Vascular Rehabilitation

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Introduction

Patients with atherosclerotic coronary disease have shown tremendous improvement through structured programs for physical reconditioning and risk factor modification. However, similar programs for patients whose initial atherosclerotic complication is peripheral arterial insufficiency have not been widely developed. This has occurred in spite of the known benefit of exercise in increasing ambulation distances and the acceptance of exercise by most vascular surgeons as a valuable tool in the management of patients with claudication. Practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease.

Vascular Rehabilitation Program

Vascular rehabilitation programs aim to limit the psychological and physiological stresses of PAD, reduce the risk of mortality secondary to CVD, and improve cardiovascular function to help patients achieve their highest quality of life possible. Accomplishing these goals is the result of improving overall cardiac function and capacity, halting or reversing the progression of atherosclerotic disease, and increasing the patient's self-confidence through gradual conditioning

CR ere the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals are encouraged to support and achieve and maintain optimal physical and psychosocial health. The involvement of partners, other family members, and carers is also important”

They require a team approach, including a multidisciplinary the multidisciplinary team including:

• • Cardiologist/Physician and co-coordinator to lead cardiac rehabilitation
  • Clinical Nurse Specialist
  • Physiotherapist
  • Clinical nutritionist/Dietitian
  • Occupational Therapist
  • Pharmacist
  • Psychologist
  • Smoking cessation counselor/nurse
  • Social worker
  • Vocational counselor
  • Clerical Administration

It is essential that all cardiac rehabilitation staff have appropriate training, qualifications, skills, and competencies to practice within their scope of practice and recognise and respect the professional skills of all other disciplines involved in providing comprehensive cardiac rehabilitation. The cardiac rehabilitation team should actively engage and effectively link with the general practitioner and practice nurses, sports and leisure industry where phase IV is conducted, community pharmacists and other relevant bodies to create a long-term approach to CVD management.

Types of Rehabilitation

Structured exercise program

• Planned program that provides individualized recommendations for type, frequency, intensity, and duration of exercise.
• Program provides recommendations for exercise progression to assure that the body is consistently challenged to increase exercise intensity and levels as functional status improves over time.

There are 2 types of structured exercise program for patients with PAD:

1. Supervised exercise program

2. Structured community- or home-based exercise program Supervised exercise program Structured exercise program that takes place in a hospital or outpatient facility in which intermittent walking exercise is used as the treatment modality. n Program can be standalone or can be made available within a cardiac rehabilitation program. n Program is directly supervised by qualified healthcare provider(s). n Training is performed for a minimum of 30 to 45 min per session, in sessions performed at least 3 times/wk for a minimum of 12 wk (36–46). Patients may not initially achieve these targets, and a treatment goal is to progress to these levels over time. n Training involves intermittent bouts of walking to moderate-to-maximum claudication, alternating with periods of rest. n Warm-up and cool-down periods precede and follow each session of walking.

Structured community- or home-based exercise program

Structured exercise program that takes place in the personal setting of the patient rather than in a clinical setting (41,47–51). n Program is self-directed with the guidance of healthcare providers who prescribe an exercise regimen similar to that of a supervised program. n Patient counseling ensures that patients understand how to begin the program, how to maintain the program, and how to progress the difficulty of the walking (by increasing distance or speed). n Program may incorporate behavioral change techniques, such as health coaching and/or use of activity monitors.