ex perscription

Question 1

Intensity

Answer 1

Heart Rate
Post MI
≤120 bpm or resting HR +20 bpm
Post Surgical
Resting HR +30 bpm
Rating of Perceived Exertion (RPE)
For all ≤13 (Borg 6-20 scale)

ACSM, 2010

Question 2

Duration

Answer 2

Begin with intermittent bouts lasting 3-5 minutes, as tolerated
Rest periods
At patient discretion
Aim for shorter than exercise bout duration

ACSM, 2010

Question 3

Frequency

Answer 3

Early mobilization 2-4 times/day
PT once a day
Nursing once a day
When safe, encourage ambulation with family or independently
Later mobilization 2 times/day with increased duration of exercise bouts

ACSM, 2010

Question 4

Progression

Answer 4

Initially, increase duration to 10-15 minutes
Then, increase intensity (speed or elevation)

ACSM, 2010

Question 5

Deconditioned

Answer 5

Start with shorter duration, more frequent bouts

Consider supine AROM (handout #2)

Question 6

Beta Blocked

Answer 6

Beta Blocked

Use RPE scale to gauge exercise intensity due to flat HR response on beta blockers

Question 7

COPD

Answer 7

Shortness of breath due to lung disease may make it difficult to differentiate symptoms due to heart disease
Be careful with patients on bronchodilators. They may already be tachycardic at rest with little reserve for exercise

Question 8

PVD

Answer 8

Claudication may limit duration of exercise, consider shorter, more frequent bouts or stationary bike

Question 9

Diabetes

Answer 9

Be aware of blood glucose levels

Don’t request holding of tube feeds for ease of therapy in patients on IV insulin

Question 10

Heart Transplant

Answer 10

Heart Transplant

• Acutely, HR at rest may be slow and in some cases may even require pacing due to lack of sympathetic innervation (goal is RHR >80). In time, resting HR will increase to ~80-120 due to circulating catecholamine response
• Acutely, may see flat HR response to exercise. Eventually, HR will rise due to circulating catecholamines and Frank Starling mechanism. HR recovery may be delayed.
• Remember to include strengthening, especially for proximal LE muscles due to the potential for steroid myopathy and osteoporosis
• ***Remember, patient should wear mask outside of hospital room

Question 11

Pacemakers

Answer 11

Avoid shoulder forward elevation above 90 degrees on the involved side for 4 weeks post-op to avoid bleeding or lead displacement

Question 12

Temporary pacing wires

Answer 12

1-2 hours bedrest post removal (if pulled)

No restrictions if cut at skin

Question 13

Left Heart Catheterization

Answer 13

Left Heart Catheterization
Period of bedrest post left heart cath is dependent on size of cath, closure device, type of procedure, etc..
Check individual orders

Question 14

Right Heart Catheterization

Answer 14

If internal jugular vein approach no bedrest, but avoid forward bending
If femoral vein approach check orders for period of bedrest (not usually >2 hours)

Question 15

Right Heart Catheterization

Answer 15

If internal jugular vein approach no bedrest, but avoid forward bending

If femoral vein approach check orders for period of bedrest (not usually >2 hours)
Electrophysiology (EP) Study
See before test if possible

Usually hold PT post study unless impending discharge-check orders and confer with MD

Question 16

Showering

Answer 16

Everyone is allowed to shower @ home upon discharge
Use luke warm water because hot water can make you dizzy
Let shower hit your back, not directly on incision
Avoid creams and lotions on your incision
Avoid taking a tub bath for 4-6 weeks
No jacuzzi (never a good idea for cardiac patients-clear with cardiologist

Question 17

Sternotomy

Answer 17

No lifting more than 8-10 lbs for at least 6 weeks

You will feel much better in 4-6 weeks; it may be 3-6 months before you are 110% (better than before)

Question 18

Driving

Answer 18

No driving for 3-4 weeks
Wear seatbelt in passenger seat
If afraid of airbag, sit in back seat