Cardiac Rehab Flashcards
Average length of hospital stay for uncomplicated MI
3-5 days
Phase 1- exercise/activity goals and outcomes
- initiate early return to independence; typically after 24hrs or until pt is stable for 24 hours; monitor tolerance
- counteract deleterious effects of bed rest
- help allay anxiety and depression
- provide additional medical surveillance of pts
- provide pt and family ed
- promote risk factor modification
Phase 1- Program components
- ADLs
- selected arm and leg exercises, early supervised ambulation
initial activities in phase 1
low intensity (2-3 METs); progressing to > 5 METs by discharge
post MI activity guidelines
limited to 70% HRmax and/or 5 METs until 6 weeks post MI
Phase 1 duration
short exercise session, two to three times a day
- gradually duration is lengthened and frequency is decreased
Phase 1 post surgical pt guidelines
- typically are progressed more rapidly than post-MI; unless was a peri-op MI
- lifting activities are restricted generally for 6 weeks
patient and family education goals for phase 1
- improve understanding of cardiac disease, support risk factor modification
- teach self-monitoring procedures, warning signs of exertional intolerance
- teach concepts of energy costs, fatigue monitoring, general activity guidelines, activity pacing, energy conservation techniques, HEP
- provide emotional support and assist with referral to social work as needed
Who may benefit from HEP during phase 1
low risk patients
phase 1 - unsupervised HEP for low risk patients
gradual increase in ambulation time: goal of 20-30 mins, 1-2 times per day at 4-6 weeks post-MI
Phase 1 - elderly homebound patient HEP
this population may benefit from a home cardiac rehab program
in order for patients in phase 1 to do HEP, what should they be?
- skilled in self-monitoring procedures
- recommend family training in CPR and AED; emergency lifeline for some patients
eligible patients for phase 2 cardiac rehab
- MI/acute coronary syndrome
- CABG
- PCI
- stable angina
- hear valve surgical repair or replacement
- heart or heart/lung transplantation
- heart failure
- PAD may not be covered by insurance but this population would benefit from supervised exercise program
Exercise goals for phase 2
- improve functional capacity
- progress toward full resumption of activities of daily living, habitual and occupational activities
- promote risk factor modification, counseling as to lifestyle changes
- encourage activity pacing, energy conservation; stress importance of taking proper rest periods
who benefits from an outpatient phase 2 cardiac rehab?
pts at risk for arrhythmias with exercise, angina, other medical problems
- due to the availability of ECG monitoring, trained personnel, and emergency support
what can help in risk factor modification and lifestyle changes during phase 2 of cardiac rehab?
group camaraderie and support of program participants
phase 2 frequency
2-3 sessions/wk
phase 2 duration of sessions
30-60 mins with 5-10 mins of warm up and cool down
modes of training in phase 2
programs may offer a single mode of training or multiple modes using a circuit training approach; also includes strength training
suggested exit point of phase 2
9 MET functional capacity
(5 MET capacity is needed for safe resumption of most daily activities)
during phase 2, when can you begin strength training
- after 3 weeks of cardiac rehab
OR - 5 weeks post-MI or 8 weeks post-CABG
progression of strength training in phase 2
- begin with elastic bands and light hand weights (1-3lbs)
- progress to moderate loads; 12-15 comfortable repetitions
what is phase 3 of cardiac rehab
community exercise programs (postacute, post discharge from phase 2)
exercise goals and outcomes from phase 3
- improve and/or maintain functional capacity
- promote self-regulation of exercise programs
- promote lifelong commitment to risk factor modification
location of phase 3
- community centers
- YMCA
- clinical facilities
entry level criteria for phase 3
- functional capacity of 5 METS
- clinically stable angina
- medially controlled arrhythmias during exercise what
is the progression of phase 3
- from supervised to self-regulation of exercise
- to 50-80% of functional capacity
- 3-4 times/wk
- 45 mins or more/session
what is required during phase 3
regular medical check ups and periodic GXT
when is discharge from phase 3
typically in 6-12 months
goals of resistance training
- improve muscle strength and endurance
- enhance functional independence
- decrease cardiac demands during daily activities
patient criteria for resistance training post-MI
permitted if remain under 70% HRmax or 5 METs for 6 weeks post MI
- be cautious of valsalva
criteria for resistance training post cardiac surgery
- LE resistance training can be initiated immediately, in the absence of peri-op MI
- UE training should be avoided until soft tissue and bony healing has occurred: 6-8 weeks
criteria for resistance training post-transcatheter procedure
minimum of 3 weeks following procedure and 2 weeks of consistent participation in a supervised cardiac rehab insurance training program
exercise prescription for resistance training
- start with low resistance (1 set of 10-15 reps); progress slowly
- resistance can include: weights (50% or more of 1RM), elastic bands, light cuff and hand weights, wall pulleys
- RPE should range from 11-13
- RPP should not exceed that prescribed during endurance exercise
