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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,CARDIAC REHABILITATION:Historical Perspectives and the Last Fifty Years,Adolfo B.Bellosillo,MD,FACC,FSGC,FPCC,FPCP,FPCCP,Makati Medical CenterMakati CityPhilippines,CARDIAC REHABILITATION:Histor,1,Although the concept of cardiac rehabilitation as a means by which a person can be restored to an optimal physical,medical,physiological,social,emotional,sexual,vocational and economic status prior to a cardiovascular event may have gained momentum,ONLY,in the late 1950s,Although the concept of cardia,2,As early as 250 years ago,Heberden already advocated physical activity for patients with angina claiming it to be beneficial.,As early as 250 years ago,H,3,1912Herrickdescription of the clinical characteristics of myocardial infarction.,1912Herrickdescription of th,4,Mallorypathologic studies showingit would take 6 weeks for themyocardial tissue to form a firm scar,Mallorypathologic studies sho,5,1933Lewis advocated 6-8 weeks of,bed rest,the patient to be guarded day andnight,nursed and helped in every way to,avoid,voluntary effort or movement.,1933Lewis advocated 6-8 weeks,6,Activity as strenuous as climbing up a flight of stairswere deferred until after one year.Return to productive livingwas practically unknown.,Activity as strenuous as clim,7,In the first half of the 1900s,the mainstays of treatment of acute myocardial infarction:,In the first half of the 1900s,8,1.Protracted bed rest,1.Protracted bed rest,9,2.Prolonged hospitalization,2.Prolonged hospitalization,10,WHY?,WHY?,11,Physical activity would cause 1.Recurrence of MI 2.Ventricular aneurysm 3.Ventricular rupture 4.Serious arrhythmias 5.Sudden cardiac death,Physical activity would,12,1930sRedwood,Rosing and Epstein:,1930sRedwood,Rosing and Eps,13,Physical activity 1.Decrease in HR 2.Decrease in systolic BP 3.Increase in O2 utilization 4.Increase in physical capacity,Physical activity 1.Dec,14,Prolonged immobilization 1.Decrease physical work capacity 2.Tachycardia on ambulation 3.Orthostatic hypotension 4.Thromboembolism 5.Decrease pulmonary ventilation 6.Negative nitrogen balance causing delay in the healing process,Prolonged immobilization,15,1940Levine and Lownadvocated the“armchair treatment”after acute MI.,1940Levine and Lownadvocated,16,Long continued bed rest 1.Saps morale 2.Provokes desperation 3.Unleashes anxiety 4.Ushers in feeling of hope-lessness in resuming a normal life,Long continued bed rest 1.,17,Sitting for 1-2 hours after MI:1.Increased venous pooling 2.Decreased venous return 3.Decreased cardiac workload,Sitting for 1-2 hours after MI,18,1944 DOCKExtended bed rest results:1.Thromboembolism 2.Bone demineralization 3.Muscular wasting 4.Gastrointestinal problems 5.Urinary complications 6.Vasomotor instability,1944,19,Bedside commode 1.Less energy requirement 2.Cardiac output and myocardial work less in sitting position 3.Avoids Valsalva maneuver,Bedside commode 1.Less ener,20,Benefits of early ambulation:1.Prevents de-conditioning 2.Prevents anxiety and depression 3.Increases physical capacity 4.Improves self image 5.Shorter hospital stay 6.Early return to work,Benefits of early ambulation:,21,ROSE“the burden of proof now lies on the physician who advocatesextensive activity restriction asbeneficial for the patient withuncomplicated acute MI”,ROSE“the burden of proof now,22,1957the start of cardiac rehabilitationprograms in the U.S.,1957the start of cardiac reha,23,Torkelsen,Tobias,HellerSkinner,Fox,McPherson,Hellerstein,Kaufman,Shaeffer,Bouyer and Cardus,Torkelsen,Tobias,HellerSkin,24,Their efforts became the foundation of modern cardiacrehabilitation.,Their efforts became the fou,25,Early 1960sfocus on In HospitalCardiac Rehabilitation,Early 1960sfocus on In Hospi,26,Late 1960sOut patient cardiac rehabilitationprograms started to proliferate,Late 1960sOut patient cardia,27,1960 1970advocacy for early institution of physical activities for MI patients,1960 1970advocacy for early,28,Rationale for early ambulation and early exercise:1.Demonstrated safety 2.Shortened hospital stay 3.Fewer complications related to bed rest 4.Psychological gains 5.Improved cardiac function 6.Earlier and higher frequency of return to work,Rationale for early ambulation,29,Key objective of most programs:1.Preparing the individual for return to work.,Key objective of most programs,30,Stipulations for early ambulation:1.Uncomplicated MI and stable 2.Absence of any of the following:a.cardiac failure b.shock c.arrhythmias d.persistent angina e.non-cardiac complications f.over 65 years old,Stipulations for early ambulat,31,1970 1980Establishment of outpatient cardiac rehabilitation program,1970 1980Establishment of o,32,Patients referred 12-24 weeks post myocardial infarctionGraded exercise testing utilizedRisk stratification popularized,Patients referred 12-24 weeks,33,In the 70s,“For cardiac rehabilitation to be complete,it must include:1.Psychol
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