Tag: COVID-19

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How cardiac care has evolved during the pandemic

Cardiac care can be broadly divided into acute management of cardiac emergencies and longer-term prevention and rehabilitation strategies for the heart patient. In this post, we would like to share our experience on how cardiac rehab has evolved with the ongoing pandemic.

During the pre-COVID era, our focus was predominantly on conventional centre-based cardiac rehab where patients and their caregivers would visit our rehab centre on a periodic basis for sessions with the doctor, physiotherapist, dietician, counselling psychologist and yoga therapist. Home-based cardiac rehab offered through tele / online modality occupied a minor portion of our work prior to the pandemic and was reserved for those living outside Chennai or abroad. However, it was gratifying to note that both formats were well appreciated by the participants and the program outcomes were excellent irrespective of whether they were attending in-person or home-based sessions and we have shared our thoughts on this topic in June of 2019 (click the link for the earlier post).

http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/what-is-home-based-cardiac-rehabilitation/.

The biggest advantages of in-person care are the personal touch and the ability to examine the patient. Looking back, these are the things we have missed the most in the past year since the start of the lockdown as our entire team of healthcare professionals switched to the work-from-home mode to maintain continuity of care and uninterrupted services for patients.

We initiated HeartHealth@Home, an online consultation service to cater to patients’ queries and concerns related to cardiac care while at home during the lockdown. Some common issues for which people approached us were:

  • Symptoms like gastritis, heartburn and chest pain for which detailed history was elicited and appropriate guidance given
  • Doubts about cardiac medications and their dosages as they were not able to contact their primary physician
  • Questions about COVID-19 related safety measures in individuals with diabetes, hypertension and heart ailments
  • Queries pertaining to when to approach the hospital and whether it was safe to do so during the pandemic

We realised that our home-based cardiac prevention and rehab program soon became a much sought after service as patients were able to make use of the online services seamlessly and cardiologists and heart surgeons were happy to refer their patients. The initial evaluation, the program planning and the execution of the rehab sessions were all done online and smooth communication was maintained with the enrolling participant, their family members and the referring doctors. Without the technological advances of video calls through smartphones, audiovisual presentations for groups of people using various platforms and online questionnaires and forms to evaluate and track patient progress, the home-based programs would not have been possible.

As we embrace the new normal and gradually resume in-person consultations and regular centre-based programs this month, we are making sure we closely adhere to the COVID prevention protocols and maintain high standards of safety and hygiene for our patients. We encourage all our patients to get vaccinated against the novel coronavirus at the earliest possible time and to continue following personal precautions for the timebeing. Moving forward, patients will have the option to choose centre-based or home-based programs or a hybrid model with a combination of both formats. We are confident that after having pioneered the concept of preventive cardiology in South India and having sailed through the pandemic situation with minimum impact on patient care, we are better poised to continue in our exciting journey of best-in-quality cardiac care for our people.

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Post COVID Syndrome and ways to Overcome it

While you may be aware of the symptoms of COVID-19 by now, it is equally important to know that around 20% of those who recover from the acute phase of the infection may continue to have health issues in the weeks and months that follow, this is known as post-COVID syndrome. With a high rate of recovery in India, several individuals are struggling to cope with the aftermath of the infection. There is strong scientific evidence to show that a medically supervised rehabilitation program helps in the complete recovery from this post-COVID syndrome.

Individuals affected with COVID-19 may be left with physical and mental impairments such as:

  • Impaired lung functions
  • Severe muscle weakness
  • Joint stiffness
  • Fatigue
  • Limited mobility and ability to do daily tasks
  • Delirium and other cognitive impairments
  • Difficulty in swallowing and communicating
  • Mental health disorders and psychosocial support needs

It has been found that not only does the presence of diabetes pose a threat when it comes to recovery from COVID-19, but non-diabetic persons may also develop diabetes as a complication of the COVID-19 infection. Both the direct effect of the virus on sugar metabolism as well as the indirect effect of steroid medications on blood sugar levels have been implicated in this. The impact of the coronavirus on the heart has also been recognised. Acute inflammation of the cardiac cells known as myocarditis, blocks in the coronary arteries leading to heart attack and abnormal heart beat known as arrhythmias are some established cardiac complications of the COVID-19 illness.

Post COVID rehabilitation is the need of the hour to improve the overall wellbeing of individuals by  improving their lung function, functional capacity and exercise tolerance, by enabling early return to work and daily routine and by enhancing psychosocial wellbeing.

The main focus areas in post COVID rehab as outlined by the World Health Organization, European Respiratory Society and American Respiratory Society are:

  1. Improve lung functions
  2. Decrease fatigue at rest
  3. Improve mobility and joint functions
  4. Prevent further muscle weakness
  5. Provide customised exercise training
  6. Provide appropriate dietary advice
  7. Provide adequate psychological counselling
Benefits of Post COVID rehabilitation

Individuals recovering from COVID-19 are advised to focus on some self management techniques as follows:

  • Improving lung functions and breathlessness

Breathing exercises such as diaphragmatic breathing exercise and thoracic expansion exercise will help to improve lung expansion and avoid further deterioration. Forced expiratory technique such as coughing and huffing will improve the bronchial hygiene and also assist in expectorating the mucus. Breathing exercises are proven to decrease the severity of breathlessness and paves the way for being more active.

  • Improving fatigue and exercise intolerance

Fatigue and exercise intolerance are the most common symptoms of post-COVID syndrome and can be managed by appropriate exercise training. Exercise capacity testing is a must to identify the level of functioning and to administer appropriate exercise training. A combination of aerobic exercises, resistance exercises that improves muscle strength and endurance and breathing and flexibility exercises is a must for rapid recovery. Activity pacing and energy conservation techniques should be advised such that it avoids the onset of fatigue and also aids exercise performance.

  • Improving psychological health and mental wellbeing

Survivors of COVID-19 face several psychosocial challenges such as stigma in the living community, at work, at social gatherings and public places. This in turn can result in insomnia, isolation, anxiety, depression and other psychological disorders. It is important that the rehab program provides counselling, reassurance, coping skills, and emotional support to overcome this stressful period.

  • Improving dietary intake

A healthy balanced diet is key to full recovery from any illness. Consumption of fruits & vegetables, protein rich foods and whole grain products with appropriate vitamins and minerals and staying away from unhealthy foods like fast food, packaged food, fatty food and artificially sweetened dishes will aid in the speedy recovery from the coronavirus.

We at Cardiac Wellness Institute are providing Post COVID Rehabilitation through a completely online service. You may contact us at +919902155772 for further information.

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Stay Fit at Home without any Equipment

Exercise is nothing but physical activity done in a structured, planned and repetitive manner. The importance of regular exercise in maintaining health and preventing disease is well known. But many of you might be of the impression that walking is the only exercise that can be done without equipment. While brisk walking is a great way to stay fit and can be done almost universally, there are infinite numbers of other exercises that do not require any equipment and can be performed at home.

In this current situation of being confined to your homes due to the COVID-19 outbreak and the work-from-home demands for many of you, keeping yourself active and exercising regularly should be your main goal. This habit of exercising will not only help avoid a sedentary lifestyle but will also help you be more productive in your work. Go ahead, read on and find out how to perform exercises at home without any equipment.

A robust exercise routine should include a warm-up phase (5-10 minutes), an active aerobic exercise phase (30-45 minutes) and a cool-down phase (5-10 minutes), adding up to a total of at least 40 minutes of exercise. This regime should be followed on at least 5 days weekly.

Warm-up is a pre-exercise phase which involves active movements of all joints right from your head to your toes. A good warm-up prepares you adequately for the exercise phase and also helps avoid injuries to muscles, joints and ligaments. Here are 6 warm-up exercises everyone should do. Each warm-up exercise should be done 10 times.

Aerobic exercises that you might have been doing are walking, running, cycling, swimming etc. Some alternatives that can be done inside your house are:

On spot jogging/marches (10 – 20 minutes)
On spot pogo jumps
Jumping jacks
High knees
Butt kicks
Step up & down

On spot marching or jogging can be done for 10-20 minutes. Each of the other 5 exercises can be done for 15 – 30 times (repetitions) per set for 2-3 sets. For step up & down, you can use your stairs as a platform to climb up an down. Repetition is the number of times you perform a particular exercise and Set is the number of cycles of repetitions one completes. A rest period of 30-60 seconds is advised in between each set.

Cool-down is a post-exercise phase which involves active stretching of the major joints to avoid muscle cramps or soreness after exercising. Each stretch position should be held for about 20-30 seconds and repeated 2-3 times. Remember to be gentle while releasing from the stretched position to avoid muscle catch.

Those who are acquainted with exercising in fitness centres and groups can perform these home exercises easily. However, beginners should take note of the following precautions to avoid injuries and other complications while exercising at home:

  • Start with 5-10 repetitions and take adequate rest in between each set
  • Total exercise time may be 15-20 minutes to begin with and gradually go up to 30-40 minutes within a months’ time
  • Keep a log of your exercise duration and the occurrence of pain, swelling, discomfort etc.
  • If you experience giddiness, chest pain, breathlessness or abnormal heartbeat, please stop the exercise immediately

In conclusion, you do not need modern equipment or machines to exercise but you definitely need the knowledge on how to perform the exercise, need to allot time for exercise and need dedication and determination to stay healthy without an external push.

Cardiac Wellness Institute has initiated the HeartHealth@Home program where we are open for online consultation and also provide home-based heart health programs and fitness and diet guidance for individuals. Please feel free to contact us for further information.

In fact, once you master these basic exercises, you can start incorporating strength training exercises and core strengthening exercises at home. I will guide you on these exercises in my subsequent blog post. Until then, STAY HOME, STAY FIT!