Phase III cardiac rehabilitation

This is traditionally the outpatient education and structured exercise programme component of CR. Phase III continues risk factor changes and education established in previous phases. An individual, menu-based approach continues, with monitoring and feedback regarding risk factors and lifestyle.

There is an emphasis on addressing multi-factorial risk factor modification, appropriate to each patient. Baseline patient assessment can be carried out and outcomes reviewed and audited. Traditionally this phase is hospital-based, though it is increasingly recognised that it can be undertaken safely and successfully in the community (SIGN, 2002). Phase III can also be structured to be sited in the hospital for the first half and in the community for the second half of phase III CR (Armstrong, et al., 2004).This novel design assists patients to enter a community setting where phase IV will be based, thus exposing them to a more social and less medical environment.

The structure of phase III is usually at least two supervised exercise sessions per week, lasting over a period of between 6 and 12 weeks. One session of education per week may be offered. Physical training is often the key component of phase III CR, but psycho-social counselling and education regarding risk factors and lifestyle are important. Strategies to enable a reduction in depression, anxiety and uncertainty, accepting the heart disease and learning to cope with it are discussed as appropriate. As with earlier phases of CR, the involvement of family and significant others continues to be important. Risk stratification prior to patients commencing phase III exercise classes is essential and will be examined in Chapter 2.

In the UK, aerobic circuit interval training for group exercise training is commonly used and is an effective method for delivering aerobic exercise (SIGN, 2002). In addition to the aerobic conditioning phase, resistance training is part of CR exercise. Home-based exercise is also prescribed with self-monitoring skills being used by the patients. Typically an exercise class consists of a warm-up, an aerobic conditioning phase, a cool-down period and a conditioning phase. The exercise programme should be tailored to the needs of the patient.The latter is important to encourage adherence to exercise. Details regarding the exercise component of CR are provided in Chapters 3-5.

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