Exam 2: Wk 3: Prescription of Exercise and Interventions for Cardiovascular Patients Flashcards
Loss of VO2 is approx ______ per decade? ____ METS
5ml/kg*min
1.5-2 METS
Independence requires VO2 at ______
18ml/kg*min
Mortality risk is decreased by ____for every 1-MET increase in VO2
17%
Walking ___min a day decreases mortality by ___%
15 min a day by 14%
Hemoglobin lab value that you shouldnt exercise with
<7
Containdications for MAX Exercise Testing
- acute MI within 2 days
- Myocarditis, Endocarditis, Pericarditis (inflammation around the heart)
- Acute PE or DVT
- Decompensated Heart Failure
- Unstable Angina
- ST elevation or depression
- Inverted T wave
- V FIb
S&S of dysrhythmias
- flutter or pounding chest
- lightheaded, dizzy
- ataxia
- confusion
- dyspnea
- diaphoresis
- pale/gray and clammy
relative contraindications: resting hypertension
systolic>200 mmHg
diastolic >110 mmHg
cardiac rehab
coordinated sum of interventions required to ensure the best physical, psychological and social conditions so pts w/ chronic or post acute CV disease may, BY THEIR OWN EFFORTS, preserve or resume optimal functioning in society, and through improved health behaviors, slow or reverse progression of disease
What type of PTs benefit the most from cardiac rehab
- stable angina
- stent placement; post angioplasty
- post MI
- CHF
- heart transplant, CABG, Valve Replacement
Phases of Cardiac Rehab
Phase I: IP (covered by insurance)
Phase II: OP w/ EKG monitoring (covered by good plans 1-8-12wks)
Phase III: OP; less monitoring
Phase IV: independent maintenance (not covered)
Inpatient Rehab Goals: PHASE I
- Mobilize ASAP to prevent effects of bed rest
- Educate on risk factors, CAD, ex intolerance
- progress activity (4 MET level)
- prepare to return home
- independent in HEP
Responsibilities of the PT
- assess physiologic responses
- supervising the exercise program
- accurately charting and recording the pts program and tx response
- pt and family edu
- prepare for discharge
Phase I: No exercise if HR is
> 120 bpm if medical tx (MI)
> 130 bpm if surgical
Phase II
1-2 wks after discharge from MI, CABG, PCI
3 visits /wk for 12wks
- closely supervised
- group exercise
- GXT
If you cant use HR (bc of cardiac transplants, pacemakers, beta blockers), what would you use?
RPE 12-13
or an increase of 2 or 3 on 7-20 borg scale
What is the functional capacity met level for phase III cardiac rehab
at least 5 METS
Phase III structure
- no direct medical supervision
- less structure
- more individualized
- self monitoring
Phase IV structure
- for maintenance or improvement from Phase I and II
- not supervised by PT
- program set by PT
Resistance Exercise Parameters
- large muscle groups
- light weight for 20 reps
- if pt can do 30, increase rate
*less resistance for lesser BP response and strain on CV system
Phases of Cardiac rehab exercise examples
Phase 1: constant intensity treadmill, cycle, rowing
Phase 2: varying intensity swimming, running, biking
Phase 3: game activity so intensity varies; sports LOW RISK PTS
HIIT
interspersing intervals of exercise at greater than 85% of peak HR or workload w periods of low intensity of rest
Why is HIIT better than MICE (mod intensity continuous activity) >
- HIIT elicits greater changes in VO2Peak
- HIIT appears safe and better tolerated
- HIIT mimics short and long term peripheral and central adaptations
- like walking and then going up a flight of stairs (more functional)
Low Volume HIIT parameters and examples
<15 min
30 sec intervals-60 sec
60-80 min/wk
71% training response and higher
adherance
Examples: walking, side stepping, seated marching, seated dealing cards, reaching activities
according to research, when should you start HIIT with a CVP patient?
after successful completion of 12-18 sessions of a supervised early CR program (PHASE II)
Median sternotomy
midline incision: sternal notch to base of sternum
common symptoms post CABG
- increased fatigue
- decreased MAX aerobic capacity
- impaired gas exchange
- shoulder pain
- back pain
- TTP and itching
- pain during activity
Activity limitations following CABG
decreased upright staning tolerance
impaired balance
impaired functional mobility (walking, transfers, stairs)
Participation restrictions following CABG
- adls and work
- family roles and responsibilities
- recreation and leisure activities
- community life
- intimate relationships
- QoL
Sternal Complications
- dehiscence,
- infection
- sternal instability
Sternal Instability Scale
0: clinically stable sternum - normal w no motion
1: minimally separated sternum - slight increase in mvmt
2: partial separated sternum
3: completely separated sternum - entire length
Sternal Precautions
- completely or partially decrease use of arms during everyday stress
- prevent skin shear
no pushing, pulling, lifting >10 lbs
no bilateral shoulder flexion of abd >90
no driving
no prone
no bilateral UE ext past neutral
How long post op can you scar massage
- 6 wks assuming incision is fully healed
- perpendicular, circular, and parallel
Bed Mobility post cabg
be able to explain it
airway clearance w CABG
upright position w pillow
hugg coughing/splinting coughing
we want to gradually increase endurance tolerance to ____ HRR during phase 1
40-80%
You’re doing great!
No, seriously! You know so much already!!
What scale is better than RPE for patients with heart disease
dyspnea scale
