Lecture 11: CV Rehab Management Pt. 1 Flashcards
describe activity tolerance of pts with CV dysfunction and APTA recommendations
poor activity tolerance and physical inactivity = increased risk mortality
decreased walking/standing tolerance; inability to perform ADLs
APTA recommends increased physical activity by increase in total activity, number of steps, and total time out of bed
ASCM/AHA/CDC guidelines for activity
150-300 min/week of moderate intensity aerobic exercise
OR
75-150 min/week vigorous exercise throughout week
moderate intensity strength at least 2 days/week
what does research say about activity tolerance for CV pts
variety of literature on when and how much activity
most research is only on exercise with treadmill/cycle
poor definition of parameters
may have to look at similar but not exact diagnoses
ASCM guidelines for older adults
when older adults cannot do >150 of moderate aerobic activity due to chronic conditions, they should be as physically active as their abilities/conditions allow
perform balance training in addition to aerobic and strength
strength training considerations for pts with CV dysfunction
ACSM/AHA recommends 10-15 reps of RPE 11-13/4-6
slower progression of exercise weights and reps
lower 1RM
decreased resistance tolerance with these pts
limited research on resistance training post op CV pts due to beliefs about sternal precautions
known benefits of strength training
decreased insulin resistance
SVR
BP
CABG ACSM guidelines on resistance training
wait 4-8 weeks
start low weight high reps
12 weeks or more until higher weight is added
PCI/stent ACSM guidelines for resistance training
wait 2-5 weeks
gradual increase in weight
valve repair/replacement resistance training guidelines
wait 4-8 weeks
start with low weight and high reps
MI resistance training guidelines
wait 3-4 weeks
start <30-40% 1RM
HF guidelines on resistance training
wait 3-4 weeks post event
start with 8-10 reps of low weight
gradual increase in resistance based on symptom response
focus on weight for pt to perform high reps
guidelines for addressing ROM limits in pts with CV dysfunction
if pt has prolonged sx precautions they may present with decreased ROM that can affect chest wall movement and posture
pain free ROM beneficial post sternotomy, especially unilateral, to prevent adhesions during healing
things to keep in mind when addressing balance impairments with pts with CV dysfunction
take neuropathy or PVD into consideration; how will it affect balance
implications of cognitive impairments in pts with CVD
1/3 pts with CVD present with some type of cognitive impairment
potential causes:
- hypotension
- alterations in CO affecting cerebral hypo perfusion
- micro emboli
- O2 desaturation
- cardiopulmonary bypass “pump head”
implications = ability to follow instructions for rehab/precautions, med compliance, performing ADLs, and qualification for post acute rehab
% of pts with HF with mild cognitive impairments (MOCA scores 17-25)
74%
interventions for CVD pts with cognitive deficits
family involvement
frequent reorientation
healthy sleep/wake cycle
structured schedule
increased mobility and ADLs
things to keep in mind regarding pain with CV pts
intercostals = highly innervated; pain very common with chest sx
post op lines = irritate parietal pleural
LE vein graft site can be very bruised/swollen
sx positioning can cause neck/shoulder pain
post op pain has major effects on respiratory function
higher pain levels = stimulate SNS
what does SNS activation look like in pts with higher pain levels
decreased peripheral autonomic function (i.e. GI tract)
increased stress hormone release
decreased immune function
barriers to CV rehab
baseline functional capacity, disability, or frailty
poor exercise tolerance
decreased knowledge of condition, poor health literacy
poor medical compliance
frequent hospitalization
QOL, depression
lack of resources or access to resources
implications of HTN meds
more HTN meds pt is on, the more you need to be aware of side effects
context is important
anti-HTN meds lower resting BP but might now have the same effectiveness during exercise or isometric activities
pharm implication of thiazides and loop diuretics
higher risk of hypokalemia
mm cramps/fatigue
ST depression
GI slowing
K-sparing diuretics and BB pharm implications
higher risk of hyperkalemia
mm weakness/paralysis, hypotension, bradycardia, ventricular arrhythmias, ST elevations
only intervention for critically elevated K is emergent dialysis
how much of a reduced exercise capacity do pts with HTN have
15-30% reduction in exercise capacity
watch for exaggerated response to exercise even if on anti-HTN meds
APTA rec for monitoring BP
monitor BP in pts >35 with HTN risk factors in any setting
