Cardio Rehab Flashcards
S3Q1
CARDIAC REHAB:
primary prevention - what, who, how/purpose (2)
secondary - who, how/purpose
components of rehab (3)
goals of rehab (5)
primary prevention
- screening
- for clients
- prevention, individual behavior change
secondary prevention
- for patients
- intervention
components of rehab
- pt educ, risk modification, exercise training
goals of rehab
- overall function not just cardio
- atherosclerosis restore blood flow
- lipid, obesity, adult-onset DM
CARDIAC REHAB:
candidates for secondary intervention (7), primary (2)
secondary
- Htn
- angina
- CVD, pulmonary diseases, non-ischemic diseases
- surgery
- arrythmia
- PVD
- elderly c conditions
primary
- healthy c risk factor
- elderly
CARDIAC REHAB:
duration of warm up, cool down, conditioning
what happens if no warm up + conditioning acute progression chronic + IP acute
- warm up & cool down: 5-10 mins
- conditioning: 20-60 mins
if no warm up
- sudden inc in VS
- acute: lower limit of grey
- progression: middle grey
- chronic: upper limit
- IP acute: white below grey
CARDIAC REHAB:
calisthenics - how (2), for (2)
endurance exercises table - exercise, for, examples (4.3.2.3)
CALISTHENICS
- gross, large general movements
- for flexibility & endurance
ENDURANCE EXERCISES
endurance (minimal skill)
- adults
- walk, cycle, aerobic water, slow dance
vigorous endurance
- physically active
- run, aerobics, fast dance
endurance requiring skill
- adults c skill
- swimming, skating
recreational
- adults c regular exercise
- basketball, soccer, hiking
CARDIAC REHAB:
frequency - vs. intensity & duration, IP vs. OP + METS (2)
progression - which parameter first, progress x if (1) + sx (2), progress x if (3)
FREQUENCY
- IVP intensity & duration
- IP & <5 METS = bid
- OP & >5 METS = 3-5x/wk
PROGRESSION
- duration first
- if no ischemia sign (angina, cyanosis) = inc intensity
- RPE 9 + normal BP + HR<THR = inc intensity
CARDIAC REHAB: Intensity
HR method - formula, if beta + formula
O consumption - what, how, HRmax equivalent
HRmax - formula, goal for healthy vs. cardiac pt
HRreserve - formula, goal for healthy vs. cardiac pt, when
THR - goal for healthy vs. athlete vs. cardiac pt
which most ideal
HR method
- karvonen’s formula
- beta blocker = training SBP = %(SBPmax - SBPrest) + SBPrest
O consumption method
- determine VO2max using gas analysis
- 60-70% VO2max = HRmax
HRmax
- 220-age
- healthy: 60-80% of HRmax, cardiac: 40-60%
HRreserve (HRR)
- HRmax-HRrest
- healthy: 60-80% of HRmax, cardiac: 40-60%
THR
- healthy: 60-80% of HRR + HRrest
- athlete: 80-95%
- cardiac: 40-60%
CARDIAC REHAB: Intensity
METs - what, equivalent to O, goal if cardiac pt, activities (7)
- amount of oxygen consumed for activity
- 1 MET = 3.5 O/kg of BW/min
- if cardiac pt: 50-60%
- lying quietly: 1
- sitting at ease: 1.2-1.6
- sitting writing: 1.9-2.2
- stand: 1.4-2.0
- walk 1mph: 2.3
- light housework: 1.7-3.0
- heavy housework: 3.0-6.0
CARDIAC REHAB:
4 phases
- IP
- early post-op, intensive monitor
- late recovery, training
- long-term maintenance
CARDIAC REHAB: Phase I
duration + if MI, goals (2), contraindications (7)
guidelines - METs initial & end goal, F (frequency & days), I (2 positions) (1.3), T (warm up & ratio), type (1)
- 7-14 days
- mild MI/heart attack: 2-3d
- goals: bed rest effects, referral
contraindications
- severe pump fail, 2-3 degree heart block
- arrythmia, angina at rest, unstable angina <24h ago
- hypotension (<90) even c vasopressors
- rapid atrial rhythm
guidelines
- 2-3 METs –> 5 METs by discharge
- F: 2-4x/day during first 3 days
- I: sitting or standing; if MI = HRrest + 20bpm; if heart surgery = HRrest + 30 bpm; stay in <120bpm & RPE13
- T: 3-5 mins walking, 2:1 exercise:rest
- type: walking
CARDIAC REHAB: Phase I
cardiac ICU case - (1=1)
exercise terminate if - SBP, DBP, SaO2, (3+2)
cardiac ICU
- regain conscious = AAROM
terminate if
- SBP dec >10mmHg (should inc during exercise)
- DBP >110mmHg
- SaO2: <85%
- angina, arrythmia, heart block, dyspnea, ECG revealing ischemia
CARDIAC REHAB: Phase I
PCTA - how (1=1=1=1), exercise when
CABG - how, precautions (1) (3 + duration), graft sites (2)
CHF - classes (4) + METs + tx (0.0.1.2)
CORONARY ANGIOPLASTY
- insert & inflate balloon = push atherosclerotic plaque to side = widen lumen = blood flow
- exercise 2 wks p surgery
CABG
- median stenotomy
- keep elevation <90, avoid lift push pull 4-6w
- radial vessel graft = forearm, saphenous = thigh
CHF
- class I: mild, slight limit (<6.5 METs)
- class II: slight limit (<4.5 METs)
- class III: marked limit (<3.0 METs)
- class IV: unable
- tx: 1-3 = active, 4 = passive & GBRE
CARDIAC REHAB: Phase I
DM - hypo vs. hyper + what to do (1.2), sx (0.3)
hyperlipidemia - CAD vs. non-CAD pt
DM
- if fasting blood glucose >250 mg/dL = stop exercise
- if FBG <100 (hypoglycemia) = stop, carbs, resume when stable
- sx of hypoglycemia: weak, irritant, confused
HYPERLIPIDEMIA
- CAD pt = non-pharma mx (PT) when LDL-C >100
- non-CAD = when LDL-C >160
CARDIAC REHAB: Phase II
duration, goal (3), ADL METs + exit METs
strength training - when if cardiac rehab + MI + CABG, weight, reps
F, I (RPE & threshold), T (warm & proper), T (1)
- 2-12 weeks
- goal: cardiovascular fitness, lifestyle, return
- METs: 5 (ADL), 9 (exit)
strength training
- cardiac rehab: after 3 wks
- MI: after 5 wks
- CABG: after 8 wks
- 1-3lbs, 12-15 reps
guidelines
- F: at least 3x/wk
- I: RPE 11-16, before ischemic threshold
- T: 5-10 mins warm up, 20-60 mins
- T: aerobics
CARDIAC REHAB: Phase III
duration, monitor via, goal (1)
ETT - when (2), purpose
F, I (RPE), T (duration), T (2)
consider (4)
- 4-6m
- monitor via ECG only
- goal: fun & recreation
exercise tolerance test
- before discharge, done at 6th month
- to test body changes
guidelines
- F: 3-5x/wk
- I: RPE 12-14
- T: 20-45 mins
- T: aerobics, resistive
considerations
- pt’s work & environment
- involve large muscles
- balance aerobics & resistance
CARDIAC REHAB: Phase IV
what/duration, goal (1=1), monitor via
- lifetime exercises
- goal: 1000 kcal/wk = 20 mins walk daily
- monitor: annual ETT
