Cardiac Rehabilitation: Components and Diet

• Cardiac rehabilitation is a complex intervention that includes health education, cardiovascular risk reduction, physical activity, and stress management for heart disease patients.
• Cardiac rehabilitation programs last about 3 months, with sessions 2-3 times each week, for a total of about 36 sessions over 12 weeks.

Core Components of Cardiac Rehabilitation

• Patient assessment
• Exercise training
• Physical activity counseling
• Tobacco cessation support
• Nutritional counseling
• Weight management
• Management of coronary risk-factors
• Psychosocial counseling

Dietary Recommendations for Cardiac Rehabilitation

• Dieticians run workshops on healthy eating, how to read food labels, and cooking.
• Recommendations promote moderation and plant-based foods.
• Reduced saturated fats and cholesterol intake is recommended.
• Increased polyunsaturated and monounsaturated fats are encouraged.
• Calorie sources should be 50-60% carbohydrates, 15% protein, and 25-35% fat.
• Daily fiber intake should be increased to 20-30g.

Waist Circumference for Cardiac Rehabilitation

• Waist circumference ≥88 cm in women and ≥102 cm in men suggests central obesity, per WHO standards.
• European standards for Turkish society: >80 cm for women and >94 cm for men.
• BMI > 25 kg/m2 means that individual short and long-term weight goals should be set.

Hypertension in Cardiac Rehabilitation

• Lowering systolic blood pressure by 10 mmHg can decrease cardiovascular mortality by 20-40%.
• Reducing diastolic blood pressure by 5-6 mmHg is linked to a 42% reduced stroke risk and a 15% reduced risk of coronary heart disease.
• Education on blood pressure control, medications, side effects, and blood pressure devices is important.

Pulmonary Rehabilitation

• Pulmonary rehabilitation uses a multidisciplinary approach to improve the physical and emotional well-being of patients with chronic respiratory diseases.
• Supervised exercise, education, support, and behavioral interventions are included.
• Improves daily functioning and quality of life for chronic lung disease sufferers.
• Common conditions that benefit: COPD, ILD, cystic fibrosis, pulmonary hypertension, severe asthma, post-transplant, post-surgical recovery, and pulmonary fibrosis.

Benefits of Pulmonary Rehabilitation

• Improved exercise capacity
• Reduced breathlessness
• Improved survival rates
• Reduced hospitalizations
• Less anxiety and depression
• Better quality of life
• Improved psychological well-being

Goals of Pulmonary Rehabilitation

• Improve exercise capacity
• Enhance quality of life
• Reduce symptoms, like dyspnea
• Prevent hospital readmissions
• Enhance emotional well-being and self-management

Components of Pulmonary Rehabilitation

• Exercise training
• Inspiratory muscle training
• Psychosocial counseling
• Nutritional evaluation and counseling
• Education, including prescribed drug use

Nursing Assessment in Pulmonary Rehabilitation

• Thorough health history and clinical assessment
• Monitoring vital signs (oxygen saturation, heart rate, blood pressure)
• Assessment of physical function (mobility, muscle strength, endurance)
• Psychological assessment (anxiety, depression, coping strategies)

Nursing Interventions in Pulmonary Rehabilitation

• Breathing techniques (diaphragmatic, pursed-lip)
• Exercise programs (low-impact aerobic like walking or cycling)
• Patient education (medication adherence, oxygen, energy conservation, environmental triggers)
• Psychosocial support (emotional support, coping strategies, psychological support if needed)
• Nutritional support (adequate nutrition, weight management, especially for obesity-hypoventilation syndrome)

Barriers to Pulmonary Rehabilitation

• Physical limitations (low exercise tolerance, dyspnea, fatigue)
• Psychological factors (anxiety, depression, lack of motivation)
• Socioeconomic factors (limited access to healthcare, financial constraints)
• Cultural factors (lack of understanding, mistrust of healthcare interventions)

Pulmonary Rehabilitation in Special Populations

• Older adults (COPD, ILD, pulmonary fibrosis) need programs that are individualized and of lower intensity, with focus on functional independence, addressing comorbidities and polypharmacy management.
• Patients with obesity hypoventilation syndrome need to focus on weight management and sleep hygiene, and CPAP/BiPAP for respiratory support.

Pulmonary Rehabilitation Program Design

• National guidelines suggest six-week PR program with two sessions per week.
• Each session includes supervised exercise and education.
• Patients are expected to conduct home training.
• Program content typically includes 12 sessions, seminars, relevant health topics, and individualized plans.
• Aims to improve physical and psychological conditions, promoting ongoing adherence to health-enhancing behaviors.

Goal-Oriented Therapy During Pulmonary Rehab

• Patients define specific goals such as reduced breathlessness or improved mobility.
• The six-week program is structured around these goals.
• Encourages self-responsibility by clarifying dependence, interdependence, and independence.
• Empowers patients to take responsibility for achieving treatment goals, fostering independence and confidence.

Pulmonary Rehabilitation Program Includes

• Relaxation training and techniques
• Disease education
• Dietary advice
• Benefits advice such as financial schemes
• Energy conservation techniques
• Medication advice
• Chest clearance techniques
• Breathing control techniques

Advance Care Planning in Pulmonary Rehabilitation

• Evaluate the physical, emotional, and psychological impact of ongoing treatments.
• Discuss options like ventilation and their implications for quality of life.
• Confirm patient wishes regarding desired place of death.
• Provide compassionate guidance to patients and carers through decisions.
• Create a care pathway that reflects the patient’s values and goals.
• Guarantee dignity, autonomy, and a patient-centered approach to end-of-life care.
• Lessen uncertainty and emotional distress for patients and their families.

Neurological Rehabilitation

• Neurological rehabilitation requires undergoing therapy to enhance function and general well-being.
• Rehabilitation is for individuals experiencing issues that affect nerve systems, with the goal of improving functionality.
• Aims to restore health, independence and functionality using the most suitable strategies.
• Rehab phases include acute rehab, subacute rehab, and care at long-term care facilities or nursing homes.
• Acute rehab involves physical therapy, occupational therapy, and speech therapy, for 3 hours each day.
• Subacute rehab is less intense, suitable for patients who are stable but not yet independent.

Common Conditions Requiring Neurological Rehab

• Traumatic brain injuries
• Spinal cord injuries
• Strokes (hemorrhagic or ischemic)
• Subdural hematoma
• Transient ischemic attacks (TIAs)
• Bell's palsy
• Cervical spondylosis
• Carpal tunnel syndrome
• Brain/spinal tumors
• Peripheral neuropathy
• Muscular dystrophy
• Myasthenia gravis
• Guillain-Barré syndrome
• Headaches
• Seizure disorders
• Dizziness
• Neuralgia
• Brain infections (polio, meningitis, brain abscesses, encephalitis)
• Neurodegenerative disorders (multiple sclerosis, Alzheimer's, ALS, Parkinson's, Huntington's)

Goals of Neurological Rehabilitation

• Prevent complications with early diagnosis and helping patients with physical issues.
• Teach adaptive strategies to enable daily living despite the patient's condition.
• Create strategies to reduce disability.
• Facilitate function in a normal environment, as patients may need help with everyday activities and support after leaving hospital.

Neurological Rehabilitation Approaches

• Bobath Approach (Neuro-developmental Treatment): focuses on motor learning and repeating movement patterns with therapist guidance.
• Carr and Shepherd Approach: teaches functional movements through repeated practice until mastery.
• Gait re-education: is aimed at addressing gait issues post-injury, with physical therapists identifying and correcting issues in walking.
• Exoskeletons: Emerging tools in gait re-education for automated exercise without therapist involvement.
• Transfer rehabilitation: teaching transfer techniques such as bed-to-chair.
• Mobility rehabilitation: enhances mobility through balance, range of motion, and stretching exercises.
• Contracture management: employs strategies like splinting and weight-bearing to address tight muscles in the lower limbs.
• Adaptive equipment assessment: uses specialized equipment or adaptations (e.g. wheelchairs) to enhance movement.

Targeted Exercise Programs for Neurological Recovery

• Functional Movement Training: Essential for mirroring daily life, going beyond exercises and integrating back into everyday life, with physical therapists making sure it's appropriate and individually tailored.
• Tailored Workouts: Specifically addresses neurological challenges through customized exercise programs.
• Adaptive Equipment Integration: Enhances the effectiveness of rehab programs, offering better support.
• Assistive Technologies (Augmented Reality Tools, Smart Wearables, Robot-assisted Therapy): Enhances rehabilitation efficiency through interactive approaches.

Oncology Rehabilitation

• Oncology rehabilitation aims to lessen cancer-related morbidity and improve functional limitations.
• It overlaps with cancer rehabilitation, and focuses on improving functional limitations.

Phases of Oncology Rehabilitation

• Preventative/Prehabilitation: reduces the impact of expected disability before cancer treatment.
• Restorative rehabilitation: focuses on improving function after successful cancer treatment.
• Supportive rehabilitation: maximizes function during stable or progressive cancer stages.
• Palliative rehabilitation: prioritizes comfort and function during the terminal stages of cancer.

Oncology Rehabilitation Settings

• Post-acute care facilities (hospitals, SNFs, home healthcare agencies)
• Outpatient therapy centers

Advantages of Oncology Rehabilitation

• Function: programs improve patients' physical abilities, strength and mobility.
• Energy and endurance: programs provide intervention methods to boost energy and endurance.
• Emotional and mental support: supports patients emotionally and mentally, beyond physical recovery, addressing challenges, and fostering positive outlooks.
• Improved body image and self-confidence: Helps patients cope with distress and improves self-image.
• Enhanced survivorship: educates on long-term effects and provides strategies for managing survivorship.
• Nurturing community: support groups and shared experiences build a supportive environment.