Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy

Abstract

Cardiac rehabilitation protocols applied during the in-hospital phase (phase I) are subjective and their results are contested when evaluated considering what should be the three basic principles of exercise prescription: specificity, overload and reversibility. In this review, we focus on the problems associated with the models of exercise prescription applied at this early stage in-hospital and adopted today, especially the lack of clinical studies demonstrating its effectiveness. Moreover, we present the concept of "periodization" as a useful tool in the search for better results.

The implementation of an intensity regulated exercise programme in coronary artery bypass graft surgery patients: A pilot randomised controlled trial

“…(19) It has also been proposed that patients will return to their pre-surgery default activity levels if not held accountable. (15) The poor adherence of patients with CR programmes supports this proposition. It will be valuable to investigate whether earlier enrollment into a CR programme, supported by predefined requirements from medical insurance companies, could improve long-term patient outcome.…”

“…(15) Basic principles in exercise prescription namely specificity, overload and reversibility are not adhered to. (15) We argue that the objective of early mobility of CABG patients should not primarily be prevention of the adverse effects of bed rest, but rather to provide a stimulus sufficient for cardiovascular conditioning.…”

“…(15) Basic principles in exercise prescription namely specificity, overload and reversibility are not adhered to. (15) We argue that the objective of early mobility of CABG patients should not primarily be prevention of the adverse effects of bed rest, but rather to provide a stimulus sufficient for cardiovascular conditioning. This pilot trial aimed to determine the safety and early effect of an intensity regulated exercise programme, compared to a structured usual care mobilisation protocol, on the functional capacity of patients following CABG surgery, at discharge and 10 -14 days after discharge.…”

Rehabilitation in Cardiology and Cardiosurgery

“…На протяжении многих лет авторы утверждали, что больные после ИМ не должны быть физически активными в течение 3 нед. Эти разногла-сия стали одной из причин проведения 1-го Междуна-родного конгресса по сердечной реабилитации (Гам-бург, 1977), на котором была подтверждена необходимость ранней активизации кардиологических больных [19]. E. Braunwald, S. Sarnoff, E. Sonnenblick, M. Hellerstein, F. Naughton и многие другие авторы до-казали пользу физических упражнений, что привело к развитию программ кардиореабилитации в качестве междисциплинарного подхода [20].…”

“…Улучшение показателей работоспособности достигается при регулярной физической активности и связано с лучшей переносимостью упражнений. По-стельный режим значительно снижает сердечно-сосу-дистую толерантность к выполнению упражнений и способствует физической слабости [19].…”