resistance to a moderate level where you can maintain a steady Aim to reach the target intensity level. Adjust resistance as needed to stay within the desired heart rate range or RPE.

3.    Cool-Down (5 minutes):

• Reduce the resistance and slow down your pace to gradually bring your heart rate back to its resting Finish with some gentle stretching for your legs and lower back.

Progression

• Weeks 1-2: Start with 15 minutes of cycling, 3 times per
• Weeks 3-4: Increase to 20-30 minutes per session, 4 times per
• Weeks 5-6: Aim for 30-45 minutes per session, 5 times per week, adjusting resistance and duration based on comfort and fitness

Notes

• Monitor Your Heart Rate: Use a heart rate monitor or check your pulse periodically to ensure you’re exercising at the appropriate
• Adjust Resistance: Modify the resistance on the bike to stay within the target intensity range and ensure a challenging but manageable
• Safety: If you experience any discomfort or unusual symptoms, stop the exercise and consult with your healthcare

Prepared By

Wei Kei

Your Physio Puchong