Your Guide to. Cardiac Rehabilitation Programme

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1 Your Guide to Cardiac Rehabilitation Programme 1

2 1 What is Cardiac Rehabilitation? Cardiac rehabilitation programme (CRP) is designed to help individuals with heart diseases, and those recuperating from cardiac surgery, to safely resume an active and healthy lifestyle. It also reduces the risk of another cardiac event for heart patients. CRP consists of four phases: Phase 1 Inpatient cardiac rehabilitation During hospital stay Phase 3 Maintenance of exercise 6-8 weeks Phase 2 Outpatient cardiac rehabilitation 6-12 weeks Phase 4 Community-based exercise Lifelong Who is a suitable candidate for CRP? If you have had one of the following: Open heart surgery, such as coronary artery bypass graft (CABG) surgery, valve repair or replacement Percutaneous coronary intervention (PCI), such as ballooning or stenting Heart attack Chronic heart failure Heart transplant Medically managed coronary artery disease

3 2 What is Phase 1 inpatient CRP? Chest Care We will check on your pulmonary system (lungs) to prevent you from developing chest complications during hospital stay. This involves teaching you deep breathing exercises and positioning. Exercises Prescribe safe exercises, such as walking short distances several times a day, to improve your mobility and cardiac fitness. In addition, exercise also helps to control cholesterol, blood pressure, diabetes and weight as well as increase your strength and stamina. Education Provide education about your condition and the expected risks and benefits associated with a cardiac rehabilitation program. Your active participation while you are an inpatient at the hospital will allow you to return to a healthy lifestyle. What activities can I do after a heart attack? First 4 weeks 1-3 months After 3 months Activities of daily living (showering, grooming) Light housework (dishes, sweeping floor) Engage in hobbies or activities you can do sitting down (watching TV, reading, handicraft) Be a passenger in a car Climb stairs Driving Return to work Travelling Sports (soccer, badminton, table tennis, swimming) Please discuss with your cardiologist before starting a new exercise.

4 3 How to monitor intensity of exercise? Either using the Talk Test the ability to talk during your workout which determines how hard you re working: Can you talk continuously during the activity? Yes, but are you able to sing? No, you must pause for breath Yes - Light intensity No - Moderate intensity Vigorous intensity Or using the Rate of Perceived Exertion (RPE) scale: Rate of Perceived Exertion (RPE) 0 Nothing at all 0.5 Barely noticeable 1 Very light 2 Light 3 Moderate 4 Hard 5 Heavy 6 7 Very heavy Very, very heavy Always exercise at RPE 2-3

5 4 What if I just want to exercise on my own? Walking is the best form of exercise after a cardiac event. You should always warm up before exercise and cool down afterwards. Warm up and cool down exercises include stretching and walking at a slower pace than during your workout. When at home, you can follow these guidelines: Frequency Most days of the week (5-7 days) Intensity Moderate intensity. Check using the talk test or the rate of perceived exertion (RPE) scale. Time Type Start with 15 minutes for first week and then gradually increase by 5 minutes every week. Your goal is to reach 30 minutes of continuous training. Walking on a level surface or on a treadmill. Did you know? Sedentary behavior increases the risk of cardiac disease and mortality.

6 5 How should I increase my exercise program? Week Time (in minutes) Frequency (times / week) Pace Stroll Comfortable Comfortable Comfortable / Brisk The End Goal Walking 30 minutes continuously at a moderate intensity for 5-7 days a week! When to stop exercising? You should slow down or stop exercise if you experience the following signs and symptoms: Heart rate increase of >20 beats / minute above resting heart rate Giddiness or light-headedness Shortness of breath Chest pain Cold sweat Palpitation Nausea Unsteady gait

7 6 Stretching exercises Stretching exercises help to increase your range of motion and flexibility. You can perform these stretching exercises before or after your workout. Each exercise should be performed for 3-5 repetitions and held for a duration of seconds. Shoulder stretch: Cross your fingers behind your back and pull the shoulders backwards. Shoulder stretch: Rotate your shoulders clockwise and anti-clockwise 20 times. Quadriceps stretch: Pull your heel towards your buttock. Repeat for the other leg. Hamstring stretch: Straighten one leg in front of you and reach towards your toes. Repeat for the other leg. Calf stretch: Lean against a wall and bring your back leg as far as possible behind you. Repeat for the other leg.

8 7 What is Phase 2 outpatient CRP? Your cardiologist will assess and determine your suitability for Phase 2 CRP. If deemed suitable: Your cardiologist will conduct an exercise stress test prior to participating in CRP. You will have a counselling session with the physiotherapist to explain the modes and intensity of exercises, and to set goals for the programme. Your height, weight, body-mass index (BMI), blood pressure, percentage body fat will be taken. On the first session, a six-minute walk test will be conducted as a measure of your fitness. Telemetry leads are necessary during the first session and every session you will need to put on a heart rate monitor. The exercise programme will consist of 12 sessions (based on your set goals). This may include exercises such as treadmill walking, stationary cycling and resistance training. In the final session, you will be re-evaluated with the six-minute walk test and prescribed with an individualised home exercise plan. You will be encouraged to continue exercising on your own.

9 8 What do I need to prepare before attending? Appropriate exercise attire (e.g. t-shirt, shorts and shoes) Take your medication according to prescription Avoid caffeinated drinks 2 hours before exercise (e.g. coffee, tea and coke) Have your meal two hours before exercise Avoid heavy exercise before your appointment Patients with diabetes are encouraged to bring along their own glucose monitoring device to avoid additional charges (as blood glucose will be tested before and after exericse) For enquiries about the programme, please call Tel: * If you have any questions regarding the information provided, please request to speak to your physiotherapist. * The information provided in this brochure serves as a guide only. Depending on your condition, please follow any additional self-care advice provided by your doctor(s), nurses and physiotherapists.

10 2 Simei Street 3 Singapore Tel: Fax: Reg No R For appointments and enquiries, please call the CGH Appointment Centre at Tel: (65) CGH Appointment Centre operating hours: 8.30 am to 8.00 pm (Monday to Friday) 8.30 am to pm (Saturday & Sunday) Closed on Public Holidays For more information, please visit Organisation Accredited by Joint Commission International Like us on Facebook Changi General Hospital All information is valid at the time of printing (December 2015) and subject to revision without prior notice.

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