Explain puewabilitation programme in details ?

Education, counselling, and behavioural interventions are important elements of cardiac rehabilitation. In this guideline, "education" is defined as systematic instruction, and "counselling" is defined as providing advice, support, and consultation. "Behavioural interventions" refer to systematic instruction in techniques to modify health-related behaviours. Patients with cardiovascular disease have to learn to manage their illness and prevent or retard progression or induce regression of atherosclerosis. This management focuses on techniques of lifestyle changes, guided by health professionals.

A multifactotial risk-reduction model developed by the Stanford Coronary Risk Intervention Project showed that individualized changes in lifestyle and medical treatment reduced the risks of disease progression and coronary events in patients with coronary heart disease. The risk-reduction goals, which were consistent with national guidelines, encompassed body weight, blood pressure, lipid levels, nutrition, and physical activity. Over a four-year follow-up period, patients assigned to this model of care, as compared with patients who received usual care, had a 30 per cent reduction in saturated-fat intake, a four per cent reduction in the body-mass index, a 22 per cent reduction in LDL cholesterol levels, a 12 per cent increase in HDL cholesterol levels, and a 20 per cent improvement in exercise capacity. The rate of disease progression, assessed by angiographic evaluation of coronary lesions, was reduced in the intervention group, and the lesions were more likely to regress in this group.
The rates of major clinical cardiac events and hospitalization were also significantly decreased in the intervention group. The following general scheme is followed:

Inpatient : Smoking cessation and prevention; Assessment of physical activity, Outpatient referral.

Outpatient :  Evaluation: Medical history; Risk factors; Stress testing; Vocational counselling prescribed Exercise: On site or at home; Aerobic training; Resistance exercise.

Modification of Risk Factors: Education; Nutritional counselling; Exercise; Medication. Specification of Long Term Goals: Physical; Vocational; Psychological; Clinical.

Safety, Intensity Level and Frequency of Exercise Training : The level and frequency and type of exercise should be determined for each individual patient by the team taking into consideration the risk stratification, stress testing, age, physical disabilities and other factors.

The safety of cardiac rehabilitation exercise training is inferred from aggregate analysis of clinical 'experience. None of the more than three dozen randomized controlled trials of cardiac rehabilitation exercise training in patients with CHD, involving over 4,500 patients, described an increase in morbidity or mortality in rehabilitation compared with control patient groups.

The effects of lower versus higer intensities of exercise training on exercise tolerance were evaluated in five randomized controlled trials. Reports from the same study population found no significant differences in exercise tolerance between lower and higher intensity exercise training.

Until recently, .patients were traditional) advised to exercise to a target heart rate range between 70 and 85 per cent of the highest level safely achieved at exam testing.

However, exercise training intensities in the 50-70 per cent heart rate range have been shown to effect comparable improvement in functional capacity and endurance, may provide greater safety during unsupervised exercise, and are likely to promote long-term adherence to exercise.

Lower intensity exercise training also increases both he applicability to and the acceptance of exercise training by larger numbers of coronary patients, particularly unfit and elderly patients and those with low exercise capacities.
Studies have reported statistically significant improvement in exercise tolerance after exercise training compared with baseline. The use of beta-blocking drugs in patients following myocardial infarction did not impair improvement in exercise tolerance following cardiac rehabilitation exercise training.

Exercise rehabilitation decreases angina pectoris in patients with coronary disease and decreases symptoms of heart failure in patients with left ventricular systolic dysfunction. Exercise training is recommended as an integral component of the symptomatic management of these patients.

Don't over do it: You should start slow and progress gradually. If you are injured you should rest until you are recovered. Know the difference between injured and sore. Inability to finish, nausea, and trouble sleeping are all signs of over doing it. Have fun: Choose something that you enjoy. Emphasize the 'want' rather than the 'should' when you exercise.

Find a friend: Exercising by yourself will work, but the combined motivation of a friend will prevent you from skipping as many days. '
Make it important: Make exercise a priority rather than m extra. If you include it as part of your daily schedule it will get done. Do it at the same time every day.