Cardiovascular disease(CVD) is defined as any critical or abnormal condition of the heart itself or its blood vessels (arteries and veins). One of the significant causes of death worldwide and in the United States is CVD. Cardiovascular disease includes o Coronary heart disease, o Stroke, o Peripheral vascular disease, o Congenital heart diseases& heart failure, o Myocardial infarction. Causing factors for CVD CVD is the main cause of death globally. • Behavioural risk factors such as physical inactivity, tobacco use and unhealthy diet explain nearly 80% of the CVD burden. Symptoms of CVD o Pain or discomfort in the centre of the chest o Pain or discomfort in the arms, left shoulder, elbows, jaw, or back. o Shortness of breath o Nausea or vomiting o Light-headedness o Pallor o Cold sweat Indications For Cardiac Rehabilitation : o Heart attack or Myocardial Infarction o Angina o Angioplasty o After Coronary Artery Bypass Surgery o Other cardiac issues that involve cardiac surgery. Beginning of the Cardiac Rehab by the Physiotherapist : Cardiac Rehabilitation should start as early as possible, in the ICU (Intensive Care Unit). The early start of rehabilitation and mobilization improves the patient’s physical functioning and return to work after cardiac urgery. The Phases Of Cardiac Rehabilitation Cardiac Rehabilitation consists of 3 main phases that are : Phase 1: The Clinical Phase In this phase, the patient’s current physical abilities, motivation, and will to start and tolerate the rehabilitation process is checked. The physiotherapist and or the nurse can start rehabilitation by non-strenuous exercises and simple passive movements to avoid complications such as bed sores etc. Should start these passive movements to maintain the patient’s range of motion (ROM), achieving ADLs, i.e., activities of daily living. Phase 2: The Outpatient Cardiac Rehabilitation When the patient is stable and is marked out of danger by the cardiologist, this phase starts. His functional limitations, painful ranges of motion, and activity are assessed by his physiotherapist. The therapist enhances his mobility by PNF techniques, Passive Exercises, Assisted Exercises, etc., to make the patient perform his daily life activities. Phase 3: The Post Cardiac Rehab or Return to The Home Phase After the patient is independent to perform his basic daily life activities, his physiotherapist teaches him strengthening exercises and a few aerobic exercises to improve his endurance while performing his tasks. The patient can continue to perform those exercises at home by himself or with the assistance of his family members. The Warm-up Period: Before starting any exercise, there must be a warm-up time for about 5-10 mins in which the patient stretches his limbs and raises the blood supply to the required area. The Main Class : Depending on the patient’s current cardiovascular and physical state, the therapist makes a plan of care and an exercise regimen followed by the patient regularly. The exercise should be started by following a proper warm-up period guided by the patient’s physiotherapist. The aerobic exercises should be of fixed time interval followed by a fixed amount of rest time period between the repetitions; this means that the exercises should be rhythmical and have equal rest intervals. The Cool Down Time Period : After the exercise, there must be a 10 min rest or cool down time given to the patient to bring their body back to the resting phase. Health And Safety : If the patient’s general health is not stable enough or they are still in a critical state, then the patient should not be advised of proper physical therapy or follow an exercise program. But still, the passive movements (to avoid bed sores and other complications like loss of available range of motion, etc.) should be continued by the therapist or the head nurse as guided by the physiotherapist in charge. Following are the cardiac symptoms in which any type of exercise must be avoided or discontinued : o In fever o If a patient’s blood pressure rises or drops significantly o Resting BP systolic >200 mmHg and diastolic > 110 mmHg o If the patient has uncontrolled diabetes o If there is breathlessness o In lethargy, nausea, and if the patient feels dizzy o Chest pain or unstable angina