Phase IV cardiac rehabilitation

Phase IV CR is the long-term maintenance of risk factor modification, with long-term follow-up in primary care. For the benefits of physical activity and lifestyle change to be sustained, the available evidence suggests that both need to be maintained (SIGN, 2002). As clinically indicated, referral to specialist clinicians, such as smoking cessation or psychological support, may still be required (DoH, 2000). This stage is likely to be the most informal stage of cardiac rehabilitation, where there is long-term maintenance of individual goals and monitoring of clinical issues and risk factor modification, mainly by the primary healthcare team (BACR, 1995). It is important that the patient is aware of the exact nature of the follow-up system available.

Continuation and progression of appropriate physical activities are encouraged outside the hospital setting, on either a formal or informal basis. By this time it is hoped that individuals will be aware of their exercise capabilities and be able to monitor themselves appropriately. The BACR offers a comprehensive training course in phase IV exercise for exercise professionals, such as health and fitness officers who may be involved in community-based programmes.

Phase III discharge information, including goals set, should be sent to the relevant healthcare professional in the community, and formal referral to phase IV exercise classes made. As for earlier phases of CR motivational interviewing and exercise consultation are methods that can be used to maintain behaviour change (see Chapter 8).

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