Exam 2 Flashcards
exercise testing (27 cards)
cardiac rehabilitation is multidisciplinary and involves
Education
Structured, progressive physical activity
Lifestyle modification
Vocational counseling
cardiac rehab candidacy
Post myocardial infarction within a year
Post CABG
Post percutaneous coronary intervention (stent)
Post heart valve surgery
Post heart or heart/lung transplantation
Chronic stable angina
Compensated heart failure EF <35% —Must be 6 weeks s/p hospitalization
who is not a candidate for cardiac rehab
Unstable angina
Hemodynamic instability — SP> 200, DP > 100, orthostatic fall > 20 mmHg
Serious arrhythmias
Conduction abnormalities (20 and 30 blocks)
Active infections
Uncontrolled diabetes
Resting ST segment depression
research benefits of cardiac rehab
Early, progressive rehabilitation intervention results in greater improvements in physical function than usual care.
phase 1 cardiac rehab
Acute phase/inpatient
Starts immediately upon the patient becoming medically/hemodynamically stable
ECG monitored
phase 2 cardiac rehab
Subacute/rehabilitation/conditioning phase (Also called outpatient cardiac rehab sometimes)
Begins Immediately or shortly after discharge from the hospital
ECG Monitored for at least a part of this phase
Insurance covers 36 sessions or 72 if intensive
phase 3 cardiac rehab
Training or intensive Rehabilitation
Rarely monitored or supervised
Outpatient (Traditional outpatient PT)
phase 4 cardiac rehab
Maintenance
Equivalent of a fitness facility membership
No monitoring and no staff oversight
exercise tolerance in phase 1
Monitor BP 3-5 min/is patient hemodynamically stable?
Patient is mobilized with therapist
If no unusual HR, BP or EKG readings were seen, then the walk is repeated and over time lengthened according to the patient’s subjective feelings as well as the HR, BP and EKG responses.
Activity is progressed as long as the patient tolerates the exercise (remains hemodynamically stable).
treatment in phase 1
Start slowly
Use short duration sessions, multiple times per day
(often educating nursing staff/family)
Warm up/cool down
Intensity— < 120 BPM or < 20-30 BPM increase during exertion
when to stop treatment
presence of:
Angina
DBP>110mm Hg
Drop in SBP >10 mmHg with increasing workload
Inappropriate dyspnea
Excessive fatigue
Mental confusion or dizziness
Excessive fatigue
Pallor, cyanosis, diaphoresis
EKG abnormalities
Patient choice
goals in phase 1
Initiate return to independence in ADLs
Counteract the deleterious effects of bed rest - reduce the risk of a thomboembolic event and developing pneumonia, maintain some muscle tone
Provide medical surveillance during ADL types of activities
GET TO NEXT PLACE
provide patient and family education
activities to consider in phase 1
Self care
Arm and Leg AROM
Very light weights
Independent transfers
Bedside sitting to ambulation to stairs
3-5 METs of activity by discharge
when does phase 2 start
Begins 2-12 weeks after discharge (some hospitals different in requirements)
Exercise test may be implemented to prescribe exercise– but not needed
8-12 weeks in duration and is medically supervised (visit based)
goals of phase 2
Improved exercise tolerance & functionality
Provide patient and family education
Risk factor reduction/secondary prevention strategies
Prepare patient to return To Work
Promote psychological, behavioral and educational improvement
Perform 3-5 METS or 2.0 - 3.0 mph for 30 min
how to establish intensity in phase 2
Use RPE
For older patients, rating scale 1-10 recommended
abnormal response to exercise in phase 2
SBP > 240, DBP > 110
Systolic hypotension, > 20 BPM drop during activity
Unusual heart rate response
Symptoms
– Anginal response
– Undue dyspnea (sudden and severe– think PE)
– Excessive fatigue
– Mental confusion/dizziness
– Severe claudication or pain in the leg
– pallor
– cold sweat
– ataxia
– pulmonary rales
resistance training in phase 2
onset and prescription
Onset: 5 weeks post MI, 8 weeks post CABG, 2 weeks post PCTA and stent,
30-50% of 1 rep max
8-10 reps, 2-3 X/wk with a day of rest in between
Large muscle groups= more blood flow needed to oxygenate it
Control weights
Breathe/exhale during effort
what is phase 3 rehab
3-6 months post event
HEP
Community exercise programs
YMCA
Patients may or may not be seen by staff
No ECG monitoring
Self monitoring
Goals
– Achieve 50-80% of HRR on treadmill test (moderate activity)
– 3-4 exercise sessions/week
– >45 min per session
cardiac programs remain less utilized because patients may have
Poor functional status
Higher body mass index
Continued tobacco use
Depression
Long-distance to CR facilities
Low health literacy,
high costs (e.g., copays),
inflexible work schedules
FITT-VP
frequency
intensity
time
type
volume
progression
threshold model
Achieve sufficient physiologic challenge to bring about adaptive changes
what composes an exercise training session
Warm-up/initiation
Conditioning
Cool-down
warm up
A transitional phase that allows the body to adjust to the changing physiologic, biomechanical, and bioenergetic demands of the specific exercise session
The warm-up should include light-to-moderate intensity activities specific to the muscle groups that will be employed during exercise
Warm-ups also improve ROM and may reduce the risk of injury
less than 15 min
