Post CABGRehabilitationDefinition Cardiac rehabilitation services arecomprehensive, long-term programsinvolving :medical evaluation.prescribed eercise.cardiac ris! factor modification.education and counselingAim of Rehabilitation"hese programs are designed to limit the:ph#siologic and ps#chological effects ofcardiac illness.reduce the ris! for sudden death or Re infarction.control cardiac s#mptoms, stabili$e or reversethe atherosclerotic process and enhance the ps#chosocial and vocational status of selected patients%ndicationComprehensive cardiac rehabilitation isindicated to all stable patients after CABG.Contraindications Patient &ith post operative angina.'ncontrolled h#pertension. 'ncontrolled Arrh#thmiasRecent (CG changes denoting acute ischemia.)ound infection.'nstable sternum.*+,A %%% and %-.Cardiac Rehab "erminolog#Phase %: %npatient Rehab - A program thatdelivers preventive and rehabilitative services to hospitali$ed patients follo&ing CABG. Phase %%: (arl# outpatient CR - a programmedthat delivers preventive and rehabilitativeservices to patients in the outpatient setting earl# after CABG &ithin the first .-/ &ee!s. Phase %%%: 0ong-term outpatient CR 0ongerterm deliver# or preventive and rehabPhase % includes: 1onitored hall &al!ing program.(ducation about coronar# arter# disease, the need for aerobic eercise and the fundamentals of eercise. An outline of the s#mptoms of eercise intolerance, and a home &al!ing program.personal plan of ris!-factor management and activit# progressionPhase %% 2 3utpatient"he outpatient phase of cardiac rehabilitation begins t&o to si &ee!s after discharge from thehospital. "he second phase is conducted b# an Registered *urse and eercise specialist or ph#siotherapist. "he patient attends one-hour outpatient sessions, t&o to three times per &ee!.Phase %% includes:'p to 4/ sessions of (5G monitored eercise6"&o to three sessions per &ee!, one hour per session7.Blood pressure and heart rates monitored. (ercise performed on treadmills, stationar#bi!es, ro&ing machines, stair masters and light &eight-lifting.%ndividual dietar# consultation. Phase III Outpatient Maintenance "his optional phase of cardiac rehabilitation promotes independence &ithin a structured eercise program. "he third phase is conductedb# an eercise ph#siologist in consultation &ith the program director. At the outpatient facilit#, cardiac patients eercise under supervision t&o times a &ee! during regular facilit# hours. Pulserate and blood pressure continue to be monitoredPhase %%% includes: "&o sessions per &ee!, one hour per session.Blood pressure and heart rate monitoring Ris! 8tratification for (erciseClass A Class BClass CClass D9 Guidelines published b# the American ,eart Association use four categories of ris! according to clinical characteristics class A: apparentl# health# and no clinical evidence of increased cardiovascular ris! of eercise. Class B: established C,D that is clinicall# stable. 3verall lo& ris! of cardiovascular complications of vigorous eercise. Class C: moderate or high ris! of cardiac complications 6multiple m#ocardial infarctions or cardiac arrest, *+,A class%%% or %-. Class D: unstable disease for &hom eercise is contraindicated Content and duration of eercise session(ach eercise session includes three phases 9 )arm-up for : to minutes. )arm-up eercises consist of stretching, fleibilit# movements9 Conditioning or training phase, &hich consists of at least .; minutes and preferabl# 4; to uences can include h#potension, angina, ischemic 8"-" changes, and ventricular arrh#thmias Cardiac Rehab Safety Supervision: Important consideration whenprescribing an eercise: Patients at moderate or high ris! "C#ass C$ shou#d participate in a medica##y supervised program with %C& monitoring and personne# and e'uipment suitab#e for advanced cardiac #ife support.(his #eve# of supervision shou#d be continued for ) to*+ wee!s unti# the safety of the prescribed eercise regimen has been estab#ishedCARD%AC R(,AB%0%"A"%3* ,31( (?(RC%8( PR3GRA1G'%D(0%*(8 @3R (?(RC%8( &al!ing on level surfaces. )al!ing slo&l# if #ou do &al! on hill# terrain. 8pacing patientAs activities. )aiting at least =hour after eating a heav# meal or bathing before eercising. Avoidance of eercising in etremel#hotBhumid &eather: greater than C;D@BE: percent humidit#. Avoidance of eercising in etremel#coldBdamp &eather: less than 4.D @ unlesscovering patientAs face &ith a scarf or mas!.%f patient feels ill, he must not eercise. )hen he feels better, he can start his program again slo&l#.Cardiac risk factorsreductionFF Blood pressure managementFF 8mo!ing cessation.FF Control diabetes.FF *utritional counseling.FF)eight management.FF 0ipid control.FF Ps#chological counseling.Rehab , C-.&Cardiac rehabi#itation has been shown to reduce morta#ity.Cardiac rehabi#itation beginning / to ) wee!s after coronary bypass and consisting of 01times wee!#y educationa# and eercise sessions for 0 months is associated with a 023 increase in eercise to#erance 4 a s#ight "+3$ but signi5cant increase in 6781C4 and a 93 reduction in body fat.Proved clinical benefits Published reports have documented that cardiac rehabilitation after CABG improvespatient outcomes in the form of reducing mortalit# and morbidit# rates..ene5ts of cardiac rehabi#itation after coronaryartery bypass surgery: 7eath4 myocardia# infarction4 bypass surgery or angiop#asty6edbac!et a#. ; CardiovascRis! +