3.3 CRP components
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.