Cardiac Rehabilitation The Loughlinstown Experience

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Cardiac RehabilitationThe Loughlinstown
Experience
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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.

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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

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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

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Phase 4Exersise classes

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

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Cardiac RehabilitationThe Loughlinstown
experienceWould like to take this opportunity
to thank the SCH CR team for their hard work and
enthusiasm
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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

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The Why

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

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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

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2006

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

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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

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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

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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.

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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.

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• MODULE 1
•  
• CARDIAC REHAB BACKROUND
• History
• Evidence of benefit
•  
•  
• REHABILITAION PROCESS
• CR team
• P1
• P2
• P3
• P4
•  

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• MODULE 2
•  
• RISK FACTORS
•  

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

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

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

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

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• 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

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

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

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

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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
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Issues

• Safety
• Insurance/Indemnity
• Medical Director
• BP
• Medical cover
• Local policies

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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

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St Columcilles Hospital

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