8) Exercise Guidelines (Cardiac Rehab) Flashcards
Cardiac Rehab
Enables pt’s to resume active & productive luves w/in imposed limitations
What are the goals of cardiac rehab?
- Restore optimal physiological, & vocational status
- Alleviate sx’s
- Prevents progression of disease
- Reduce risks of SD & reinfarct
What pt’s are candidates for cardiac rehab?
- MI
- CABG
- PTCA/Stents
- Valve Replacement
- Heart/Lung Transplant
- Stable Angina
- Silent Ischemia
- High Risk for CHD
- Congenital heart defect correction
- CHF
- Arrythmias
- PAD
- 2° & 3° prevention
What does cardiac rehab consist of?
- Exercise Therapy
- Risk Factor Management
- Psychological changes
- Behavioral Changes
- Lifestyle Changes
- Education
What can a pt do if they can climb 2 flights of stairs?
Have sex w/their normal partner
What does phase 1 rehab involve?
Low-level fxnl activities such as PROM, AROM, & amb
Phase 1 Rehab
In-pt lasting about 3 days (until d/c) to counteract the deleterious physiological effects of bed rest & prevent a “cardiac cripple” from emerging
What needs to be evaluated in phase 1 rehab?
- Contraindications
* MD Clearance
Frequency of phase 1 cardiac rehab
5-7days/wk, 15min bid
Intensity of phase 1 cardiac rehab
20 BAR for MI; 30BAR for CABG
What is the pt told to do when they get home from phase 1 cardiac rehab?
To walk
Phase 2 Cardiac Rehab
Out-pt phase focused on incr pt’s fxnl & CV efficiency; Lasts about 3 months
What is used to eval a pt in phase 2 cardiac rehab?
- Cardiac stress test
- Lab studies
- PFT if pt has pulmonary involvement
- Repeat stress test at end
Frequency of phase 2 cardiac rehab
- 3-5x/wk of 20-45min of aerobic activity
* Evening walks are encouraged
What is the intensity of phase 2 cardiac rehab?
- 50-70% of karvonen HR–>Incr monthly by 5% to a max of 80%
* BORG
Exercise prescription implications for phase 2 cardiac rehab
Intermittent Training
*Warm-up for 5min w/low level amb
*Rest for <1min in between devices
*Alternate leg & arm exercises
*Resistance training implications for phase 2 cardiac rehab
- Wait until 5wks post-MI or CABG; Pt should be supervised for at least 4wks
- Wait until 3wks post-PTCA & other procedures; Pt should be supervised for at least 2wks
- No evidence of problems w/CHF, severe valve disease, uncontrolled HTN, or unstable sx’s
Phase 3 Cardiac Rehab
Supervised phase lasting 4-6wks to decr supervision of exercise program & to promote self-regulation of the program
How are pt’s monitored during phase 3 cardiac rehab?
HR
Intensity of phase 3 cardiac rehab
70-80% of Karvonen HR
Phase 4 Cardiac Rehab
Unsupervised phase lasting forever to maintain lifestyle changes acquired in cardiac rehab
What are the benefits of exercise?
*
What measures are used to monitor a pt’s progress?
- VO2max
- Lipid profile
- Vitals
- ECG Changes
- THR
- Psychosocial
- Alcohol
- Daily ECG, RGR, RBP, peak BP, & adverse rxn’s
- Duration, intensity, & adjusted work load
Why are stress tests done?
- Determine max capacity for physical work
- Detect/confirm ischemic heart disease in apparently healthy pt’s
- Assess pt’s w/cardiac pathologies
- Exercise prescription
What is important to know about a pt’s status?
- Hyperventilation prior to the test
- Resting vitals
- ECG Changes
- BP response
- HR max prior to any sx’s
- Meds
- MHx
- Length of test
- Reason for termination
Considerations for cardiac rehab
- UBE makes BP spike
- Aquatic Therapy–>Temperature indications but generally not good to do
- Sternal pxns–>Don’t pick up >5lbs & no driving
- DM
