Cardiac Rehab Flashcards
Effects of cardiac rehab
- reduces body weight
- unloads the heart
- improves cardiac function
- (maybe) changes in lifestyle
- modifies RF
Cardiac Rehab Phase I:
acute/inpatient
immediately upon becoming medically stable
monitored
Cardiac Rehab Phase II:
subacute/rehab/conditioning
immediately upon d/c
monitored
Cardiac Rehab Phase III:
training or intensive rehab
outpatient
Cardiac Rehab Phase IV:
maintenance
Phase I initial assessment
- Hx
- family interview
- physical exam
- quality of ADLs
- ROM, Strength, Gait
- sternal precautions
phase I physical exam:
- BP
- HR
- auscultation
- neuropathy
- edema
- JVD
- skin color
- wound care
Phase I exercise tolerance
- monitored BP 3-5 min
- pt slowly walked by therapist 25-50 ft w/rest break
- if no unusual HR, BP, or EKG then walk is repeated and lengthened according to subjective feelings, HR, BP, and EKG
- activity progressed as long as patient tolerates exercise
Phase I treatment
- start slow
- use short duration multiple times per day
- warm up and cool down
- <120 BPM
OR - 20-30 BPM increase
Phase I: when to stop treatment
- unusual HR increase
- . inappropriate BP response
- SP > 210
- DP >110
- 10 mmHg or more drop in DP w/exercise
- presence of symptoms
Common symptoms in Phase I cardiac rehab that signal to stop treatment
- angina
- dyspnea
- excessive fatigue
- mental confusion/
5/ dizziness - excessive fatigue
- pallor
- cyanosis
- cold sweat
- EKG abnormalities
- Arrhythmias
Phase I goals
- initiate return to independence w/ADLs
- counteract deleterious effects of bed rest
- provide med surveillance during ADLs
- provide pt/family edu about disease process, CV monitoring, CPR, exertional intolerance, energy conservation
Activities to consider for Phase I
- self care
- arm and leg AROM
- very light weights
- independent transfers
- bedside sitting to ambulation to stairs
Amount of METs by D/C of cardiac rehab phase I
3-5 METs
Phase II goals
- improved exercise tolerance
- pt edu
- RF reduction/secondary prevention
- Return to work
- promote psychological, behavioral, and edu improvement
- 9-10 METs
Phase II exercise plan
- individualized
- fraction of HRR:
HRmax = 207 ((.7)age)
Phase II establishing intensity
keep HR below levels that
- elicit symptoms
- cause dyspnea
- elicit plateauing or decreasing SBP
- elicit EKG abnormalities
- elicit arrhythmias of >6/min
Phase II endurance training zone RPEs
11-13
Phase II strength training zone RPEs
15-17
Phase II abnormal response to exercise
- SBP 240
- DBP > 110
- Systolic hypotension
- > 20 BPM drop
- unusual HR response
- signs and sympoms
- ECG abnormalities
Phase II resistance training
- begin 5 weeks post MI, 8 weeks post CABG, 2 weeks post PCTA
- 30-50% of !RM
- 8-10 reps 2-3x/wk with day of rest between
- large muscle groups
- control weights
- breathe/exhale during effort
- RPE 11-13
- 10-12 reps/1-2 sets
- 2-3 x / week
- smooth, controlled, full ROM
- balance exercise between muscle groups
- core str
- avoid gripping handles tightly
Phase II components
- flexibility
- warm up/cool down
- 4 vs 2 extremity exercise
- frequency (2-3/week)
- duration (20 min up to 60 min)
Phase III
- 3-6 months post event
- HEP
- Community exercise programs
- may or may not be seen 1/week
- No ECG monitoring
- Self monitoring
Phase III goals
- achieve 50-80% of HRR on treadmill test
- 3-4 sessions/week
- > 45 min per session
Cardiac Rehab Phase IV
- HEP
- Self Monitoring
- Environmental concerns
- Adherence
Exercise after cardiac stenting
- avoid vigorous exercise and heavy lifting short period post procedure
- consult physician
- cardiac rehab
