Hogeschool van Amsterdam

Urban Vitality

Tailored cardiac rehabilitation for frail elderly patients

21 Feb 2019 00:00 | Urban Vitality

Patients who are hospitalised after a cardiovascular event recover better with cardiac rehabilitation. This means routinely returning to hospital for several consecutive months for a supervised programme of fitness, strength and balance exercises. But for elderly people who are frail, all that travelling back and forth is too taxing. Home rehabilitation could potentially solve this problem, but what would it entail? In January, lecturer-researcher Michel Terbraak received an NWO Doctoral Grant for Teachers to investigate this question.

Home-based rehabilitation under a physiotherapist's supervision could be a lifesaver for older patients who are unable to make weekly hospital trips.

Standard cardiac rehabilitation

Cardiac rehabilitation requires patients to go to hospital to exercise twice or thrice a week for several months. It's important that they do this under supervision, because their hearts are still on the mend. This is why, beforehand, the doctor will do an ECG while the patient is working out on a stationary bike, and also why patients have to be supervised by an experienced physiotherapist during exercises.

For patients who are elderly and frail, the current system for cardiac rehabilitation is not an option. It entails a lot of travelling back and forth, which is time-consuming and tiring, especially if they cannot drive themselves. What is more, since these patients tend to be the oldest member of their rehabilitation groups, they often are unable to keep up.

Tailored cardiac rehabilitation

Home rehabilitation could be the answer for these patients, but it is tricky to organise. First of all, the supervising physiotherapist needs a whole different skill set. Also other equipment, like blood pressure and heart rate monitors. If these give abnormal readings, the physiotherapist has to consult with a doctor or district nurse.

The physiotherapist also has to draw up an effective exercise regimen with the patient. This has to take account of the patient's (in)abilities, since older people tend to have more health problems. For someone with a bad knee, it can be better to do some exercises seated, and a person with high blood pressure should not exert themselves as hard.

In short, to work with frail elderly patients, a physiotherapist needs an adapted exercise regimen that can be done at home. That is: tailored cardiac rehabilitation. Although this is already provided by some physiotherapists, there has been no research on it yet.

What's needed for home rehabilitation?

Terbraak wants to find out what physiotherapists need to provide the right kind of supervision to frail elderly patients recovering from a heart attack. Ultimately, he envisions creating a kind of ‘rolodex’ with a wide range of exercises from which patients and physiotherapists can choose, thus tailor-making a cardiac rehabilitation programme together.

First, Terbraak will study existing data to identify which factors affect exercise capacity in the elderly, such as strength, nutrition, informal care and self-assurance. After pinning down these factors, he will discuss them with patients and experts in order to reach a consensus on key elements of a treatment protocol. When this protocol is ready, he will trial it with a small group of patients and experts.

Cardiac stress test feasible at home?

In tandem with this research, Terbraak will also be trialling a cardiac stress test for the elderly. Subjects will go into hospital for a regular test first, and after a certain interval a second adapted stress test is done at home. If the results of the two tests coincide, it will mean the home variant – which reduces hospital visits – is a viable alternative.

Terbraak is conducting his research within the Complex Care research programme and the Rehabilitation in Acute Care professorship. The project has a duration of four years and is titled ‘Development of tailored home-based cardiac rehabilitation in frail patients’. Alongside Terbraak, several other researchers at the AUAS have been awarded an NWO Doctoral Grant for Teachers.