Cardiac Rehab Phase I

Question 1

What does Phase I Cardiac Rehabilitation (Inpatient Rehab) consist of?

Answer 1

Pt/family education
self-care evaluation
continuous monitoring of vitals
group discussions
low-level exercise: ROM, ambulation, and self-care

Question 2

What is the average length of Phase I Cardiac Rehab?

Answer 2

3-5 days

Question 3

When can a pt start Phase I?

Answer 3

When deemed medically stable by referring physician

Question 4

What constitutes “medically stable” to begin phase I cardiac rehab? (4)

Answer 4

1) No new/recurrent chest pain in 8 hours
2) No new significant, abnormal heart rhythm or ECG changes in 8 hours
3) No new signs of uncompensated heart failure (dyspnea at rest with bilater basilar crackles)
4) Stable creatine kinase and troponin levels

Question 5

What warrants immediate termination of exercise in Phase I? (6)

Answer 5

1) HR > 130 bpm or > 30 bpm above resting HR
2) Diastolic BP > or = 110 mmHg
3) Decrease in SBP > 10 mmHgg
4) 2nd or 3rd degree heart block
5) Signficiant Ventricular or Atrial dysrhytmias
6) S/sx including angina, marked dyspnea, and ECG changes suggestive of ischemia

Question 6

Guidelines for active Exercise

Answer 6

May begin 24 hours after CABG and 48 hours after MI
Progresses from sitting to standing (1-4 METs)
Should not stress incisions

Question 7

Aerobic Exercise Mode

Answer 7

Supervised level walking (2-3 METs) progressing to walking up/down steps or treatmill walking (3-4 METs)

Question 8

Aerobic Exercise Intensity (RPE)

Answer 8

RPE < 13**

Question 9

Post-Infarct Aerobic Exercise Intensity

Answer 9

HR < 120 bpm OR < 20 bpm above resting HR

Question 10

Post-surgery Aerobic Exercise Intensity

Answer 10

< 30 bpm above resting HR

Question 11

Aerobic Exerise Duration

Answer 11

Intermittent bouts of 3-5 minutes, progressing to 10-15 minutes of continuous activity

Question 12

Aerobic Exercise Frequency

Answer 12

First 3 days: 3-4x daily

> 3 days: 2x daily with increased duration

Question 13

Aerobic Exercise may be progressed provided: (4)

Answer 13

1) Adequate inc in HR
2) Adequate rise in systolic BP: 10-40 mmHg
3) No new dysrhythmias/ST changes on ECG
4) No cardiac symptoms are observed (i.e. palpitations, dyspnea, angina, excessive fatigue)

Question 14

By end of Phase I Cardiac Rehab pts are expected to be able to: (7)

Answer 14

1) Prevent hamful effects of bed rest
2) Walk 5-10 minutes continuously OR 1000 ft, 4x daily
3) Walk down/up one flight of stairs independently
4) Know safe HR and RPE limits for exercise
5) Recongize abnormal signs/sx suggesting activity intolerance6
6) Promote a more rapid and safe return to ADLs within the limits of their disease
7) Prepare the pt and home support system to optimize recover post-discharge