Cardiac Rehabilitation Flashcards
(15 cards)
What are the core components of cardiac rehab?
- Health behaviour change
- Lifestyle risk factor management
- Physical activity
- Healthy eating and body composition
- Tobacco cessation
- Psychosocial health
- Medical risk management (BP, chol, meds etc)
- Long term strategies
- Audit and evaluation
What is the definition of cardiac rehab?
The coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease
What is the target population for cardiac rehab?
- Coronary heart disease
- Individuals with new onset or worsening exertional angina
- Acute coronary syndromes (MIs and unstable angina)
- Before and after revascularisation - percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG)
- Other cardiac surgery (valve, aortic dissection)
- Stable heart failure and cardiomyopathy
- Stable heart failure and cardiomyopathy
- Following arrhythmias and implantable device interventions (i.e. implantable cardioverter defibrillator, permanent pacemaker, cardiac resynchronisation therapy
- Other specialised interventions (e.g.: cardiac transplantation and ventricular assist devices)
- Other atherosclerotic disease (e.g.: peripheral arterial disease)
- Congenital heart disease
- Those at high multi-factorial risk of CVD
-Metabolic syndrome (hypertension/diabetes/obesity).
What are the benefits of exercise for cardiac patients?
Reductions in:
- All cause mortality (by 11-26%)
- Cardiac mortality (by 26-36%)
- Unplanned hospital admissions (by 28-56%)
Improved:
- QOL
- Functional capacity
- Early return to work
- Development of self-management
What are contraindications to exercise in cardiac rehab?
- Unstable angina
- Uncontrolled hypertension (Resting systolic blood pressure (SBP) >180mmHg, or resting diastolic blood pressure (BP) (DBP) >110mmHg)
- Orthostatic blood pressure drop of >20 mmHg with symptoms
- Significant aortic stenosis (aortic valve area <1.0 cm2)
- Acute systemic illness or fever
- Uncontrolled atrial or ventricular arrhythmias
- Uncontrolled sinus tachycardia (HR>120 bpm)
- Acute pericarditis or myocarditis
- Uncompensated HF
- Third degree (complete) atrioventricular (AV) block without pacemaker
- Recent embolism
- Acute thrombophlebitis
- Resting ST segment displacement (>2 mm)
- Uncontrolled diabetes mellitus
- Severe orthopaedic conditions that would prohibit exercise
- Other metabolic conditions, such as acute thyroiditis, hypokalaemia, hyperkalaemia or hypovolaemia (until adequately treated)
- Severe grade 3 rejection (cardiac transplantation recipients)
What risk levels are patients categorised into based on signs, symptoms and baseline presentation?
- Lower risk
- Moderate risk
- High risk
What are some physical measurement tools for cardiac rehab?
- 6 Minute Walk Test (6MWT)
- Chester Step Test (CST)
- Shuffle Walk Test (SWT)
What are some psychosocial measurement tools for cardiac rehab?
- HADS
- Dartmouth COOP
What should be included in the exercise component?
- Warm up (15mins)
- Conditioning phase (should be designed to produce a training effect, achieved by setting and progressing the appropriate frequency, duration, intensity and mode of exercise)
cool down component (10-15mins)
Throughout the structured exercise session, attention should be paid to:
- Breathing pattern
- Posture and positioning
- Types of movement that would prevent hypotension, instability and falls.
How do you monitor heart rate response during exercise in cardiac rehab?
- HR monitor
- Pulse oximetry during CV exercise
Why do you monitor heart rate response during exercise in cardiac rehab?
- Individuals should work within their pre-determined THR range during CV exercises (calculated using HR max)
- A post-cool down HR should be taken to ensure that the individual has returned to their pre-exercise state
- In certain situations, medication or clinical status may influence the effectiveness of using HR as a monitoring tool for example arrhythmias, HR control medication or with cardiac transplant recipients.
How do you increase the reliability, validity and effectiveness of respiratory protective equipment (RPE)?
- Keep the chart in view at all times
- Rate exertion during a CV activity
-Focus on the verbal statements rather than a number - In order to avoid individuals just giving the rating the practitioner asks for, initially do not tell individuals which level you want them to achieve. Simply guide their intensity of exertion to a level which elicits the appropriate RPE. With practice the individual will then realise the appropriate target levels (this may take up to 3 or 4 sessions)
How do you measure respiratory protective equipment (RPE)?
- BORG RPE (6 - 20 scale).
OR - CR10 Scale.
When educating individuals about how to rate their exertion they should consider ‘anchoring to known exertions’ and using total body feelings such as strain and fatigue in the muscles or breathlessness.
Describe the circuit design.
- It combines ‘cardiovascular exercises’ and ‘active recovery’
- Circuit can be adapted to a seat based option
- Encourage regular review of RPE throughout
- CV- using a range of large muscles and ‘aerobic’
- Active recovery- lower intensity incorporating resistance/strength work (standing or seated)
What must be done at the end of the programme?
- Reassessed to compare since initial assessment
- Advice and encouragement to continue regular exercise
- Discuss exercise referral options
- Inform GP
- Complete referral forms
