Biokinetics is a health profession working in alliance with other health and medical professionals in the aftercare and rehabilitation of cardiac patients. A Biokineticist forms part of the medical team who are authorized and highly qualified to administer scientific based assessments, program prescription and application thereof in a controlled and supervised environment. Biokineticists are recognized and is required to be registered with the Health Professions Council of South Africa.

Biokinetic rehabilitation is one of the key components in the rehabilitation process of cardiac patients.
The aims of rehabilitation are:

1. Reversal of Coronary Heart Disease in some cases and the prevention of progression of coronary disease.
2. Modification of the patients risk factors
3. Improvement of quality of life
4. Increase and optimizing of cardiovascular function
5. Increase level of confidence in physical ability

Pre-operative rehabilitation program aim to reduce and modify existing risk factors diagnosed before serious cardiac events.
Factors such as:

1. Hyper cholesterol
2. Reduce triglycerides levels
3. Lower unacceptable levels of blood pressure
4. Aims to manage unacceptable body composition and obesity
5. Reduce stress levels
6. Aiding in prevention  and management of sugar diabetes
7. Assist patients to become and remain smoke free
8. Physical inactivity
9. Aiding in modifying unhealthy eating habits

Post-operative biokinetic rehabilitation is one of the crucial components to manage the cardiac condition.

The program is based on:

1. The stage of cardiac complications
2. The patients individual needs (orthopedic and neuromuscular)
3. The influence of medication

Phase 1:

Usually the in-hospital treatment aims to help the patient through the acute effects of surgery. Introducing phase one as soon as possible reduce the negative effects of bed rest and to return the patient to activities of daily living with confidence.

The positive goals are to provide additional monitoring for special problems and educate patient and the family on how to manage their condition. Supervision by qualified staff is crucial.

The program guidelines:

* Low intensity cardiovascular activities for 10 to 15 minutes
* 2 to 3 times a day
* At about 30 – 50% of the patient’s capacity
* Warming up and cooling down remains important.
* Avoid stressing the chest
* Involve big muscle groups
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications
* Confirmation of program prescription can only happen after monitoring of the patients response  

Activities involve simplistic cardiovascular (walking, climbing stairs) activities to increase breathing rate. Important that the patient must maintain a low perceived exertion level during cardiovascular activity. A practical guideline is that the patient can comfortably talk while they walk.

Phase 2: (6 weeks duration)

As soon as the medical team gives the go ahead after initial 2 to 6 weeks a moderate intensity out-patient program can be started. The Biokineticist will initiate the program capturing a thorough history and sub maximal exercise testing and continuous monitoring during the assessment. Supervised sessions are crucial.  

The program guidelines:

* Continue with activities of daily living
* Moderate intensity cardiovascular activities 20 to 30 minutes per training session         
* 3 to 4 formal training sessions per week
* Progressive moderate rate between 40 and 60% of patient’s capacity
* Warming up and cooling down remains important.
* Avoid stressing the chest
* Involve big muscle groups include mobility and strengthening exercises
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications

Phase 3: (6 weeks duration)

After 6 weeks of controlled exercise the cardiac patient will be re- assessed and goals will be set for this phase. Generally 60 to 80% of the patient’s capacity can be achieved. With the patient’s knowledge of his condition and exercise limitations he will feel more confident to continue. Supervised sessions are still important.  

The program guidelines:

* Continue with activities of daily living
* Moderate to high intensity cardiovascular activities 30 to 60 minutes per training session        
* 3 to 5 formal training sessions per week
* Progressive moderate rate between 60 and 80% of patient’s capacity
* Warming up and cooling down remains important.
* Avoid over stressing the chest light upper body exercises can be considered  
* Involve big muscle groups include mobility and strengthening exercises
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications

Finally after 12 weeks of hard work the formal cardiac rehabilitation ends with a final re-assessment.  Recommendations for a maintenance program will follow provided that the patient’s heart condition is stable. Exercise will now form part of the healthy lifestyle regime. The cardiac patient will be fully educated to manage his exercise program for life. Regular visits to your Cardiologist and Biokineticist is recommended.

For further information contact the Biokineticist:

Ilse Senekal
Milpark Hospital
Medical Suite no.10
Parktown West
Tel: (011) 482 - 2465
Fax: (011) 726 - 7896