Exericse Guidelines For CV Disease Flashcards by Jessica Deak

Goal of cardiac rehab is to enable patients to _________ within imposed limitations

Resume active and productive lives

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Objectives of cardiac rehab include

Restore optimal physiologic, psychosocial, and vocational status

Prevent progression or reversal of disease

Reduction of risk of SD or reinfarction

Alleviation of symptoms

Patients become responsible and autonomous for their medical treatment and lifestyle changes

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Candidates for cardiac rehab (13)

MI
CABG
PTCA/Stents
Stable angina pectoris
Silent ischemia
Valve replacement

High risk for CHD
Congenital heart defects
CHF
Cardiac arrhythmias
Transplants (heart and lung)
Secondary and tertiary prevention
PAD

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Components of CV Rehab include multidisciplinary approaches including:

Medical treatment
Nutritional counseling
Smoking cessation
Risk stratification
Stress management
Hypertension management
Control of diabetes or dyslipidemia

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How many cardiac rehab phases are there?

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Phase I of cardiac rehab is the _____ phase

Inpatient

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How long does phase I cardiac rehab last?

Lasts about 3 days until discharge

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What is the goal of phase I?

NO physiological effects of bed rest

NO cardiac cripples

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What exercise can you do in phase I?

Low level functional activities
PROM to AROM
Walking and stairs

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Phase II of cardiac rehab is the ______ phase

Out patient

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How long does phase II last?

3 months duration

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What is the goal of phase II?

Increase the functional and CV efficiency of the patient

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How is phase II monitored?

Telemetry (ECG)

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What is phase III otherwise known as?

Supervised phase

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How long does phase III last?

4-6 months duration

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What is the goal of phase III?

To decrease supervision of exercise program and to promote self regulation of SAID program

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Phase III is monitored how?

Heart rate. NO telemetry

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Phase IV is otherwise known as

Unsupervised phase

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What is the duration of phase IV?

Lifetime in duration

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What is the goal of phase IV?

Maintain the lifestyle changes acquired in cardiac rehab

Client exercises on their own

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True or false (Benefit of exercise?) reduces long term mortality?

True

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True or false (Benefit of exercise?) May retard the atherosclerotic process?

True

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True or false (Benefit of exercise?) negative changes in lipid profiles

False- positive

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True or false (Benefit of exercise?) Decrease cellular sensitivity to insulin?

False- increases

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True or false (Benefit of exercise?) Modification of TABP

True

True or false (Benefit of exercise?) Decrease platelet adhesiveness

True

True or false (Benefit of exercise?) Enhanced fibrinolysis

True

True or false (Benefit of exercise?) Decreased PNS outflow

False- increase

True or false (Benefit of exercise?) Little change in central, but significant change in peripheral parameters?

True

True or false (Benefit of exercise?) Decrease in ECG abnormalities?

True

True or false (Benefit of exercise?) Decrease in RHR, submax HR, SBP, RPP, and MVO2 demands

True

True or false (Benefit of exercise?) Can develop collaterals

True

True or false (Benefit of exercise?) Improves psychosocial functioning

True

``` Percentages for increase in VO2 max: ____ for MI ____ for CABG ____ for AP ____ for severe LVD ```

11-56% 14-66% 32-56% 20%

___% of the beneficial effects are still unknown for exercise -- many call some of these vascular conditioning effects

65%

Exercise and diet are superior to _________

Percutaneous coronary intervention

True or false (Benefit of exercise?) Exercise promotes vascular stability?

True

True or false (Benefit of exercise?) Improves vascular wall inflammation and endothelial dysfunction

True

True or false (Benefit of exercise?) Exercise in tertiary prevention decreases mortality

False- secondary

15 contraindications/precautions

``` Unstable angina Unstable dysrhythmias Unresolved CHF Uncontrolled HTN Uncontrolled atrial or ventricular dysrhythmias Uncontrolled diabetes ``` ``` Serious heart block PE Cardiogenic shock Severe physical or emotional impairment Moderate to severe aortic stenosis Active pericarditis or myocarditis Pulmonary HTN ``` GH below 7 - check with MD RHR >100

Do not exercise a patient if there RHR is greater than...

100

What phase of cardiac rehab is inpatient phase/early mobilization?

Phase I

What phase of cardiac rehab is post discharge (low level activities, monitor pt, tell them to get a HR monitor?)

Phase 1.5

What phase is supervised outpatient?

Phase 2

What phase is lifetime maintenance?

Phase 3

In phase I of early mobilization, what should you be doing in evaluation?

Get clearance from MD | Look at contraindications to phase I

In early mobilization (phase 1), what should the frequency be?

5-7 days per week (ideally daily)

In early mobilization (phase 1), what should the duration be?

15 min twice a day

In early mobilization (phase 1), what should the intensity be?

20 BAR for MI | 30 BAR for CABG

In early mobilization (phase 1), develop criteria for _____

Exercise termination

In phases II-III, what should be done during evaluation?

Cardiac stress test Lab studies (SMA12, lipid profile, CBC, electrolytes) PFT if pulm involvement

In phases II-III, what should the frequency be?

3-5x per week | Weekend/evening walks are encouraged

In phases II-III, what should the duration be?

20-45 min of aerobic exericse | Phase specific for total length of time

In phases II-III, what should the intensity be?

THR= target heart rate 50-70% Karvonen for phase II 70-80% Karvonen for phase III

What is the Karvonen formula?

[(MHR-RHR) x _____%] + RHR

In phases II-III, the intensity is usually increased monthly by __% to a max of 80%

5% to 80%

In phases II-III, when should you repeat the stress test?

At the end of phase II

MHR =

Peak HR off of stress test

In phases II-III, what should the intensity be?

An objective target is used and not a RPE value

What is RPE

Rate of perceived exertion (Borg Scale

RPE of 6=

No exertion

RPE of 11=

Light

RPE of 13=

Somewhat hard

RPE of 15=

Hard (heavy)

RPE of 17=

Very hard

RPE of 20=

Max exertion

In phases II-III, what does intermittent training consist of

Rest periods of less than one minute between modalities (exercise devices) Alternating leg and arm activities

RPE can only be used in conjunction with the ___

THR

In phases II-III, with intermittent training- warm up first for about 5 minutes using what kind of exercise?

Low level walking

In phases II-III, in intermittent training, during the cooldown, it consists of

Low level walking then stretching at the end

NY Heart Association: Class I And max met level

Patients with cardiac disease but resulting in no limitation of PA Ordinary physical activity does not cause fatigue, palpitation, dyspnea or angina pain MAX MET level is 6.5 METS

NY Heart Association: Class II

Can still do ADLs, not everything, need to be monitored

NY Heart Association: Class III

Not doing very well- may be waiting for heart or lung transplant

NY Heart Association: Class IV

Usually not doing well at all- hospice, home care

Resistance training has no evidence of the following:

``` CHF Uncontrolled dysrhythmias Severe valve disease Uncontrolled HTN - SBP > 160 DBP > 100 Unstable symptoms ```

Resistance training after a MI or CABG is minimum ____ weeks including at least __ weeks in a supervised program

5 weeks | 4 weeks

Resistance training after a PTCA is minimum ____ weeks including at least __ weeks in a supervised program

3 weeks | 2 weeks

Out of cardiac arrest, MI, or fatality, which one has the greatest chance of occurring during exercise ?

Cardiac arrest

What do you want to monitor during exercise?

``` VO2 max Lipid profile Vital signs- RHR, RBP ECG changes Psychosocial ```

When stress testing for cardiac, what needs to be done (5)

1) determination of human max capacity for physical work 2) detection of confirmation of ischemic heart disease in individuals who are apparently healthy 3) assessment of treatment procedures for patients with ischemic heart disease 4) eval of cardiac dysarrhythmias 5) Rx for exercise

Contraindications for exercise prescription?

Arm bike- typically increases BP Aquatic therapy- too hot for pts Sternal precautions- no more than 5 lbs pick up Diabetes