Rehabilitation

Medicine of
Cardiovascular Diseases

dr. Dwi Indriani Lestari, SpRM

INSTALASI REHABILITASI MEDIK
RSU Dr. SAIFUL ANWAR
FK UNIBRAW MALANG

Rehabilitation Medicine of

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

health of the patient according to the level of
physical and mental activity as the level of heart
function

 The goals of CR are to change the natural

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

OUTCOMES OF CARDIAC
REHABILITATION SERVICES

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

Classification of NEW YORK HEART

ASSOCIATION
Class 1 : Patient with heart disease but there is not
limitation of physical activity

Class 2 : Heart disease patient with few physical activity.

Taking a rest there is no symptom but with daily
activities there is palpitation, short of breath, chest pain

Class 3 : Heart disease patient with limited physical

activities. Taking a rest there is no symptom, but with

light activities, there is symptoms

Class 4 : Heart disease patient with all limited activities

Taking a rest, there is symptom. All activities will
worsened symptoms

METABOLIC EQUIFALENT ( METS ) :

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

The Pillars of Rehabilitation Programs

Hospital
Level I
Stadium I

ICCU / CVCU

Level III
Stadium II

Home

Level IV
Stadium III

Post Recovery

Level II
Ward

STADIUM I
A. Level I : In

ICCU / CVCU ( 1 3 Day )

1. Approximate the capacity of the heart : Class IV

1, 5 CAL

1,2 METS

( 1 2 METS )

2. Classification of Activities: Minimal

1,25 1,5 METS

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

60 % same with level I

5. Frequency and Duration

Exercise
: 5 - 10 Minutes
Rest :
5 - 10 Minutes
Frequency : 2 3 Times / Day

Level 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
Working 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
5. INTENSITY : According the result of STRESS TEST
6. Exercise every day
Duration
15 - 20 minutes
Or
25 - 30 minutes three times a week

Dont do during exercise:

ISOMETRIK CONTRACTION
HOLD BREATH
VALSAVA MANUVER
STEPPING UP

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

 Sexual intercourse can be done if :

Blood pressure 160 / 89 mmHg

Capacity > 5 METS
Can step up (up stair) : 10 12 STEP
Able to walk with velocity N 6 KM / hour
With definite position

ENERGY COST OF AMBULATION FOR

THE AMPUTEE
AMPUTATION
METS

% INCREASE IN ENERGY

No prostheses with crutches

50%
Unilateral BK with prostheses
9-28%
Unilateral AK with prostheses
40-65%
Bilateral BK with prostheses
41-100%
BK plus AK with prostheses
75%
Bilateral AK with prostheses
280%
Unilateral hip disarticulation with prostheses
82%
Hemipelvectomy with prostheses
125%

4.5
3.3-3.8
4.2-5.0
4.2-6.0
5.3
11.4
5.5
6.75