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dr. Dwi Indriani Lestari, SpRM INSTALASI REHABILITASI MEDIK RSU Dr. SAIFUL ANWAR FK UNIBRAW MALANG
Cardiovascular Diseases:
Cardiac rehabilitation (CR) is an individualized, comprehensive program developed by using various principles of rehabilitation medicine with the aim to maintain, restore, and increase the optimal physical, medical, psychological, social, emotional, vocational, and economic status of patients with cardiovascular diseases (CVD).
Effort to restore the function of heart and the healt of the patient according to the level of phycical and mental activity as the level of heart function
Rehabilitation Medicine of
history of the disease, to reduce mortality and morbidity, to increase the patient's functional capacity, and ultimately to limit or reverse the pathological process leading to CVD. Secondary prevention of CVD and exercise training remain the cornerstones of CR.
Etiology of CVD :
Defect in coronary system Defect in heart valve and muscle of the heart Defect in increment
Medical Problem
Heart diseases, hypotension, increase pulse rate Complication of long standing immobilization : Muscle atrophy Joint Contracture Decubitus
Rehabilitation Problem:
Disability of mobilization Restricted of daily activity. Defect of Vocational Defect in working Defect in communication Defect in psychosocial
Improvement in exercise tolerance Improvement in symptoms Improvement in blood lipid levels Reduction of cigarette smoking Improvement in psychosocial well-being and stress reduction Reduction in mortality
Class 2 : Heart disease patient with few physical activity. Class 3 : Heart disease patient with limited physical
Taking a rest there is no symptom but with daily activities there is palpitation, short of breath, chest pain activities. Taking a rest there is no symptom, but with light activities, there is symptoms Taking a rest, there is symptom. All activities will worsened symptoms
The need of oxygen in condition body take a rest and quit sitting
1 Kilo calory ( KKal ) EQUIFALENT with using 200 CC O2 1 METS EQUIFALENT 3,5 CC O2/ Kg BB/ minute 1 METS EQUIFALENT 1,5 CC Calory / minute
Protocols: STADIUM & Level of Disease Approximate the heart capacity Classification of activities The foundation of activities program Programs recipe 220 age ( Years ) = Frequency Heart MAX / minute
Level I
Stadium I
ICCU / CVCU
Level II
Ward
STADIUM I A. Level I : In ICCU / CVCU ( 1 3 Day ) 1. Approximate the capacity of the heart : Class IV
3. Type of activities: Change body position Passive movement ROM AGA / AGB Active movement ROM AGA / AGB 4. Intensity Heart pulse target : 40 50 % from maximal HEART RATE TENTION SISTOLE 20 mmHG TENTION DIASTOLE 10 mmHG MONITOR SUBYEKTIF / OBJEKTIF SIGN ABNORMALITY OF ECG 5. Frequency and Duration 5 times, 2-3 times a day Duration 2 5 Minutes, take a rest 10 minute
B. Level II : In Ward
( 3 14 days)
1. Approximate the capacity of the heart : Class III 1, 5 - 2,7 CAL 1,2 - 2,2 METS 2. Classification of Activities: Minimal 1,5 2,5 METS 10th 15th Days 3. Type of activities Sitting position Eat, drink, wash face Active Activities AGA / AGB Defecation Standing Exercise Slow walking 4. Intensity
5. Frequency and Duration Exercise : 5 - 10 Minutes Rest : 5 - 10 Minutes Frequency : 2 3 Times / Day
Stadium II C. Level III : At Home ( 2 8 weeks ) 1. Approximate the capacity of the heart : Class II 2, 7 - 4 CAL 1,2 - 2,2 MET 2. Classification of Activities MODERAT 2, 5 3,5 METS 3. Type of activities Previous exercise to be continued Walking exercise 2 MILE / hour Take a bath in bathroom Cycling without resistance 4. Intensity
70 80 % MHR
5. Frequency and Duration Exercise 2 times/ day Deconditioning 5 10 minutes Duration 15 20 minutes Cool down 5 minutes
STADIUM III D. LEVEL IV : ( POST RECOVERY ) 1. Approximate the capacity of the heart : Class I 4 - 6,6 CAL 3,2 - 5,3 METS 2. Classification of Activities Severe 3, 5 5 METS 3. Base Program: STRESS TEST 4. Type Activities According the result of STRESS TEST Walking activities, gynamctic, cycling Sexual intercourse can be considered
Stop Exercise:
Tension is not up nor down, or up more than systole
20 mmHg/Diastole 10 mmHg. Excess than hearth rate target. Chest pain Cyanosis, pale, vomiting Hypotension, diaphoresis Short of breath ARITMIA