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Cardiac Rehabilitation The Loughlinstown Experience

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Success depends on the transfer of client from phase 3 to phase 4 with ... American College of Sports Medicine Guidelines for Exercise Testing and Prescription ... – PowerPoint PPT presentation

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Title: Cardiac Rehabilitation The Loughlinstown Experience


1
Cardiac RehabilitationThe Loughlinstown
Experience
2
PHASE 4
  • Phase 4 cardiac rehabilitation is the long-term,
    or lifetime, stage of the rehabilitation process.
    Phase 4 classes are generally held in leisure
    centres or similar facilities. Exercises are
    delivered individually or in group classes.

3
Phase 3 to Phase 4
  • Success depends on the transfer of client from
    phase 3 to phase 4 with mutually agreed protocols
    and criteria, referrals.
  • Information including
  • Current cardiac status
  • Current medication
  • Past medical history
  • Compliance
  • Details of exercise prescription at phase 3

4
Phase 4 Benefits
  • Improved survival rate
  • Reduced Heart rate for a given amount of work
  • Reduces arrhythmias
  • Lowers blood pressure
  • Improves lipid profile
  • More efficient use of oxygen
  • Delayed onset of Angina
  • Reduces body fat
  • Improved confidence and self esteem
  • Decreased anxiety and depression

5
Phase 4Exersise classes
  • Structured supervised exercise class, individual
    or group classes
  • BP
  • Warm up (10/15 mins)
  • Aerobic circuit
  • Cool down (10 mins)
  • BP

6
Cardiac RehabilitationThe Loughlinstown
experienceWould like to take this opportunity
to thank the SCH CR team for their hard work and
enthusiasm
7
Rationale for P4 SCH
  • Need identified
  • 1000 patients rehabbed P 3 since 2002
  • Educational/social Phase 4 (Board Bia,cardiology,
    newsletter, walks, Christmas night,
  • Research (Caulfield 07) found 42 of clients 2
    years post P3 were not exercising at recommended
    levels

8
The Why
  • Promote adherence to exercise
  • Reducing recurrent cardiac events
  • Encourage and motivate patients
  • Develop links with community
  • Referral pathway from hospital to community

9
How
  • Submitted proposal for feasibility study
  • Developed links with county councils/Ilam/Gym/Leis
    ure centres
  • Already established informal links with local
    gyms
  • Produced a manual by SCH CR team (similar to BACR
    but adapted to Irish context)
  • Validated by Cardiologist

10
2006
  • Contacted local gyms (NCEF/NCEHS/ITEC/ILAM)
  • Determined interest, commitment and feasibility
  • Hospital management informed of programme.

11
Insurance
  • Insurance manager HSE-Estates
  • CIB (clinical insurance body)
  • Risk assessment of gyms
  • Gyms have to have own Public Liability cover
  • Indemnity of gym instructors providing
    instruction and advice

12
Funding
  • HSE bursary funded manuals and AEDs
  • Training initially provided free of charge by CR
    team
  • Phase 4 classes are pay as you go basis
  • BLS/AED training provided by resuscitation
    officers

13
2007
  • Feb 07 first phase 4 training
  • Practical session with P3 patients
  • Trained gym instructors negotiated with gym
    management to set up P4 classes (times/days/no of
    participants and class format)
  • Contacted by CR re starting dates and class
    format discussed.

14
2007
  • Patients contacted for expression of interest
  • Referral forms completed and forwarded to gym
  • Starting date agreed
  • Initial 5 classes were (although run by gym
    instructors) supervised by CR team.

15
(No Transcript)
16
  • MODULE 1
  •  
  • CARDIAC REHAB BACKROUND
  • History
  • Evidence of benefit
  •  
  •  
  • REHABILITAION PROCESS
  • CR team
  • P1
  • P2
  • P3
  • P4
  •  

17
  • MODULE 2
  •  
  • RISK FACTORS
  •  

18
  • MODULE 3
  •  
  • HEART AND CARDIOVASCULAR SYSTEM
  • Heart anatomy physiology
  • CARDIOVASCULAR DISEASE
  • Coronary heart disease
  •  

19
  • MODULE 4
  •  
  •  
  •  
  • INVESTIGATION AND DIAGNOSIS
  • MEDICAL AND SURGICAL TREATMENTS
  •  
  • Medical
  • Ptca
  • Surgical
  • Others (valves, pacemakers, aicds)
  •  
  •  

20
  • MODULE 5
  •  
  •  
  • MEDICATION
  • DIET
  • CHANGE BEHAVIOUR
  • Models
  • Adherence
  • MOTIVATIONAL INTERVIEWING
  •  

21
  • MODULE 6
  •  
  • PATHOLOGY
  • CO MORBIDITY
  • CONSIDEATIONS FOR SPECIAL POPULATIONS
  • COPD
  • Muscoskeletal
  • Hypertension
  • Diabetes
  • Pvd
  • Obesity
  • Ageing
  • Neuro
  • Heart Failure
  • Others

22
  • MODULE 7
  •  
  • PHASE 4 PROGRAMMING AND EXERSISE PRESCRIPTION
  • Referral routes
  • Programmes aims and objectives
  • Content
  • Sessions
  • Warm up
  • Aerobic
  • Cool down
  • Inclusion/exclusion criteria
  • CARDIOVASCULAR EXERSISE

23
  • MODULE 8
  •  
  • EXERSISE TESTING
  • Interpretation
  • EXERSISE PHYSIOLOGY
  • Acute/chronic response to exercise
  • Role of resistance exercise

24
  • MODULE 9
  •  
  • Questions and answers
  • Roundup
  •  
  •  

25
  • MODULE 10
  •  
  • BLS
  • AED
  • SCENARIOS
  • CARDIAC EMERGENCIES

26
EACH MODULE 2 HOURS 20 hours and 6 hours BLS (if
necessary)   E.g. SATURDAY AM 4 HOURS  1 EVENING
2 HOURS (8 modules 16 hours) (Round up and Phase
3, 4 hours) (BLS/AED training 6 hours)    
assessment and attendance at Phase 3
classes    Validation Cardiologist IHF IACR   Text
book American College of Sports Medicine
Guidelines for Exercise Testing and
Prescription  IACR Guidelines
27
Issues
  • Safety
  • Insurance/Indemnity
  • Medical Director
  • BP
  • Medical cover
  • Local policies

28
October 07
  • 20 gym instructors trained
  • 3 gyms have commenced Phase 4
  • 3 Gyms ready top start in next two months
  • Next training course Nov 07

29
St Columcilles Hospital
  • Cardiac Rehabilitation Unit
  • St Columcilles Hospital
  • Loughlinstown
  • Co Dublin
  • 01 2115153
  • Sophie.charles_at_hse.ie
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