Cardiac rehabilitation guidelines
provide different types of exercises include anaerobic training,
resistance training, and flexibility training with the intensity of
exercise ranging from 40-85% resting heart rate (HR) for 20 – 60
minutes for up to three to five sessions per week for six to 12 weeks up
to six months in most guidelines and using HR monitoring, blood pressure
(BP) monitoring, symptoms monitoring and continuous Electrocardiogram
(ECG) monitoring in the exercise training.16,17 This
could be found in the study by Nobari et al.10 who
used two CRP after CABG surgery. The HELP was applied in four 45–60-min
training sessions, included face-to-face training and sharing
experiences among patients. The information of the HELP was chosen based
on the up-to-date scientific studies, with the assistance of
psychologists, cardiologists, nutrition and religious experts. They
included nutrition, physical activity, spiritual growth, interpersonal
relations, health responsibility, and stress management. The selected
contents were collected into an educational pamphlet and booklet.
Monitoring using telephone was used in the 4th and
8th weeks post discharge to ensure patients would
perform the program. The second group patients (CEG) received routine
education at discharge. This strategy advice a 30-min daily walk, low
salt diet, and medication compliance. The education was administered at
the bedside and took between 5 and 10 min at discharge.
In Salavati et al.14 study, the patients received
usual education and home-based CRPs, which consist of: education about
their disease, usual and unusual signs and symptoms and illness
potential complications, drug treatment, lifestyle changes (stress
management, nutrition counseling, smoking cessation, control blood
pressure, and control weight,), workout programs (obligation walking and
education). Also distributed a booklet about their disease (in hospital
and at home based on the training). In between the visits a call by the
nurses to answer any questions.
Laustsen et al.12 in their interventions included a
12-week telemonitored exercise-based cardiac rehabilitation program 2–6
weeks after hospital discharge, i.e., walking, biking, spinning, or
fitness center. Physiotherapists gave separate weekly feedback on
exercise training intensity, provided sessions on cardio-protective
lifestyle in-hospital group-based education.
Akbari and Celik9 used a discharge training program
and post-discharge counseling together with routine program. Educational
booklet (that discusses CAD and care-related subjects such as
complications of CABG, and self-care activities), encouraged to discuss
their problems and ask their care-related questions. Then, care-related
training in small three-person groups offered using teaching strategies
such as question-and-answer, lecture, feedback-giving, demonstration,
summarization and reinforcement. Applied in the meeting room or in
patients’ rooms. Sessions lasted 1-4 hours. Counseling via home visit
and follow-up telephones provided at 2nd and
10th days and 6 weeks after discharge.
Alexiev et al.8 program was consisting of early
ambulation, psychological counseling, pulmonary clearing techniques,
breathing exercises, range of motion exercises, and risk factors
management beside best medication treatment on the 4thday post discharge.
Pacaric et al.13 study used a cardiac rehabilitation
intervention that focus on physiotherapy in which patients were taught
coughing, exercises, deep breathing, and walking exercises to improve
physical functioning. Patients showed improvement one year after
rehabilitation in mental and physical health in comparison with
pre-surgery status but no significant improvement was noticed one month
after surgery and before the rehabilitation program.
Spiroski et al.15 used CRP consist that had two parts:
an in and outpatient CRPs. The intervention involved information
sessions, nutrition counseling, exercise training, smoking cessation,
and psychosocial support. The inpatient intervention comprised of daily
walking for 45 minutes and cycling 7 times/week. The outpatient
intervention included cycling 3 times/week and walking 5 times/week for
45 minutes. All participants completed symptom-limited cardiopulmonary
exercise testing (CPET) on a bicycle ergometer for 3 weeks, and for 6
months.
Zolfaghari et al.11 interventions were physiotherapy
totally 15 min with 16 sessions (3 times a week for 1 month). The
approaches of physiotherapy were individualized. It involved postural
drainage, breathing exercise, positioning and cough exercise, chest
tapotement, and thorax mobilization exercises.
Hence, from previous studies we can conclude that there is no specific
CRP fits all patients but the general components were the same. Also,
whatever the physiological variables vary from one study to another all
had the same results of improving.