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 Exercise & Workout Routines

February 2010
Cardiac Rehabilitation Programme
Dr P Srikanth
 
Here is a medically supervised programme to help heart patients recover quickly and improve their overall physical, mental and social functioning - the first in a two part series

A cardiac rehabilitation programme helps you to understand and reduce your risk factors of heart disease. You will learn how to manage your condition with a healthy diet, and develop a safe exercise programme that will return your optimal physical condition. Your stress and anxiety levels would also be brought down, helping you rebuild a healthy lifestyle. This programme is recommended for those who have had either angina, heart disease, bypass surgery, or angiography showing blockage. Those who have had angioplasty (stent), heart valve surgery or heart transplant surgery would also be benefitted by this. There are four phases of cardiac rehabilitation.

Phase I
The programme can start with its first phase while the patient is in the hospital, and Phase I lasts for a week. This aims to reduce the deconditioning effect of the prolonged bed rest the patient has had in the hospital, and to initiate patient and family education (individual and group sessions regarding lifestyle changes). Phase I comprises of personal, supervised monitored exercise sessions - having activities not exceeding two to three METS (Metabolic Equivalents).

Days 1 & 2
Breathing exercises are the way to start.
  1. Diaphragmatic breathing: In a sitting/standing position, put your hands below the sternum. Slowly inhale through the nose and exhale through the mouth. Make sure that when you are inhaling, the diaphragm is raised upwards. Inhalation and exhalation should be for 10 seconds each.
  2. Intercostal breathing: In a sitting/ standing position, put your hands at the thoracic region (on your ribs). Slowly inhale through the nose and exhale through the mouth. Make sure your chest is expanding while inhaling. Inhalation and exhalation should be for 10 seconds each.
  3. Apical breathing: In a sitting/ standing position, put your hands below the level of clavicle (on top of your shoulders). Slowly inhale through the nose and exhale through the mouth, making sure that your collarbone is raised upwards. Inhalation and exhalation should be for 10 seconds each.
Ankles and toes can be flexed after that. Active movements are to be limited to five repetitions though, since the patient is just recovering. These help you prevent bed sores. During these initial days, you will need a lot of bed rest, and even sitting will have to be supported. You can feed yourself though and use the bedside commode.

Days 3 & 4
You should continue with all of the above exercises. The ankle/toe flexing can be increased to 10, from the five you started with. You progress to sitting in a chair for five to 10 minutes, these days. You can also try raising your leg straight (Straight Leg Raise) – and repeat for five times. You are advised partial self-care – you can take bath in sitting position on a high stool.

On day four, you can increase your SLR (Straight Leg Raise) repetitions to 10, and even walk for five to 10 minutes. Isometric activities, where your joint angles and muscle lengths do not change during contraction, can be started. You can now sit and feed yourself.

Days 5 & 6
Here is when you are allowed to exercise the upper part of your body, the trunk. You are to continue the earlier exercises, increasing their repetitions. You can walk 50 to 100 metres now. You will be allowed to dress by yourself, and have an assisted shower.

Days 7 to 9
You continue with the activities from the earlier days, but can walk up to 200 metres now, and even climb two steps. You'll be allowed to sit in a chair most of the day, and shower on your own.

Day 10
You continue with the activities from the earlier days, but can walk up one flight of steps now. Before you are discharged, Exercise Tolerance Tests as below are performed based on which your home exercise programme is charted. You will primarily undergo the 12 minutes walk test, where after measuring your resting pulse, BP and RR, you will be asked to walk at a comfortable pace for 12 minutes. The readings are taken again, measuring your exertion levels.

PHASE-II
This phase begins when the patient is discharged from the hospital and continues for three weeks at home, or even a clinic. This phase covers supervised home exercises or supervised monitored exercises. Phase II of the cardiac rehab aims to improve functional capacity and lower cardio vascular risk factors. Activities up to 5 METS (Metabolic Equivalents) are safe during this period, and involve walking, and even gardening! The activities are restricted to low level to less restricted, moderate level. Duration of walking/cycling begins with 10-20 minutes and progresses to 50 minutes or an hour within six weeks. Each exercise session is divided into warm up and cool down periods. These last for at least five minutes, at a heart rate of 12-18 minutes with a frequency of two times per day, five or six times a week. Mostly, walking and stationary cycling is given. Occupational and recreational exercises are recommended.

Training
Your training methods will be two pronged. The first are called continuous exercises, including walking and cycling. Circuit training, on the other hand, is the second, done along with it to improve both muscular strength and cardiovascular endurance. Circuit training involves both upper and lower workouts. While the lower body is conditioned with stationary cycling, treadmill walking and stair climbing, the upper body is toned up with rowing, lightweights and wall pulleys.

Follow a Heart Healthy Diet
Confine your food intake to 1500 (for women) to 1800 (for men) calories per day. Eat three meals and two snacks (fruits, vegetables and nuts) per day. Your night time meal must be your lightest (soup and salad).

7 Foods to Eat
  1. Grain and cereal (preferable unmilled) – 40 percent of your diet
  2. Vegetables and fruits (including uncooked) - 35 percent of your diet
  3. Dairy products (skimmed milk, curd) - 10 percent of your diet
  4. Vegetable protein (pulses, beans) or non-veg protein (chicken and fish) - 10 percent of your diet
  5. Oil for cooking - 30 ml per person / day (sunflower or olive oil)
  6. Fluid – water, tea, juices etc., - eight to 10 glasses
  7. Green leafy vegetables daily
4 Foods to Avoid
  1. Sugar - Mithaai, pastries, ice cream, shakes
  2. Fat - Butter, margarine, ghee
  3. Drink - Alcohol, aerated drinks
  4. Additives - Salt, sugar, commercial foods
Dr. P. Srikanth is Sr. Physiotherapist at Apollo Wellness Plus, Hyderabad

    
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