Cardiac Rehab - Outpatient Flashcards
Exercise Prescription - Outpatient
Frequency: 3-5 Days a Week
Intensity: 40-80% HRR, VO2R
Mode: Large Muscle Groups
Duration: 20-60 Minutes
- Wamup and Cool Down (Longer than warmup)
Mode - Phase 2
Multiple activities - UE & LE
1. Mobility (ROM) and Flexibility
2. Aerobic/Anaerobic (Treadmills, Cycle ergometer, stair climbers, rowes, arm ergometer
3. Resistance Training (comes later)
Intensity - Options
- RPE
- HRR %
- VO2reserve
- Sx
- BP (Pacemaker)
- Talk Test (Ventilatory Threshold)
- HRrest + 20 MI; HRrest + 30
- METs
Heart Rate Reserve - Karvonen
40-80%
[(max HR – rest HR) x desired % + rest HR]
HRR should always be a range so if you want them working at 75% you need to give the range of values from 70-80%.
% HRR Equation when you don’t have a GXT
BB (YES) = 164 - (.7 x age)
NO BB = 211 - (.64 x age)
“Guestimation” of Target HR: Modified Karvonan Formula:
[205 - ½ age or 208 - .7 age ) - Resting HR] x (intensity) then add (+) Resting HR back in.
RPE
- Prescribe between 11 - 16
- 11 - 13 = 40-60% HRR (Farily Light to Somewhat Hard)
- 14 - 16 = 60 - 80% HRR
- Phases 3-4 = RPE range 12 - 15
Talk Test
- Ventilatory Threshold
- Speak in complete sentences without gasping (upper limit)
Frequency - Phase 2
- At least 3, 5 perferred.
- If just coming out of hospital start with 3.
Duration - Phase 2
- Goal to tolerate 20-60 minutes of continuous exercise
- Start with as little as 5-10 minutes gradually increase in time (~1 - 5 minutes per session or 10-20% per week)
- Exception:Interventions for PAD
Wihtout GXT what are the exercise limits for pts.? Inpatient vs Outpatient
Inpatient
- HRrest + 20 bpm (post MI)
- HRrest + 30 bpm (post CABG, vascular)
Outpatient
- 2-3 METs (3 METs = Walking)
- 1-3 mph Treadmill (0% grade)
- 100-300 kgxmxmin-1 (bike)
- Increase 0.5 to 1.0 METs as tolerated
- Progress using RPE and Sx
2, 2.5, 3 mph into METs
- 2 mph = 2.5 METs
- 2.5 mph = 2.9 METs
- 3 mph = 3.3 METs
Lifestyle Physical Activity
Current recommendations
* 5,400-7,000 steps per day
* Add ~2,000 steps / day
References:
* Walking 30 min/day = 3,000 – 4,000 steps
* Walking 1 mile = ~2,000 steps
High Intensity Interval Training
- Alternating periods of intensive aerobic exercise with periods of passive or active moderate/mild intensity recovery.
- Elicits greater training stimulus
- Central and peripheral adaptations
- HITT (85-100% of VO2peak) is more effective than moderate intensity continuous exercise in improving cardiovascular risk factors
- No guidelines yet
Norwegian Model - HITT
- 4 min at 85-95% HRmax; attained at 2 min
- 3 min of 11-13 (fairly light to somewhat hard)
HR max versus HRR
* HRmax = .85 x max HR
* HRR = Max HR – Rest HR x .85% + Rest HR
Criteria to begin resistance exercise program
Min of 5 weeks after MI, or cardiac surgery
– Including 4 wks of consistent participation in CR (aerobic)
Min of 3 weeks wks after PCI
– Including 2 wks of consistent participation in CR (aerobic)
No resistive exercise with evidence of:
* Uncontrolled arrhythmias
* Severe valvular disease
* Uncontrolled HTN
* Unstable symptoms
CABG-may have to wait for 12 weeks; 5-8 lbs OK after 5 weeks
