Cardiac Rehabilitation

Coordinated by Prof. Alessia Rabini, Director of the Cardiovascular Rehabilitation Unit at the Department of Cardiovascular Sciences at the Fondazione Policlinico Gemelli in Rome, cardiac rehabilitation plays a fundamental role in the treatment of cardiovascular diseases.

Scientific literature unequivocally demonstrates that rehabilitation, alongside pharmacological and/or surgical therapy, must be an integral part of the treatment plan for cardiac patients. It reduces mortality and morbidity by 30%, ensures optimal clinical-functional recovery, promotes clinical stability, controls risk factors, and prevents subsequent events.

Indications for Cardiovascular Rehabilitation:

• Acute or chronic ischemic heart disease (angina, myocardial infarction, post-angioplasty patients)
• Cardiac surgery (coronary artery bypass grafting, valve replacements and repairs)
• Heart failure
• Pacemaker/ICD carriers
• Peripheral artery disease
• Congenital heart diseases
• Heart transplant recipients

Patients are managed by a multidisciplinary team, including a cardiologist, physiotherapist, physiatrist, nutritionist, and psychologist. This team conducts a thorough evaluation of the patient’s needs to create a personalized rehabilitation plan.

Physical Activity

Physical activity is a central component of the rehabilitation process. It includes controlled and monitored aerobic reconditioning exercises that are gradually implemented to retrain the heart and increase functional reserve. This helps patients regain the autonomy and confidence needed to return to a normal life. Rehabilitation programs, depending on the patient’s condition and specific pathology, can be conducted inpatient or outpatient, with long-term maintenance programs included.

Prehabilitation

Prehabilitation is a program carried out before surgical or interventional cardiology procedures to improve the patient’s functional, respiratory, and nutritional status. It significantly reduces postoperative complications and recovery times. This program is especially recommended for frail elderly patients, as it helps stratify surgical risk and aims to modify parameters such as reduced muscle strength, decreased exercise tolerance, obesity, malnutrition, and reduced autonomy. Prehabilitation can be conducted on an outpatient or home basis, utilizing digital tools (e-health) for remote monitoring, and typically spans 6 to 8 weeks before the surgery date.

Post-Surgery Rehabilitation

Rehabilitation begins the day after surgery and lasts 15 to 20 days. The patient is under constant telemetric observation, monitoring vital parameters 24 hours a day.

• Day 1: Respiratory exercises reduce pleural and diaphragmatic adhesions, increase thoracic capacity, and improve ventilation of under-ventilated areas.
• Day 2: Respiratory exercises continue, and the patient is mobilized from bed and seated.
• Days 3-4: The feasibility of ambulating the patient is assessed by measuring fatigue and monitoring oxygenation, heart rate, and blood pressure during movement.
• Day 5 onwards: Individualized aerobic activity begins in the physiotherapy department’s gym, evolving throughout the hospital stay. The protected gym environment is equipped with all necessary rehabilitation equipment (stationary bikes, treadmills, resistance bands, steps). Each patient is supervised by a dedicated physiotherapist, with a cardiologist always present. Patients are continuously monitored via telemetry, with their parameters displayed on screens in the gym.

Outpatient Rehabilitation

Upon discharge, a team plans individual goals and rehabilitation pathways to achieve these goals. Weekly rehabilitation sessions continue until the set objectives are met, facilitating an adequate return to social life.