Cardiac Cardiac RehabilitationRehabilitation

Maruli T. Simanjuntak, MD, FIHAMaruli T. Simanjuntak, MD, FIHA

Dept. Cardiology, Fac. of Medicine Dept. Cardiology, Fac. of Medicine USUUSU

Adam Malik HospitalAdam Malik Hospital

Cardiac RehabilitationCardiac Rehabilitation American College Cardiology (A.C.C)American College Cardiology (A.C.C)“ “ Exercise and counseling services which Exercise and counseling services which

reduce symptoms or improve cardiac reduce symptoms or improve cardiac function”function”

Counseling : - DiseasesCounseling : - Diseases - Medicine- Medicine

- Risk factor- Risk factor - Health Promotion- Health Promotion

Coronary DiseaseCoronary Disease

Myocardiac Infraction : USA Myocardiac Infraction : USA 1.000.000/year1.000.000/year

Coronary artery by pass Graft : Coronary artery by pass Graft : 367.000/year367.000/year

Heart transplantationHeart transplantation PTCA (percutan transluminal cor. PTCA (percutan transluminal cor.

angioplasty)angioplasty) Stable angina : 7.000.000/yearStable angina : 7.000.000/year

Guide Line Exercise Guide Line Exercise TrainingTraining

Warning Up 5'-10' Warning Up 5'-10' : strecthing: strecthing Exercise 20'-40' Exercise 20'-40' :1. walking:1. walking

2. bicycle2. bicycle

3. treadmill3. treadmill Cooling downCooling down 5'-10‘5'-10‘ Recommend : 3x/week for ≥ 12 weekRecommend : 3x/week for ≥ 12 week

(70-85% base line heart (70-85% base line heart rate)rate)

Recommended cardiac Recommended cardiac rehabilitationrehabilitation

Level of Risk: 3 ‘ walking Level of Risk: 3 ‘ walking (treadmill)(treadmill)

High riskHigh risk Angina on walkingAngina on walking Ischaemic ST depression ≥ 2 mmIschaemic ST depression ≥ 2 mm HypotensiHypotensi ArrythmiaArrythmia Left Ventr. EF ≤ 40 %Left Ventr. EF ≤ 40 % Age ≥ 70 yearsAge ≥ 70 years

Activities of daily livingActivities of daily living

Lying quietlyLying quietly 1.0 Mets1.0 Mets Sitting: light activitySitting: light activity 1.5 1.5

MetsMets Walking from house to car or busWalking from house to car or bus 2.5 2.5

MetsMets Watering plantsWatering plants 2.5 Mets2.5 Mets Walking the dogWalking the dog 3.0 Mets3.0 Mets Household taskHousehold task 3.5 Mets3.5 Mets Gardening Gardening 4.4 Mets4.4 Mets

Mild ActivitiesMild Activities

Playing the pianoPlaying the piano 2.3 METs2.3 METs Walking (2mph)Walking (2mph) 2.5 METs2.5 METs Dacing (ballroom)Dacing (ballroom) 2.9 2.9

METsMETs

Moderate ActivitiesModerate Activities

Walking (3mph)Walking (3mph) 3.3 METs3.3 METs Cycling (leisurely)Cycling (leisurely) 3.5 3.5

METsMETs Golf (without cart)Golf (without cart) 4.4 4.4

METsMETs Swimming (slow)Swimming (slow) 4.5 METs4.5 METs Walking (4mph)Walking (4mph) 4.5 METs4.5 METs

Vigorous ActivitiesVigorous Activities

Tennis (doubles)Tennis (doubles) 5.0 METs5.0 METs Skiing (water or downhill)Skiing (water or downhill) 6.8 METs6.8 METs Climbing hill (no load)Climbing hill (no load) 6.9 METs6.9 METs SwimmingSwimming 7.0 METs7.0 METs Walking (5mph)Walking (5mph) 8.0 METs8.0 METs Jogging (10 min mile)Jogging (10 min mile) 10.2 METs 10.2 METs SkippingSkipping 12.0 METs12.0 METs SquashSquash 12.1 METs12.1 METs

Management of lipid Management of lipid LevelsLevels

Assess and modify diet, physical Assess and modify diet, physical activity, and drug therapy.activity, and drug therapy.

LDL Cholesterol level < 100mg/dlLDL Cholesterol level < 100mg/dl Cholesterol level < 130mg/dlCholesterol level < 130mg/dl HDL > 45mg/dlHDL > 45mg/dl Triglyceride level < 200mg/dlTriglyceride level < 200mg/dl

Management of Management of HypertensionHypertension

Life style modification, including Life style modification, including exercise, weight management, exercise, weight management, sodium restriction.sodium restriction.

Goal : blood pressure < 140/90 Goal : blood pressure < 140/90 mmHgmmHg

Cessation of SmokingCessation of Smoking

Stopped smoking recentlyStopped smoking recently

Weight ReductionWeight Reduction

BMI ≤ 25 BMI ≤ 25 Waist circumference < 102 cm Waist circumference < 102 cm

(men)(men)

< 88 cm (women)< 88 cm (women)

Management of DiabetesManagement of Diabetes

Dietary modification, weight control Dietary modification, weight control and exercises combine with drugs.and exercises combine with drugs.

Monitor glucose blood level.Monitor glucose blood level. Goals: fasting 80 to 110 mg/dl.Goals: fasting 80 to 110 mg/dl.

Psychosocial Psychosocial ManagementManagement

Identify depression, anxiety, social Identify depression, anxiety, social isolation, anger, and hostility.isolation, anger, and hostility.

Provide individual or group Provide individual or group counseling.counseling.

Provide stress reduction classes for Provide stress reduction classes for patients.patients.

Goals: absence of significant Goals: absence of significant psychosocial problem.psychosocial problem.

Thank youThank you