Exercise Guidelines For Cardiovascular Disease Flashcards
Goal of cardiac Rehab
Enable patients to resume active and productive lives within imposed limitations
Specific objectives of cardiac rehab
- restoring optimal physiologic, psychosocial and vocational status
- Prevention of progression or reversal of disease
- reduction of risk of SD and reinfarction
- Alleviation of symptoms
- Patients become responsible and autonomous for their medical treatment and lifestyle charge
Diagnosis Candidates for cardiovascular disease
- MI
- CABG
- Stable Angina Pectoris
- Silent Ischemia
- Valve Replacement
- High risk for CHD
- Congenital heart defects
- Cardiac arrhythmia
- Transplant –> heart and lung
- Secondary and tertiary Prevetion
- PAD
What is included in the multidisciplinary program
- Medical treatment
- Nutritional counseling
- Smoking cessation
- Risk stratification
- Stress management
- Hypertension management
- Control of diabetes or dyslipidemia
Phase 1 of cardiac rehab is during what period and last how long?
-In- patient period
Lasts about 3 days (until discharge)
What is the goal of phase 1
Counteract the deleterious physiological effects of BED REST and prevent a “cardiac Cripple” from emerging
What type of activities are performed phase 1?
-Low level functional activities
Passive ROM to active ROM and progress to walking and stairs
When is phase 2 for cardiac rehab and how long does it last?
Out patient phase
-3 months duration
What is the goal of phase 2 cardiac rehab
Increase FUNCTIONAL and CARDIOVASCULAR efficiency of the patients
How is cardiac rehab monitored for phase II
Telemetry
Exercise for phase II rehab?
Individual exercise prescription for each patient
When is phase III and how long does it last?
- Supervised phase
- 4-6 months duration
Goal of phase III
To decrease supervision of exercise program and to promote self-regulation of said program
How it phase III monitored?
Heart Rate (NO telemetry)
When is phase IV and how long does it last?
Unsupervised phase
Lifetime in duration
Phase IV goal
Maintain the lifestyle the lifestyle changes acquired in cardiac rehab
What is the exercises of phase IV
Client exercises on own
Exercise reduces what ?
long-term mortality
Exercise may retard what process?
atherosclerotic
exercise causes what type of change in lipid profile?
postive change
Exercise increase cellular sensitivity to?
insulin
Exercise causes a modification of?
TABP
Exercise does what to platelet adhesiveness?
decrease
Exercise does what to fibrinolysis ?
enhance
Exercise does what to PNS outflow
increase
Exercise causes a little change in what? but has a significant change in what?
Little in central
significant in peripheral parameters
Exercise does what to ECG abnormalities ?
decrease
Exercise causes an increase in VO2 max for MI? CABG? AP? severe LVD?
MI: 11-56%
CABG: 14-66%
AP: 32-56%
Severe LVD: 20%
what is superior to percutaneous coronary intervention?
EXERCISE AND DIET
Exercise promotes?
vascular stability
exercise improve vascular what?
wall inflammation and endothelial
What are contraindication/ Precautions ?
- RHR> 100!
- Unstable angina
- Unstable dysrrhythmias
- serious heart block
- Unresolved CHF
- Uncontrolled HTN
- PE
- Cardiogenic shock
- Severe physical or emotional impairment
- Moderate to severe aortic stenosis
- Uncontrolled atrial or ventricular dysrhythmias
- Active pericarditis or myocarditis
- Uncontrolled DM
- Hh below 7
- Pulmonary HTN
what is the Frequency & duration of exercise for phase I?
5-7 days per week
15 mins BID
Intensity of Phase I (MI & CABG)
MI: 20 BAR
CABG: 30 BAR
what are phase I patients told to do when they go home?
WALK
What should be evaluated in phase II-III?
- cardiac stress test
- Laboratory studies
- PFT if pull involvement
Frequency and duration of phase II-III
- 3-5x per week with weekend of evening walks
- 20-45 minutes of aerobic
What should the karvonen be for phase II and III
II: 50-70%
III: 70-80%
MHR is what?
peak HR off of stress test
What is the calculation fro Karvonen?
[(MHR-RHR)x …..%] + RHR
What is RPE?
- rate of perceived exertion –> BORG SCALE
- subjective measurement of the exercise response (psychophysiologic measurement)
when can RPE be used?
Only in conjunction with the THR and other objective measurement variables
Intermittent Training
- rest periods of less than 1 min btw modalities
- alternating leg and arm exercises
- achieve a higher intensity level with less leg fatigue
- Allows for more diverse activities
- Permits different muscle groups to be stressed
- Ischemic signs monitored more carefully during rest periods
When are Ischemic signs monitored more carefully
during rest periods
cool down consists of?
low level walking then stretching
Walking decreases what?
cardiac output slowly and prevents syncope
when can resistance training be performed for a MI or CABG?
min of 5 weeks; 4 weeks in a supervised program
when can resistance training be performed after a PTCA
at least 2 weeks in a supervised program
Monitoring
- Impairments
- Vital signs
- ECG changes
- Psychosocial
- Daily
- Modalities
- Medication changes
- Alcohol or caffeine
- THR
impairments that are being monitored include?
- VO2 max
- Lipid profile (total cholesterol, HDL, LDL, triglycerides, risk factors)
vital signs that are being monitored include?
- RHR
- RBP
Psychosocial that is being monitored are
- return to work
- Stress level
- Coping mechanisms
Stress testing for cardiac
- Determination of human maximal capacity for physical work
- Detection or confirmation of ischemic heart disease (in “healthy”)
- assessment or treatment procedures for patient with ischemic heart disease
- Evaluation of cardiac dysrhythmias and the risk of cardiac sudden death
- Prescription for exercise
what is important to know for stress test?
- hyperventilation prior to test
- Resting vitals
- meds
- medical history
- length of test
- reason for termination
- ECG
- BP
- MAX HR prior to symptoms
what are some things you should take into consideration ? (4)
- ARM bike (shoots up BP)
- Aquatic therapy (can be okay… too hot)
- Sternal precautions
- DM
