Cardiac Rehab: Phases I-III (and special populations)

Question 1

What should phase I exercise activities look like?

Answer 1

ADLs, selected arm/leg exercises, supervised slower ambulation

• low intensity activities <5 METs

Question 2

Your post-MI patient: what limitations on exercise do they have for phase I of cardiac rehab?

Answer 2

limited to 70% max HR and/or 5 MET activities until 6 weeks post-MI

Question 3

Can you progress your patients in phase one to activities past 5 METs?

Answer 3

yes, but not if they have MI (unless they’re >6wks out)

Question 4

Which facets of exercise prescription are increased in phase one, and which are decreased?

Answer 4

increased = frequency (2-3x/day)

decreased = intensity, duration

Question 5

T/F: Post-surgical pts are typically progressed more quickly than those with post-MI.

Answer 5

true

Question 6

What patient/fam education should be included in phase I?

Answer 6

• 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

Question 7

What is the goal for ambulation for these phase I patients by the end of their term (4-6wks)?

Answer 7

20-30min ambulation, 1-2x/day

Question 8

What should HEP include for post phase I patients?

Answer 8

ambulation 20-30min/day

UE/LE mobility exercises

Question 9

Which types of patients aren’t covered under insurance for part II cardiac rehab? (2)

Answer 9

heart failure and PAD

- though def would be beneficial

Question 10

Describe each phase of cardiac rehab in simple terms.

Answer 10

phase I = acute, inpatient

phase II = subacute, outpatient; ECK monitoring required

phase III = postacute, community exercise programs; monitoring not required, more self regulated exercise

Question 11

How often do groups meet for phase II rehab?

Answer 11

2/3 times per week for 30-60min

- can be single or multimodal

Question 12

What is the suggested graduation point of phase II?

Answer 12

9 MET fxnal capacity

Question 13

When can you begin resisted strength training for your patient that’s post-CABG?

Answer 13

8 wks out

• 6 wks for MI
• 3 wks for typical cardiac rehab pts

Question 14

What are the big goals from phase III cardiac rehab?

Answer 14

1) promote life-long risk modification tactics

2) improve functional capacity

Question 15

What is entry-level criteria for phase III?

Answer 15

functional capacity of 5 METs, stable anginea, medically controlled arrhythmias

Question 16

When can you begin resistance training in your patient that just underwent cardiac surgery?

Answer 16

immediately in LEs, after 6-7wks for UEs

Question 17

What should a patient’s Borg rating be when completing resistance exercise in cardiac rehab?

Answer 17

11-13 (light to somewhat hard)

Question 18

Your patient in the hospital has heart failure. What items should you assess every visit for evidence of decompensation?

Answer 18

increased SOB
sudden weight gain
LE edema or abdominal swelling
pronounced cough
dizziness/lightheaded

Question 19

Why can we not assess heart response by just looking at change in heart rate for cardiac transplant patients?

Answer 19

heart is dennervated, pts tend to be tachy

Question 20

What types of cardiac patients will likely need a longer warm up/cool down?

Answer 20

transplant pts (physiological responses to exercise and recovery take longer)

heart failure

Question 21

What positions might you want to avoid with your patient with heart failure?

Answer 21

supine/prone d/t orthopnea

Question 22

When a patient tells you they have a pacemaker, what should your next question always be?

Answer 22

demand or fixed rate?

• fixed rate can limit activity tolerance

Question 23

After a patient gets a pacemaker put in, how long should you wait to exercise?

Answer 23

avoid UE aerobic/strengthening exercises for 4-6wks to let leads scar down