Exercise Prescription in Cardiac Rehabilitation

By John Russell

Cardiac Rehabilitation?• Cardiac rehabilitation is a programme of

exercise and information sessions that help you get back to everyday life as quickly as possible.

• To help people in the hospital community and home.

• Meeting their 30/5.• Prove that exercise is not scary.• Reducing risk of happening again.

Exercise Prescription?• Referral of patients to exercise programmes.• F.I.T.T.• Warm Up• HR Zones / Timing• Cool Down• Medications

• Measuring : • Aerobic endurance • Strength • Flexibility• Body composition• Balance• Co-ordination

Benefits of physical activityfor Heart Disease

Exercise prescription has shown to have major benefits to Coronary Heart Disease:•Decreased blood pressure•Reduction in heart rate and increased myocardial blood flow•An increase in exercise tolerance.•A reduction in the need for anti anginal and anti hypertensive medication.•An improvement in lipid profiles.•Improvement in other risk factors such as insulin resistance.•Improvements in psychological function and quality of life.•If someone is active they benefit from a reduced risk of CHD•A reduction in mortality by participation in a CR Programme incorporating exercise of 25%.

All these benefits

… yet we have a problem

Maintenance & Adherence.

- We’ve got this great product. But a

recent study for phase III found that 1/5th of participants didn’t complete the

programme and 1/10th didn’t even turn up! [3]

- If your target was 350 that means your actual number for completion would need to be 420 referrals.

Contemporary Studies in this area“Illness” and “not interested” were the most common primary reasons for non-attendance and non-completion respectively.”

“The study highlights that individual patient … needs, if unmet contribute to poor attendance.”

If these needs were identified and addressed … attendance at Phase III programmes would improve. [3]”

A previous study found that compliance was between 45% and 60% possibly caused by the absence of supervision or continued follow-up. [4]

• Patients – to live a normal, healthy life• Practitioners – to help patients with the above

whilst adhering to trust values to achieve targets.

The Challenge

F.I.T.T.

S.M.A.R.T.

What are we actually prescribing?

Exercise?

Adherence.

Motivation.

Fun.

Confidence.

A New Lifestyle.

New Skills.

How can we achieve this?What can we prescribe…

Pre F.I.T.T.Post F.I.T.T.

Assessing Motivation• Motivation Theories

– Transtheoretical Model / Theory of Reasoned Action /Theory of Planned Behaviour / Health Belief Model / Self Efficacy Theory / Motivational Interviewing

• Being Kind – Showing care• Self Monitoring / Confidence Rulers• Their own reasons for change, not ours• Personalisation• Motivational Questionnaires

Prescribing Goal Setting

• SMARTER– Evaluate Regularly

• Long Term OUTCOME Goals– Beyond a 12 week programme

• Short Term BEHAVIOURAL Goals• Plan for relapse (triggers)• Keeping Track

– Goal Setting Books/Booklets

• Rewards

Prescribing Environments

• Individualisation. Get people comfortable first.• What’s important to them, help them achieve it• Individuals/Groups/• Times of day• In home/community/medical/Combination• Comfortable environments• Face to Face/Telephone/Internet/Combination

Considerations• Clinics located in the community / medical sites

may not be appropriate for certain populations.• In home only programmes run the risk of

isolation and dependence. • Programmes should keep in mind access to

information, giving someone a book is useless if they can’t read.

• Giving someone an audio programme is English is useless if they speak Punjabi.

Prescribing Support

• Buddying• Mentoring• Past Success• Groups• Partner• Family• Rewarding Success• T Shirts/Certificates/Trophies

The Finished Product

• Quality, safe, effective enjoyable exercise programmes.

• Psychological and social benefit outcomes.• Increased adherence to programmes.• Lower drop out rates.• Better results/figures.• Happier, healthier patients families and

communities!

What are we prescribing?

Habits that last a lifetime.

Thank You.

References• 1) British Heart Foundation, (2010) Cardiac Rehabilitation, [Online];

Available: http://www.bhf.org.uk/heart-health/recovery/cardiac-rehabilitation.aspx [01 Mar 2011].

• 2) Coats, A. McGee, H. Stokes, H. and Thompson, D. (ed.) (1995) BACR Guidelines for Cardiac Rehabilitation, Oxford: Blackwell Science.

• 3) Kerins, M. McKee, G. and Bennet, K. (2011) ‘Contributing factors to patient non-attendance at and non-completion of Phase III cardiac rehabilitation’, European Journal of Cardiocascular Nursing, vol 10, March pp. 31-36.

• (4) Froelicher, Victor F. and Myers, Jonathan. (2000) Exercise and the Heart, Philadelphia: London..