Cardiac Rehab Phase II

Question 1

What does Cardiac Rehab Phase II (Immediate Outpt) Rehab consist of?

Answer 1

Prescribed exercise
Cardiac Risk Factor modification
Education
Counseling about diet/disease management

Question 2

When is Phase II implemented and how long does it last?

Answer 2

Begins right after hospitalization

Lasts up to 12 weeks

Question 3

Monitoring/Safety with exercise for Low-Risk patients with stable coronary artery disease:

Answer 3

-6-12 sessions of ECG and BP monitoring and medical supervision recommended to ascertain desirable exercise levels

Question 4

Monitoring/Safety with exercise for Moderate- to High-risk patients and/or pts who are unable to self-regulate/understand recommended activity levels:

Answer 4

At least 12 sessions with continuous ECG/BP monitoring and medical supervision are recommended until safety is established

Question 5

Signs for Termination of exercise: (7)

Answer 5

1) Plateau/dec in HR with increase in work
2) Systolic BP plateaus/falls with inc in work or is > 250 mmHg
3) Diastolic BP > 115 mmHg
4) ST segment depression > 1 mm
5) 2nd or 3rd degree heart block
6) Ventricular dysrhythmias
7) Angina or otehr sx of cardiovascular insufficiency

Question 6

Phase II Cardiac Rehab Exercise Mode

Answer 6

Aerobic exercise: rhythmic activities that use large muscle groups that can be performed continuously and safely
i.e. walking, running, jobbing, bicycling, rowing, jump rope, stair climbing, swimming, etc

Question 7

Phase II Cardiac Rehab Intensity

Answer 7

HR in phase II can be prescribed based on HR, METs, and RPE

Question 8

Phase II Intensity using HR

Answer 8

Target HR can be found using HRmax formula or HRReserve formula aka Karvonen formula

Question 9

Appropriate target HR for pts without an entry exercise test

Answer 9

Standing resting HR + 20bpm (but use with caution)

Question 10

1 MET

Answer 10

The energy expended while sitting quietly (1 mLO2/kg/min or 1 kcal/kg/h)

Question 11

Establising appropriate exercise intensity using METs

Answer 11

To establish the training zone max METs must be measured during an exercise test
Then lower and uppper MET limits are calculated using the same percentage training intensities as the Karvonen formula (40% and 85%)

Lower/Upper METs = [(MaxMETs - RestMETs) x 40%/85%} + RestMETs

Question 12

What RPE is te appropriate upper limit for intial pahses of phase II cardiac rehab?

Answer 12

RPE of 11 to 13 aka “fairly light” to “somewhat hard”

RPE is specific to the mode of exercise

Question 13

What RPE is the appropriate upper limit for higher intensity training later in phase II if there are no signs/sx of ischemia or serious dysrhythmias?

Answer 13

RPE of 14-16 aka “Somewhat hard” to “hard”

RPE is specific to the mode of exercise

Question 14

What are the three stages of Phase II Cardiac Rehab?

Answer 14

1) Intitial Training Stage: first month
2) Improvement Stage: next 3-4 months
3) Maintenance Phase: > 6 months

Question 15

How long should duration of exercise be in each specific stage of Phase II Cardiac Rehab?

Answer 15

1) Initial phase = 15-20 minutes continous or intermittent exercise
2) Improvement stage: 25-30 minutes
3) Maintenance stage: > or = 40 minutes

Question 16

Phase II Cardiac Rehab exercise frequency

Answer 16

3-5x per week

Question 17

By the end of Phase II pt should be able to/have: (6)

Answer 17

1) Promote an active lifestyle through inc participation of domestic, occupational, and recreational activities
2) improved functional capacity
3) Lowered cardiovascular risk factors
4) Improve symptoms/physiological responses to physical challenges
5) Modification of unhealthy behaviors/psychosocial characteristics
6) Improve pt understanding of safety issues during exercise