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Nury Nusdwinuringtyas
Angela BM Tulaar
Deddy Tedjasukmana
Definition
The sum of activities required to influence
favourably the underlying cause of the disease, as
well as the best possible physical, mental and sosial
condition, so that they may by their own efforts
preserve or resume as normal a place as possible in
the community. ( WHO 1993 )
Educational program:
- lifestyle modification such as low-cholesterol diet,
stress-reduction, and smoking cessation to reduce
the risk factor for heart disease;
- reconditioning exercises to improve safety and
tolerance of daily activities (vocational, recreational,
and sexual activity)
Nurses
Physical therapists
Occupational therapists
Exercise physiologists
Nutritionist
Psychologists
Social worker
Vocational counsellors
Cardiac Evaluation
A. History :
- Chief complaint
- Past history
- Medication history
- Functional and occupational history
- Personal history
- Social history
- Family history
Cardiac Evaluation
B. Physical Examination
General
Vital signs
Cardiovascular:
Inspection
Palpation
Auscultation :
Heart sounds
Heart murmur
Pericardial rub
Pulmonary
Neurologic and musculoskeletal
Cardiac Evaluation
C. Diagnostic tests
Chest radiograph
Cardiac tests :
ECG
echocardiography
Laboratory tests
blood tests
Cardiac stress tests
Cardiac rehabilitation
Consists of four distinct phase
Each phase of cardiac
Phase I program :
Education and risk-modification
program :
Hyperlipidemia control
Hypertension control
Smoking cessation
DM control
Stress management
Exercise
Exercise program
Exercise testing
Stop Exercise if
Signs and symptoms :
angina, light-headedness, nausea, dyspnea, fatigue,
pallor, cyanosis, ataxia, hypoxia, altered mental status,
peripheral circulatory insufisiency, bradicardia (drop
in HR of more 10 bpm), activity-induce BP changes,
SBP > 220 mmHg, DBP >110 mmHg, activity-induced
ECG change
Phase II : Outpatient
Conducted in an outpatient setting or towards the end
of hospitalization
if the patient is discharged from the hospital phase
II start within 1 - 2 weeks and last for 8 -12 weeks
By end of phase II, patient should be able to perform
the daily self-administered exercise program safely,
have adequate knowledge of his or her disease and
symptoms to persue vocational , recreational, and
sexual activities safely
Phase II : Outpatient
Goals :
To enhance cardiovascular function and physical work
capacity (strength,endurance,flexibility)
To detect ECG changes during exercise
To teach the patient proper techniques of exercise and
provide him/her with guidelines for long-term exercise
To establish healthy lifestyle in patient and family
To enhance the patients psychologic function and
prepare him or her for return to work and resumption of
normal familial and social roles
Phase II program :
Education and risk-modification
program
Exercise :
Phase II program :
Exercise :
Phase II program :
Return
to work program
Phase III
The Goals of phase III are similar to those of phase II
Aerobic exercise
Resistance training
Aquatic exercisewater exercise
Cardiovascular Prognosis
Regular physical activity of at least moderate intensity
capacity
Strength training (at least 30 minutes / week) may
Kapasitas Fungsi
Aerobik =
O2 maksimal
Nilai sesungguhnya
Prediksi
Submaksimal
Steady state
Astrand
(1965)
Tabel
Jarak tempuh
Prediksi
Rumus Cahalin
(1995)
O2 Maks
Rumus Nury (2011)
30 cm
Metode Berputar 3
Langkah
Rumus VO2max
Rumus VO2 =
0,053 (jarak tempuh) + 0,022 (umur) + 0,032 (TB) 0,164 (BB) - 2,228 (jenis kelamin) -2,287