THE CARDIAC REHABILITATION PHASES

PHASE I:

It starts from the very first day in patients with IMA not complicated or when clinical and hemodynamic conditions are stabilized. This phase is intended to counteract the effects of prolonged sleep (lack of physical conditioning, orthostatic hypotension, pulmonary embolism and others) and is both the ideal time to initiate the activities of secondary prevention, because it educates the patient about his disease , diet, risk factors and modification, as he guided in their products care to be at home, physical activity allowed and warning signs for help. • From the physical point of view, the activity should be isotonic 1-2 METS, which is to correspond to an activity such as washing patient. It imposes control heart rate in the early mobilization for not exceeding 120 lat / min or exceed 20 beats in the frequency baseline patient, but if you are consuming beta blockers should not present manifestations of chest pain, shortness of breath, palpitations or fatigue , as well as alterations in the ST segment, or reduce blood pressure more than 10-15 mm Hg. It can be used with the Borg scale of intensity below 14. • Blood pressure and heart rate will be taken to the patient to 5 minutes of stretching or warming in a standing position. • Some researchers 6 recommend starting physical training to 48 hours after the IMA or immediately after surgery and saw no need to be very "protocolizado" because the purpose in the years 60 and 70 to prevent episodes thromboembolic, met today with thrombolysis and other therapeutic measures. • This phase, which includes a visit from a member of the rehabilitation team, is aimed at encouraging the sick and commit to a family member in the group. Some older patients may serve as volunteers and share their experiences about how to learn to live with heart disease. • The team comprehensive cardiac rehabilitation are: nurses, fisiatras, cardiologists, dietitians, social workers, psychologists and occupational therapists. • In the coronary care unit, patients with low risk are urged to sit beside the bed and make her self, but once transferred to the next hospital room, sit down and make it walk alone, walk attendants inside the room and corridors to 2 times daily, beginning with 5-10 minutes to half an hour. At this stage it is appropriate to stratify the risk, as this determines the protocol to be followed in Phase II. • Once the patient returns to his home (Phase 1.5 or after discharge), members of the medical team and their families continue checking their state of health and recovery, as well as providing resources for strengthening. This phase includes low-level exercises and small work home with a level of 2-3 METS. The exercises should consider the involvement of arms, legs and trunk; walk pausadamente distances growing for fitting muscle and achieve a gradual reintegration into society and the family. It is transmitted to the patient precise instructions for carrying a lifestyle satisfactory and he stresses the importance of controlling risk factors.


PHASE II (or active phase of supervised exercise)

• You can start with the test ergométrica early (5-15 days after IMA or a week after surgery). At this stage when it is raising the patient's functional capacity. 11-14 • Members of the group I (low risk) have a functional capacity normal (group 1), thus requiring no increase and the only thing needed is to moderate aerobic exercise or isometric exercises soft. Its purpose is to act as a secondary prevention against the sedentary and contribute to the control of other risk factors (dyslipidemia, hypertension, diabetes mellitus). Moreover, as your risk is very low and moderate exercise, it is imperative that they are controlled area hospital and may be exercised at home, in community spaces and even in his work, which includes surveillance and monitoring transtelefónico and Internet-based systems, but requires definitive studies on the effectiveness and safety of these approaches, 12 to increase the reference of patients and accessibility of services for cardiac rehabilitation and secondary prevention. • Patients in Groups II and III, have diminished their functional ability, it needed to increase and realize this phase of physical training in a supervised in an area hospital, follow the traditional protocols and receive outpatient care at the hospital once graduates this institution. In some countries of Eastern Europe there was a regime sanatorial, whose drawback was to isolate patients in their normal lives. 6 • During the training sessions physical monitor clinical manifestations, and the routes electrocardiográficos hemodynamic values before, during and after exercise. 8, 9 • The latter, like any other therapeutic measure is indicated and tailored along the lines of basic prescription: 1 ro. Frequency of training of not less than 3 times per week 2 do. Duration of training: 30-45 minutes. Basically is divided into 3 stages: heating, cooling and hardening resistance or, in each session may include a stage recreation of 10-15 minutes to improve psychosocial aspect, as well as integration and adherence to the plan. 3 ro. Intensity Training: Based on the pulse of training, 60-80% of V02 maximum anaerobic threshold and heart rate threshold, can be used Borg scale. 4 -7 4 to. Mode exercise. 5 to. Progression of training: It depends on the level of initial fitting, prior history of physical activity, health status, age, personal preference of the patient and other factors. The educational sessions are conducted in groups or individual.



PHASE III (maintenance phase)

• At this stage, the patient develops physical activity independently, according to a training plan established at the end of Phase II. At this stage there is no need to increase the functional capacity, but retain it. In patients with low-risk sports fan and contraindications can continue without increasing functional ability, but in those with high-risk stage II may last longer, in this case, considering the possible move to phase III when they have reached 6 METS in the stress test. 6 • Patients moderate exercise by controlling heart rate or using the Borg scale and further control risk factors, including psychosocial adjustments necessary.