L9: Cardiac Rehabilitation Flashcards
(39 cards)
1
Q
What is 3 cardiac diseases?
A
2
Q
What are 8 conditions commonly seen in cardiac rehabilitation?
A
3
Q
What are 6 characteristics of CVD in Australia?
A
- Heart disease is the leading single cause of death of men and women in Australia
- 1 in 5 Australian adults have CVD
- Increased incidence with increasing age
- More common in men than women
- In 2015-2016, >1.1 million hospitalisations were due to CVD
- 18% men and 35% women will have a second MI within 5 yrs of the first
4
Q
What is CVD in Australia?
A
- Indigenous Australians have twice as many hospitalisations and twice the mortality rate compared to non indigenous Australians
- CVD is almost twice as prevalent in people in regional centres compared to those in metropolitan centres
5
Q
What are 2 types of cardiovascular risk factors?
A
- Non modifiable
- Modifiable
6
Q
What are 2 non-modifiable cardiovascular risk factors?
A
- Male gender
- Family history
- Age >45yrs
7
Q
What are 8 modifiable cardiovascular risk factors?
A
- Physical inactivity
- High BP
- High cholesterol
- Obesity
- Smoking
- Diabetes
- Poor diet
- Depression
8
Q
What are 6 problems of modifiable cardiovascular risk factors?
A
9
Q
What are 5 components of cardiac rehabilitation?
A
- Support (What their fears and concerns are?)
- Education (What they can do to change their lifestyle to decrease the risk factors of CVD?)
- Risk factor management
- Smoking cessation
- Alcohol reduction
- Diet
- Exercise and physical activity
- Encourage weight loss
- Cholesterol monitoring
- Psychosocial health (Depression and anxiety)
- Medical management, symptom monitoring, medication management
10
Q
What are the roles of the team in cardiac rehabilitation?
A
11
Q
What are the 4 phases of cardiac rehabilitation?
A
12
Q
What are the 2 models of delivery for cardiac rehabilitation?
A
13
Q
What are the 4 benefits of cardiac rehabilitation?
A
- Decreases hospitalisations
- Improves QoL
- No impact on mortality
- Centre-based and homebased approaches equally effective
14
Q
What are the 9 benefits of exercise training in cardiac rehabilitation?
A
- Improves exercise capacity
- Decreases low density lipoprotein cholesterol (LDL) levels
- Increases high density lipoprotein cholesterol (HDL) levels
- Decreases serum triglyceride levels
- Decreases BP
- Decreases body weight
- Improves insulin sensitivity
- Improves blood glucose levels
- Improves mood
15
Q
What is the physiotherapist’s role in cardiac rehabilitation?
A
Not just about being functional, but rather a physiological change as well.
16
Q
What are the 3 initial assessments in the cardiac rehabilitation?
A
17
Q
What are 3 “1. determining risks” in cardiac rehabiltation?
A
18
Q
What are 12 characteristics of high risk in “1. determining risks” in cardiac rehabiltation?
A
- Ejection fraction < 30% without an ICD
- Untreated coronary lesion > 70% on angiography
- History of cardiac arrest
- Complex arrhythmias at rest or exercise
- Complicated MI or revascularisation procedure
- NYHA classification functional class III-IV symptoms
- Congestive HF requiring hospitalisation in the past 2 months
- Unstable or exercise-induced angina in the past 2 months
- Non-cardiac vascular events in the past 2 months
- Complex congenital heart disease associated with oxygen desaturation at rest or during exercise
- Silent ischaemia (electrocardiogram (ECG) changes during exercise testing in the absence of symptoms)
- Advanced renal failure
19
Q
What are characteristics of “2. Gather information to assist with exercise prescription” in cardiac rehabiltation?
A
20
Q
What are characteristics of “3. Provide baseline data” in cardiac rehabiltation?
A
21
Q
What are 11 characteristics of assessments in the clinical history for cardiac rehabilitation?
A
- Principal diagnosis
- Past and current symptoms
- Relevant investigations
- Modifiable cardiovascular risk factors
- Prescribed medications
- Co-morbidities and other pertinent medical history (eg DM, sleep apnoea)
- Exercise habits past and present, including lifestyle physical activity
- Personal exercise preferences
- Barriers to exercise (time, anxiety level, depression, orthopaedic limitations, personal safety concerns, financial constraints, geography)
- Enablers to exercise (things that make it easier to exercise or overcome barriers)
- Social issues (family support, socioeconomics, transport)
22
Q
What are 7 characteristics of assessments of objective measures for cardiac rehabilitation?
A
- Weight, BMI, HR, BP, SpO2
- Musculoskeletal limitations
- waist : hip ratio
- Measure of exercise capacity (6MWT, ISWT)
- Measure of strength (Grip strength)
- Measure of quality of life (AQOL, MLWHFQ)
- Other tests as relevant (Eg, BGL, TUG, walk speed)
Eg. resting HR = 120 bpm
Would you exercise the patient?
- No -> heart working too heart or low blood pressure
23
Q
What are 6 general principles of exercise training for cardiac rehabilitation?
A
- FITT principle
- Warm up (Prevent arrhythmia) + cool down (Prevent excessive vasodilation)
- *Endurance training (Most important exercise training)
- Resistance training
- +/- Balance training (Eg. elderly population)
- +/- Respiratory muscle training
If risk of ischaemia → reduce intensity and duration & physiological demand.
24
Q
What are 6 general principles of exercise training for cardiac rehabilitation?
A
25
What are 3 characteristics of frequency of exercise training for cardiac rehabilitation?
1. Exercise should be 3-5 x per week however x2/wk sufficient to maintain functional gains during maintenance phase
2. Attend centre programme x2 per week
3. Progress to 30 mins exercise most days of the week (aim for 150 mod intensity exercise/ wk)
***Note: frequency, duration and intensity all inter-connected -\> dose response is important***
26
What are 4 characteristics of time (duration) of exercise training for cardiac rehabilitation?
1. Usually 6 wks CR (Cardiac rehab) and 12 wks HF (Heart failure) rehab
2. Typically 1hr per session
3. Longer duration programmes associated with improved outcomes however sometimes poorer adherence
4. Need at least 6mths for improvements in ventricular remodelling (patients drop out)
***Note: frequency, duration and intensity all inter-connected -\> dose response is important***
27
What are 6 characteristics of exercise intensity of exercise training for cardiac rehabilitation?
1. Start conservatively and determine response to exercise
2. Individualise to patient’s functional level
3. Note: can’t rely on HR response for those on beta blockers
4. 9-14 on Borg scale (11-14 for those with lower risk profile)
5. Keep HR at least 5-10 beats below angina threshold
6. Higher intensities (up to 80% VO2 peak) may be trialled in some patients but in hospital settings only
28
What are 3 exercise limitations of exercise training for cardiac rehabilitation?
29
What are heart failure exercise limitations of exercise training for cardiac rehabilitation?
30
What are endurance training (exercise time) of exercise training for cardiac rehabilitation?
31
What is high intensity intervla training?
32
What is comboned endurance + resistance training for cardiac rehabilitation?
* Greater gains with addition of resistance training to aerobic exercise for patients with HF.
* Predominant component of programme should be endurance exercise
33
What are the 6 characteristics of resistance training for cardiac rehabilitation? What are 3 aims that should be changed?
1. ↑ exercise capacity (small changes)
2. ↑ local muscle strength
3. ↑ muscular endurance
4. Improved outcomes with aerobic + resistance training compared with either one alone
5. Particularly important in older people where sarcopenia evident
6. In frail individuals, may need to start with resistance training in order to being able to do endurance work
**Endurance training**
1. Aim for muscle endurance rather than hypertrophy (Ie low loads and high reps- ~25 reps (high reps, low load))
2. Avoid isometrics
3. Avoid valsalva
~25 reps (high reps, low load)
34
What are 6 exercise types of cardiac rehabilitation?
1. UL and LL endurance exercise
2. UL and LL resistance training
3. Choice of exercise is dependent upon patient’s co-morbidities. Generally choose large, functional muscle groups
4. Ensure good core stability during exercise performance
5. Ensure good breathing technique (Esp. HF patients)
6. Balance activities where relevant
Patients with COPD --\> poor core stability/control --\> common back pain (due to poor function of diaphragm and weak pelvic floor muscles)
35
What are 2 special considerations of cardiac rehabilitation?
1. Impact of PPMs and ICDs
2. Post surgical patients
36
What are 3 impacts of PPMs and ICDS of cardiac rehabilitation?
PPMs: pacemakers
ICDS: implantable cardioverter defibrillator
1. No elevation of arm above shoulder height for 6 weeks
2. No limitation to exercise however consider settings of devicem (ie exercise below threshold settings)
3. Avoid EMR (eg impedance scales etc
37
What are 4 characteristics of post surgical patients of cardiac rehabilitation? What are 4 actions to avoid?
1. Commence walking programme whilst in hospital
2. Commence cardiac rehab usually after 4 weeks (Aim for 30mins of walking)
3. Check stability of sternum
4. If unstable, avoid:
1. Unloaded shoulder extension
2. Bilateral resistance work that includes extension, abduction, retraction movements
3. Unilateral resistance training --\> increase pressure of sternum
4. Trunk rotation
38
What are 4 actions to avoid in post surgical patients for cardiac rehabilitation?
1. Unloaded shoulder extension
2. Bilateral resistance work that includes extension, abduction, retraction movements
3. Unilateral resistance training --\> increase pressure of sternum
4. Trunk rotation
39
What are 7 safety considerations for cardiac rehabilitation?
1. Class sizes – staff : patient ratios
* No specific
* 1:5 (staff: patient)
2. Medication changes & impact on symptoms and exercise performance
* Low doses (bet-blockers) --\> increase medication dosage
3. Change in clinical status
4. Monitoring during the exercise session
5. Ambient temperature and thermoregulation considerations
* Less blood --\> cannot shunt blood ???
6. Impact of illness/ viruses
* As heart works harder --\> need to rest/ reduce --\> start ack to normal
7. Exercising with oxygen
* Eg. drop in blood pressure --\> abnormal (but might be order of exercise activities)
* Do not do this if you have HF --\> can get very dizzy
