Exam 2

Question 1

cardiac rehabilitation is multidisciplinary and involves

Answer 1

Education
Structured, progressive physical activity
Lifestyle modification
Vocational counseling

Question 2

cardiac rehab candidacy

Answer 2

Post myocardial infarction within a year
Post CABG
Post percutaneous coronary intervention (stent)
Post heart valve surgery
Post heart or heart/lung transplantation
Chronic stable angina
Compensated heart failure EF <35% —Must be 6 weeks s/p hospitalization

Question 3

who is not a candidate for cardiac rehab

Answer 3

Unstable angina
Hemodynamic instability — SP> 200, DP > 100, orthostatic fall > 20 mmHg
Serious arrhythmias
Conduction abnormalities (20 and 30 blocks)
Active infections
Uncontrolled diabetes
Resting ST segment depression

Question 4

research benefits of cardiac rehab

Answer 4

Early, progressive rehabilitation intervention results in greater improvements in physical function than usual care.

Question 5

phase 1 cardiac rehab

Answer 5

Acute phase/inpatient

Starts immediately upon the patient becoming medically/hemodynamically stable
ECG monitored

Question 6

phase 2 cardiac rehab

Answer 6

Subacute/rehabilitation/conditioning phase (Also called outpatient cardiac rehab sometimes)

Begins Immediately or shortly after discharge from the hospital
ECG Monitored for at least a part of this phase
Insurance covers 36 sessions or 72 if intensive

Question 7

phase 3 cardiac rehab

Answer 7

Training or intensive Rehabilitation

Rarely monitored or supervised
Outpatient (Traditional outpatient PT)

Question 8

phase 4 cardiac rehab

Answer 8

Maintenance
Equivalent of a fitness facility membership
No monitoring and no staff oversight

Question 9

exercise tolerance in phase 1

Answer 9

Monitor BP 3-5 min/is patient hemodynamically stable?
Patient is mobilized with therapist

If no unusual HR, BP or EKG readings were seen, then the walk is repeated and over time lengthened according to the patient’s subjective feelings as well as the HR, BP and EKG responses.

Activity is progressed as long as the patient tolerates the exercise (remains hemodynamically stable).

Question 10

treatment in phase 1

Answer 10

Start slowly
Use short duration sessions, multiple times per day
(often educating nursing staff/family)
Warm up/cool down
Intensity— < 120 BPM or < 20-30 BPM increase during exertion

Question 11

when to stop treatment
presence of:

Answer 11

Angina
DBP>110mm Hg
Drop in SBP >10 mmHg with increasing workload
Inappropriate dyspnea
Excessive fatigue
Mental confusion or dizziness
Excessive fatigue
Pallor, cyanosis, diaphoresis
EKG abnormalities
Patient choice

Question 12

goals in phase 1

Answer 12

Initiate return to independence in ADLs
Counteract the deleterious effects of bed rest - reduce the risk of a thomboembolic event and developing pneumonia, maintain some muscle tone
Provide medical surveillance during ADL types of activities
GET TO NEXT PLACE

provide patient and family education

Question 13

activities to consider in phase 1

Answer 13

Self care
Arm and Leg AROM
Very light weights
Independent transfers
Bedside sitting to ambulation to stairs

3-5 METs of activity by discharge

Question 14

when does phase 2 start

Answer 14

Begins 2-12 weeks after discharge (some hospitals different in requirements)
Exercise test may be implemented to prescribe exercise– but not needed
8-12 weeks in duration and is medically supervised (visit based)

Question 15

goals of phase 2

Answer 15

Improved exercise tolerance & functionality
Provide patient and family education
Risk factor reduction/secondary prevention strategies
Prepare patient to return To Work
Promote psychological, behavioral and educational improvement
Perform 3-5 METS or 2.0 - 3.0 mph for 30 min

Question 16

how to establish intensity in phase 2

Answer 16

Use RPE
For older patients, rating scale 1-10 recommended

Question 17

abnormal response to exercise in phase 2

Answer 17

SBP > 240, DBP > 110
Systolic hypotension, > 20 BPM drop during activity
Unusual heart rate response
Symptoms
– Anginal response
– Undue dyspnea (sudden and severe– think PE)
– Excessive fatigue
– Mental confusion/dizziness
– Severe claudication or pain in the leg
– pallor
– cold sweat
– ataxia
– pulmonary rales

Question 18

resistance training in phase 2
onset and prescription

Answer 18

Onset: 5 weeks post MI, 8 weeks post CABG, 2 weeks post PCTA and stent,
30-50% of 1 rep max
8-10 reps, 2-3 X/wk with a day of rest in between
Large muscle groups= more blood flow needed to oxygenate it
Control weights
Breathe/exhale during effort

Question 19

what is phase 3 rehab

Answer 19

3-6 months post event
HEP
Community exercise programs
YMCA
Patients may or may not be seen by staff
No ECG monitoring
Self monitoring
Goals
– Achieve 50-80% of HRR on treadmill test (moderate activity)
– 3-4 exercise sessions/week
– >45 min per session

Question 20

cardiac programs remain less utilized because patients may have

Answer 20

Poor functional status
Higher body mass index
Continued tobacco use
Depression
Long-distance to CR facilities
Low health literacy,
high costs (e.g., copays),
inflexible work schedules

Question 21

FITT-VP

Answer 21

frequency
intensity
time
type
volume
progression

Question 22

threshold model

Answer 22

Achieve sufficient physiologic challenge to bring about adaptive changes

Question 23

what composes an exercise training session

Answer 23

Warm-up/initiation
Conditioning
Cool-down

Question 24

warm up

Answer 24

A transitional phase that allows the body to adjust to the changing physiologic, biomechanical, and bioenergetic demands of the specific exercise session

The warm-up should include light-to-moderate intensity activities specific to the muscle groups that will be employed during exercise

Warm-ups also improve ROM and may reduce the risk of injury

less than 15 min

Question 25

conditioning phase could include

Answer 25

AEROBIC, RESISTANCE, FLEXIBILITY, AND/OR SPORTS ACTIVITIES, DEPENDING ON THE SPECIFIC GOALS OF THE EXERCISE SESSION

Question 26

duration of conditioning phase

Answer 26

10 AND 60 MIN, DEPENDING ON THE INTENSITY OF THE ACTIVITY