Exericse Guidelines For CV Disease Flashcards
Goal of cardiac rehab is to enable patients to _________ within imposed limitations
Resume active and productive lives
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
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
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
How many cardiac rehab phases are there?
4
Phase I of cardiac rehab is the _____ phase
Inpatient
How long does phase I cardiac rehab last?
Lasts about 3 days until discharge
What is the goal of phase I?
NO physiological effects of bed rest
NO cardiac cripples
What exercise can you do in phase I?
Low level functional activities
PROM to AROM
Walking and stairs
Phase II of cardiac rehab is the ______ phase
Out patient
How long does phase II last?
3 months duration
What is the goal of phase II?
Increase the functional and CV efficiency of the patient
How is phase II monitored?
Telemetry (ECG)
What is phase III otherwise known as?
Supervised phase
How long does phase III last?
4-6 months duration
What is the goal of phase III?
To decrease supervision of exercise program and to promote self regulation of SAID program
Phase III is monitored how?
Heart rate. NO telemetry
Phase IV is otherwise known as
Unsupervised phase
What is the duration of phase IV?
Lifetime in duration
What is the goal of phase IV?
Maintain the lifestyle changes acquired in cardiac rehab
Client exercises on their own
True or false (Benefit of exercise?) reduces long term mortality?
True
True or false (Benefit of exercise?) May retard the atherosclerotic process?
True
True or false (Benefit of exercise?) negative changes in lipid profiles
False- positive
True or false (Benefit of exercise?) Decrease cellular sensitivity to insulin?
False- increases
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
