cardiac rehab phase 2 - part 2 Flashcards
1
Q
Risk Stratification for Exercise
- HIGHER Levels of Exercise
A
• LVEF >50% • No symptoms of cardiac failure • No ongoing ischemia • No resting or complex arrhythmias • Normal haemodynamics during exercise test and recovery • Functional capacity ≥ 7 METs • Inferior STEMI • NSTEMI or Subendocardial • Low levels of cardiac enzymes post AMI: o Troponin > 0.1 < 2.0micrograms/L o MB < 5micrograms/L o CK (total) – 170 micrograms/L RI < 5
2
Q
Risk Stratification for Exercise
- LOWER Levels of Exercise
A
• LVEF < 49% • Some degree of cardiac failure post AMI, now controlled • Angina at high levels of exercise • Area – anterolateral • STEMI • Co-morbidities • Pre-AMI fitness • Moderate to high levels of enzymes post MI: o Troponin > 2.0micrograms/L o MB > 12micrograms/L o CK (total) > 240micrograms/L RI > 6
3
Q
MET
3 - 6
A
Moderate-intensity
- Walking 3-4.5 km/h
- Dancing
- Tennis doubles
- Light housework, -scrubbing
4
Q
MET
> 6 METs
A
Vigorous-intensity
- Jogging or running
- Tennis singles
- Folk dancing
- Heavy housework
5
Q
Exercise Programs – AEROBIC
A
- 2-3x/week
- 65-75% of VO2 or METS
- 65-75% of MHR
- 50% MHR – high risk – still gets benefits
- Isotonic, alternating
- Minimum 30 minute sessions
- Interval training (rest/exertion)
- Non-competitive
- Treadmill, free walking, bike
- Aerobic classes, resisted
6
Q
Exercise Programs – RESISTANCE
A
- Properly supervised
- Caution with resistance training – low in resistance and high in repetition at first
- High risk may need to be seated + have alternative component during this session
- 2x per week
- Light weights or stretch bands
- 10-15 reps x 1
- Exhale during contraction
7
Q
Exercise – OTHER CONSIDERATIONS
A
• Group dynamics & control
o Patients may be fearful, depressed, embarrassed, aggressive, cavalier, in denial
• Use large muscle groups
• Avoid excessive arm/upper limb work as opposed to lower limb work
• Progress to low/moderate continuous aerobic exercise
8
Q
Components of Programme
A
¬ Warm-up : 10-15 minutes ¬ Aerobic : 30-45 minutes o Interval o RPE : 11-13 o Resistance: 10-20 minutes/2x per week ¬ Cool down : 5-10 minutes ¬ Increase time before intensity
9
Q
Monitoring
A
• BP • HR • BP*HR – i.e. double product • ECG • RPE NB. If on beta blockers use RPE rather than HR, observation (SOB, in-coordination, pallor, sweaty)
10
Q
Measuring Exertion
A
Heart Rate Calculations ¬ MHR on Age and Gender o Male : 220-age o Female : 226-age OR o 208 - (0.745*age) o Females 206 - (0.88 * age) o Beta blockers 164-0.7*age
11
Q
Exertion
A
¬ Lactate Threshold o Based more on fitness level than MHR o Lactate threshold – enter anaerobic zone NB. As fitness marked point should ¬ Rating of Perceived Exertion (RPE)
