Cardiac Rehabilitation.

          Exercise, as a treatment for heart disease is as old as our knowledge of the condition. In 1768 a doctor noted that his patient with angina was almost cured by sawing wood for half an hour per day. However, heart disease was diagnosed infrequently over the next 150 years. As recently as 1968 the duration of bed rest depended on the severity of the heart attack. Three weeks would be the average period leading to many complications
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          In the 1950's and the 1960's a number of groups in different parts of the world started programmes of exercise training with Coronary Heart Disease. Isreal was the cradle of a large scale rehabilitation effort. They used a four month course of working activities such as gardening together with gradually increasing gymnasium exercise. Patients were accepted into a reconditioning course some three months after the heart attack. 200 patients were monitored and many became fitter than before. Similar studies were also taking place in U.S.A. Canada and Scandinavia
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          Over the years since that time there took place a gradual growth in the acceptance world wide of the benefits of exercise for patients with heart disease. There has also been a progressive change from exercise only programmes to multifactorial intervention, to include risk factor modification and stress management.
 
          Cardiac rehabilitation today is divided into 4 stages:-
               Phase One:
                    In patient stay includes: reassurance: information: risk factor assessment: risk stratification: education: mobilization: discharge planning: involvement and support of partner/family and friends.
               Phase Two:
                    Immediate post discharge includes: staff making follow up telephone calls: patients having 24 hour access help line service: staff making home visits: patients attending individual appointments.
               Phase Three:
                    Intermediate post discharge includes: risk stratification and the identification of the high risk patient: inclusion or exclusion criteria for exercise sessions: Psycho-social interventions.
               Phase Four:

       Long term maintenance, consists of two main components.
                    1,  Long term maintenance of individual goals.
                    2,  Professional monitoring of clinical status and follow up of general  progress.
                         This involves close liaison with the primary health care team and local keep fit organisations.
          Cardiac rehabilitation in Lancaster was first set up about 30 years ago when patients came back to phase 3.

          Gaye Jackson and myself set up phase 4, 7 years ago. Using gym 4 at the RLI using staff and friends as patients and then started the scheme at Salt Ayre Leasure Complex with about 15 patients. Gradually numbers increased and we had to move to our current venue at the College of Further Education. Each week we have between 30 to 40 people attending. Not only are the physical and psychological benefits enjoyed by all, many new friendships have developed, so people have had social benefits.
 
          Many members of Heart Concern attend phase 4 and are able to encourage new people to join our support group.
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                                          Hilda Preston
                                                           Vice Chair.