Phase Ii Cardiac Rehabilitation

Phase II is the immediate post-discharge phase and normally lasts between 4 and 6 weeks. Often this period at home can be frightening for the patient and significant others. The family may feel isolated after being through a period of close supervision in the hospital environment. Despite these concerns, this phase of rehabilitation is often neglected (BACR, 2000).

Phase II is recognised as the stage where patients initiate some of the lifestyle changes and gradually begin to resume their normal daily activities. Support and guidance are normally provided by cardiac rehabilitation nurses, practice nurses and GPs, although other healthcare team members may also become involved, depending on patient need. This is commonly provided through telephone contact or home visits.

Use of the Heart Manual (Lewin, et al., 1992) is commonly provided in this phase for patients post-MI. This six-week self-help rehabilitation programme is usually introduced by a facilitator during the in-patient phase and addresses health education, exercise and stress management.

Prior to discharge, an individualised activity plan should be prescribed for phase II. An incremental walking plan that is safe and realistic for the individual is often used. A gradual increase in time and distance and the inclusion of a warm-up and cool-down should be encouraged; however, at this stage the pace should be comfortable (BACR, 2000). Intensity should be restricted to less than 4 METS at this stage, frequency of walking should be daily with progression to 30 minutes continuous activity (BACR, 2000; ACSM, 2001). The RPE (Borg, 1982) scale should be used with activity restricted to less than 13 RPE (ACSM, 2001). A pedometer is a useful way for the patient and cardiac care team to monitor walking and progression. In addition, it can help to provide feedback and motivate the patient. Progress will vary but patients should be made aware of how they should feel, avoiding symptoms of over-activity and taught how to manage activity levels accordingly.

Many patients tire easily in the early stages, but this should gradually diminish (BHF, 2002). Safety considerations, including extreme weather conditions, exercise after food and alcohol, symptom management and glyceryl trinctrate (GTN) use should also be discussed (BACR, 2000).

Dusting, light cooking and other light household tasks should be encouraged initially. Other tasks, such as hoovering, should be left until the patient feels able, or at least until one to two weeks. Around the garden only light tasks are permitted, and this should be emphasised. Heavier tasks and do-it-yourself should be discussed at phase III. Return to sexual relationships should be discussed. Patients should be informed that when they can comfortably climb two flights of stairs they are safe to return to sexual relationships (BHF, 2001). However, post-CABG patients should wait for approximately four weeks (BHF, 2002). A comfortable position should be encouraged, and the partner may want to adopt the more active role initially.

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