If you've had a cardiovascular event like a heart attack or open heart surgery, you will likely require extensive treatment to help you return to your previous level of function. Your doctor may also recommend that you participate in a cardiac rehabilitation program.
There are four phases of a cardiac rehabilitation program: the first phase takes place in the hospital immediately after your cardiac event, while phases two and three occur once you leave the hospital (these may take place via participation in a sub-acute and intensive outpatient cardiac rehab program at an outpatient cardiac rehabilitation facility). The final phase of cardiac rehabilitation is your personal maintenance of an appropriate fitness program and a healthy lifestyle.
Phase one cardiac rehabilitation occurs while you are in the hospital after your cardiac event. You may start your rehabilitation in the intensive care unit (ICU) or in a cardiac stepdown unit. Many healthcare professionals will work with you to ensure that you are able to quickly and safely return to your previous level of function.
It may seem nearly impossible to move around while in the intensive care unit, as many tubes and wires may be surrounding you, restricting your ability to move. But don't worry — your physical therapist knows how to handle these items and can still perform the necessary evaluation and treatments in the ICU.
The Physical Therapy Evaluation
When you are in the hospital and stable after your cardiac event, your doctor will likely order physical therapy services to help you get moving again. An acute care physical therapist that specializes in cardiac rehabilitation will perform an initial evaluation at your bedside in the hospital.
During your physical therapy evaluation, your physical therapist will interview you and will take various tests and measures to help determine the best treatment for you. These tests include, but are not limited to:
- Heart rate
- Blood pressure
- Oxygen saturation
- Upper extremity function, including strength and range of motion (ROM)
- Lower extremity strength and ROM
- Functional mobility such as walking and self-care tasks
Your physical therapist may also review your EKG and watch how it changes at rest and during various functional activities. Your physical therapist may also obtain specific outcome measures like the Timed Up and Go (TUG) Test or the Six Minute Walk Test to obtain a baseline of your functional status.
After your physical therapy evaluation, your physical therapist will work with you and your family to ensure that you understand the personal benefits that physical therapy can offer in a cardiac rehabilitation program.
Patient Education in Cardiac Rehabilitation
Patient education is an essential component of any cardiac rehabilitation program. Your physical therapist will teach you many important guidelines in the hospital that pertain to your specific condition. Some instructions that your therapist may give to you include:
- Sternal precautions (if you have had cardiac surgery)
- Risk factors for cardiac conditions
- Activity modification
- Bedside exercises to perform in the hospital
- Self-monitoring techniques for heart rate and exertion level
Be sure to listen closely to your physical therapist, and ask any questions that you may have. Your physical therapist should also write down any specific instructions for you to follow.
Physical Therapy Treatment in Phase One Cardiac Rehab
One of the main goals of physical therapy in phase one cardiac rehabilitation is to gradually and safely increase your activity level. Your physical therapist will monitor your heart rate, blood pressure, and oxygen levels as you increase your walking and activity tolerance. He or she may also monitor changes in your electrocardiogram (EKG) while you are performing specific activities to ensure that your cardiovascular system is responding normally to increased activity.
Your physical therapist will work with you to ensure that you are able to perform basic functional mobility like moving in bed, moving from your bed to a chair, and walking. As you progress in phase one cardiac rehab, your therapist may work with you on more advanced activities, such as stair climbing. She may also meet with your doctors and other members of the cardiac rehab team to ensure that your progression is appropriate, and that your discharge plan is in place. In addition, your physical therapist will meet with you and your family to ensure that you are able to safely get around your house when you leave the hospital.
Once you leave the hospital, your doctor will likely refer you to phase two cardiac rehabilitation to continue the progress you have made in the hospital. Be sure to follow your doctor's orders upon leaving the hospital, and ask any questions that you might have.
While in the hospital after a cardiac event like a heart attack or heart surgery, you may feel like you are unable to accomplish the most basic functional tasks. By working hard with your physical therapist in phase one cardiac rehabilitation, you can maximize your chances of safely and quickly returning to your previous level of activity and function.
Source: Hillegas, E., & Sadowski, H. S. (1994). Essentials of cardiopulmonary physical therapy. (1 ed.). Philadelphis: W.B. Saunders.