Cardiac Rehabilitation-Maruli Simanjuntak, MD, FIHA
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Cardiac Cardiac RehabilitationRehabilitation
Maruli T. Simanjuntak, MD, FIHAMaruli T. Simanjuntak, MD, FIHA
Dept. Cardiology, Fac. of Medicine Dept. Cardiology, Fac. of Medicine USUUSU
Adam Malik HospitalAdam Malik Hospital
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Cardiac RehabilitationCardiac Rehabilitation American College Cardiology (A.C.C)American College Cardiology (A.C.C)“ “ Exercise and counseling services which Exercise and counseling services which
reduce symptoms or improve cardiac reduce symptoms or improve cardiac function”function”
Counseling : - DiseasesCounseling : - Diseases - Medicine- Medicine
- Risk factor- Risk factor - Health Promotion- Health Promotion
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Coronary DiseaseCoronary Disease
Myocardiac Infraction : USA Myocardiac Infraction : USA 1.000.000/year1.000.000/year
Coronary artery by pass Graft : Coronary artery by pass Graft : 367.000/year367.000/year
Heart transplantationHeart transplantation PTCA (percutan transluminal cor. PTCA (percutan transluminal cor.
angioplasty)angioplasty) Stable angina : 7.000.000/yearStable angina : 7.000.000/year
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Guide Line Exercise Guide Line Exercise TrainingTraining
Warning Up 5'-10' Warning Up 5'-10' : strecthing: strecthing Exercise 20'-40' Exercise 20'-40' :1. walking:1. walking
2. bicycle2. bicycle
3. treadmill3. treadmill Cooling downCooling down 5'-10‘5'-10‘ Recommend : 3x/week for ≥ 12 weekRecommend : 3x/week for ≥ 12 week
(70-85% base line heart (70-85% base line heart rate)rate)
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Recommended cardiac Recommended cardiac rehabilitationrehabilitation
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Level of Risk: 3 ‘ walking Level of Risk: 3 ‘ walking (treadmill)(treadmill)
High riskHigh risk Angina on walkingAngina on walking Ischaemic ST depression ≥ 2 mmIschaemic ST depression ≥ 2 mm HypotensiHypotensi ArrythmiaArrythmia Left Ventr. EF ≤ 40 %Left Ventr. EF ≤ 40 % Age ≥ 70 yearsAge ≥ 70 years
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Activities of daily livingActivities of daily living
Lying quietlyLying quietly 1.0 Mets1.0 Mets Sitting: light activitySitting: light activity 1.5 1.5
MetsMets Walking from house to car or busWalking from house to car or bus 2.5 2.5
MetsMets Watering plantsWatering plants 2.5 Mets2.5 Mets Walking the dogWalking the dog 3.0 Mets3.0 Mets Household taskHousehold task 3.5 Mets3.5 Mets Gardening Gardening 4.4 Mets4.4 Mets
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Mild ActivitiesMild Activities
Playing the pianoPlaying the piano 2.3 METs2.3 METs Walking (2mph)Walking (2mph) 2.5 METs2.5 METs Dacing (ballroom)Dacing (ballroom) 2.9 2.9
METsMETs
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Moderate ActivitiesModerate Activities
Walking (3mph)Walking (3mph) 3.3 METs3.3 METs Cycling (leisurely)Cycling (leisurely) 3.5 3.5
METsMETs Golf (without cart)Golf (without cart) 4.4 4.4
METsMETs Swimming (slow)Swimming (slow) 4.5 METs4.5 METs Walking (4mph)Walking (4mph) 4.5 METs4.5 METs
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Vigorous ActivitiesVigorous Activities
Tennis (doubles)Tennis (doubles) 5.0 METs5.0 METs Skiing (water or downhill)Skiing (water or downhill) 6.8 METs6.8 METs Climbing hill (no load)Climbing hill (no load) 6.9 METs6.9 METs SwimmingSwimming 7.0 METs7.0 METs Walking (5mph)Walking (5mph) 8.0 METs8.0 METs Jogging (10 min mile)Jogging (10 min mile) 10.2 METs 10.2 METs SkippingSkipping 12.0 METs12.0 METs SquashSquash 12.1 METs12.1 METs
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Management of lipid Management of lipid LevelsLevels
Assess and modify diet, physical Assess and modify diet, physical activity, and drug therapy.activity, and drug therapy.
LDL Cholesterol level < 100mg/dlLDL Cholesterol level < 100mg/dl Cholesterol level < 130mg/dlCholesterol level < 130mg/dl HDL > 45mg/dlHDL > 45mg/dl Triglyceride level < 200mg/dlTriglyceride level < 200mg/dl
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Management of Management of HypertensionHypertension
Life style modification, including Life style modification, including exercise, weight management, exercise, weight management, sodium restriction.sodium restriction.
Goal : blood pressure < 140/90 Goal : blood pressure < 140/90 mmHgmmHg
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Cessation of SmokingCessation of Smoking
Stopped smoking recentlyStopped smoking recently
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Weight ReductionWeight Reduction
BMI ≤ 25 BMI ≤ 25 Waist circumference < 102 cm Waist circumference < 102 cm
(men)(men)
< 88 cm (women)< 88 cm (women)
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Management of DiabetesManagement of Diabetes
Dietary modification, weight control Dietary modification, weight control and exercises combine with drugs.and exercises combine with drugs.
Monitor glucose blood level.Monitor glucose blood level. Goals: fasting 80 to 110 mg/dl.Goals: fasting 80 to 110 mg/dl.
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Psychosocial Psychosocial ManagementManagement
Identify depression, anxiety, social Identify depression, anxiety, social isolation, anger, and hostility.isolation, anger, and hostility.
Provide individual or group Provide individual or group counseling.counseling.
Provide stress reduction classes for Provide stress reduction classes for patients.patients.
Goals: absence of significant Goals: absence of significant psychosocial problem.psychosocial problem.
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Thank youThank you