Lecture 14: HF/CAD/DM Cardiac Rehab pt. 2 Flashcards
describe phase 2 cardiac rehab
outpatient setting
starts as soon as possible after hospital dc
36 sessions (3x/wk x 12 wks)- Medicare pays this much
led largely by exercise physiologists
Vitals taken before, during, and after activity with adjustments made based on exercise response
factors that help determine frequency of monitoring and degree of direct supervision in CR exercise program
prior clinical course (complicated vs uncomplicated)
GXT results
degree of LV impairment
initial assessment
risk stratification
exercise components in phase 2 CR should consist of
combo of aerobic, resistance, and flexibility
specificity for CR
training should mirror pts regular functional tasks
changes will occur in specific mm groups or aerobic tasks that are challenged
mode of exercise for CR phase 2
should engage mm used for regular functional tasks
variety of exercise equipment to accomplish task
take pt preferences into account if able
intensity for phase 2 cardiac rehab
too intense = hazard
not intense enough = ineffective
aerobic training effects occur at 70-85% HR max, but as little as 40-60% HR max in elderly or more compromised pts
use HR max and RPE to monitor
type of activities for CR phase 2
warm up (5-10 min) = allows mm to stretch to max length used in peak exercise
steady state exercise
cool down (5-15 min) = allows slowed return to rest since abrupt end can reduce blood return to heart
interval training can be used for pts who are not yet able to tolerate long duration aerobic activities
combination of BLE and BUE exercise will produce a higher VO2 max consumption
duration of phase 2 cardiac rehab per session
goal = 45 min continuous steady state
can start with shorter period and progress per individualized pt needs
frequency phase 2 CR
typical schedule = 3x/week
more impaired pts should start with low intensity, short duration, high frequency exercise program if possible
resistance training guidelines for phase 2 CR
initiated after aerobic
goal = 30-50% 1RM, 8-10 reps, 2-3x/wk to major mm groups
can increase weights by 5-10 lbs when 12-15 reps are comfortable
train large mm before small
exhale with exertion to avoid valsalva
take individual pt needs into consideration to determine focus on mm power vs endurance
describe phase 3 CR
maintenance stage
focus on lifelong exercise involvement
progressive independence and self monitoring of symptoms and health
larger exercise groups with less individualized supervision (i.e. YMCA, senior centers, private gyms)
benefits of CR
47% lower mortality risk
31% lower risk of repeat MI if 36 sessions attended
decreased hospital readmission
higher QOL
lower cost to healthcare system
barriers to cardiac rehab
pts who would benefit but are not being referred (greatest predictor of participation is strength of MD recommendation)
geographic location; 30% less likely to participate if living outside of large city
long wait times; every day a pt waits to enroll, they are 1% less likely to ever do so
finances; pts who make >$75k are 2x as likely to participate
safety precautions in CR
avoid exercise 1-2 hours post meal
avoid isometrics and breath holds
add warm up and cool down periods to lower risk of adverse event
take shorter showers and not extreme temps to maintain normal blood flow/distribution
staff should be trained on how to respond to emergency
CR programs in high altitude ares or environments of extreme temps should adjust properly
CVD prevention methods
healthy lifestyle reduces risk of MI by 81-94%; pharm treatment alone is only 20-30% reduction
most effective treatment = combo of pharm management and lifestyle choices
key changes = diet, physical activity, weight management, smoking cessation, and stress management
