Cardiac Rehab: Phases I-III (and special populations) Flashcards
What should phase I exercise activities look like?
ADLs, selected arm/leg exercises, supervised slower ambulation
- low intensity activities <5 METs
Your post-MI patient: what limitations on exercise do they have for phase I of cardiac rehab?
limited to 70% max HR and/or 5 MET activities until 6 weeks post-MI
Can you progress your patients in phase one to activities past 5 METs?
yes, but not if they have MI (unless they’re >6wks out)
Which facets of exercise prescription are increased in phase one, and which are decreased?
increased = frequency (2-3x/day)
decreased = intensity, duration
T/F: Post-surgical pts are typically progressed more quickly than those with post-MI.
true
What patient/fam education should be included in phase I?
- monitoring for signs of exertional intolerance
- energy cost/fatigue monitoring, energy conservation techniques
- HEP
- understanding of cardiac disease and and risk factor modification
- emergency life life, fam CPR train
What is the goal for ambulation for these phase I patients by the end of their term (4-6wks)?
20-30min ambulation, 1-2x/day
What should HEP include for post phase I patients?
ambulation 20-30min/day
UE/LE mobility exercises
Which types of patients aren’t covered under insurance for part II cardiac rehab? (2)
heart failure and PAD
- though def would be beneficial
Describe each phase of cardiac rehab in simple terms.
phase I = acute, inpatient
phase II = subacute, outpatient; ECK monitoring required
phase III = postacute, community exercise programs; monitoring not required, more self regulated exercise
How often do groups meet for phase II rehab?
2/3 times per week for 30-60min
- can be single or multimodal
What is the suggested graduation point of phase II?
9 MET fxnal capacity
When can you begin resisted strength training for your patient that’s post-CABG?
8 wks out
- 6 wks for MI
- 3 wks for typical cardiac rehab pts
What are the big goals from phase III cardiac rehab?
1) promote life-long risk modification tactics
2) improve functional capacity
What is entry-level criteria for phase III?
functional capacity of 5 METs, stable anginea, medically controlled arrhythmias
When can you begin resistance training in your patient that just underwent cardiac surgery?
immediately in LEs, after 6-7wks for UEs
What should a patient’s Borg rating be when completing resistance exercise in cardiac rehab?
11-13 (light to somewhat hard)
Your patient in the hospital has heart failure. What items should you assess every visit for evidence of decompensation?
increased SOB sudden weight gain LE edema or abdominal swelling pronounced cough dizziness/lightheaded
Why can we not assess heart response by just looking at change in heart rate for cardiac transplant patients?
heart is dennervated, pts tend to be tachy
What types of cardiac patients will likely need a longer warm up/cool down?
transplant pts (physiological responses to exercise and recovery take longer)
heart failure
What positions might you want to avoid with your patient with heart failure?
supine/prone d/t orthopnea
When a patient tells you they have a pacemaker, what should your next question always be?
demand or fixed rate?
- fixed rate can limit activity tolerance
After a patient gets a pacemaker put in, how long should you wait to exercise?
avoid UE aerobic/strengthening exercises for 4-6wks to let leads scar down
