Met levels

Question 1

Met levels 
class I

Answer 1

-4.5 and over No limitations. Patients do not experience heart palpitations, shortness of breath, or extreme fatigue during normal physical activity.

Question 2

Met levels
class II

Answer 2

-Up to 4.5 Slight limitations of physical activity. Patients are comfortable at rest. Ordinary physical activity results in palpitations, shortness of breath, or fatigue.

Question 3

Met levels
class III

Answer 3

-Up to 3.0 Significant limitations of physical activity. Patients are comfortable at rest. Light to moderate activity causes palpitations, shortness of breath and fatigue.

Question 4

Met levels
class IV

Answer 4

-Up to 1.5 Unable to tolerate physical activity. Patients experience palpitations, shortness of breath and fatigue even at rest. Physical activity increases the severity of symptoms.

Question 5

Met level range
1.0-1.4
activity restrictions?
sample ADLs?

Answer 5

• Sitting up is allowed for short periods. Patients can move in bed and transfer. They can exercise all limbs while lying down but can only exercise lower extremities while sitting up.
• Self feeding, light hygiene, reading, playing cards, writing.

Question 6

Met level range
1.4-2.0
activity restrictions?
sample ADLs?

Answer 6

• Sitting up is allowed as tolerated. Slow walking is allowed. Patients may exercise all extremities but no isometric or strengthening exercises are allowed.
• Dressing, grooming, bathing, shaving, crafts.

Question 7

Met level range
2.0-3.0
activity restrictions?
sample ADLs?

Answer 7

• Standing is allowed for brief periods. Patients may shower in warm water if sitting. Exercise may include more repetitions, balance activities, and light mat activities with no resistance.
• Showering while sitting, light housekeeping while sitting, typing, sewing, playing the piano.

Question 8

Met level range
3.0-3.5
activity restrictions?
sample ADLs?

Answer 8

• Unlimited walking on a zero grade is allowed. Patients may begin walking on a treadmill at 1 to 1.5 mph at a 1-2% grade. Light resistance may be added to exercises. Patients may begin to climb stairs slowly, up to 2 flights.
• Hygiene, grooming, bathing, dressing, and showering in warm water while standing. Light housekeeping tasks while standing. Light gardening, driving.

Question 9

Met level range
3.5-4.0
activity restrictions?
sample ADLs?

Answer 9

• Patients may walk on level surfaces up to 2.5 mph. More resistance may be added to exercises completed while sitting, up to 10 lbs.
• Washing dishes, laundry, making beds, light carpentry and home repairs, slow swimming, slow bicycling, golfing using a golf cart, slow stair climbing

Question 10

Met level range
4.0 and above
activity restrictions?
sample ADLs?

Answer 10

• Unlimited walking up to 2.5 mph, 10 – 15 lbs of resistance during exercises completed while sitting.
• Mopping floors, raking, hanging up heavy clothes, light calisthenics, volleyball, basic swimming, and slow dancing.

Question 11

MET Level	
Precautions	
Activities	
Monitoring
Begins at MET level 1-2
Target MET level 3.5

Answer 11

• No isometric exercises or muscle strengthening work
• No overhead or lateral upper body activity
• No exercise if person has the following conditions: unstable angina, uncontrolled arrhythmia, acute myocardial infarction (heart attack), deep vein thrombosis (DVT), or severe aortic stenosis

Patient education in the following areas:
● Energy conservation
● Work simplification
● Risk factors
● Smoking cessation
Light activity if regular pulse is 100 bpm or less

Take vital signs (blood pressure, pulse, respiration) at the beginning of each activity, at the peak of each activity, at the end of each activity, and 4-5 minutes after each activity.
May use a perceived exertion scale to monitor the patient’s perception of effort. (example – BORG scale for exertion)

Question 12

MET Level	
Precautions	
Activities
Monitoring
Begins at MET level 4-5
Target MET level 5-6

Answer 12

• Build up activity tolerance gradually
• May start graded weight training 2-4 weeks after the initial cardiac event

-Continued patient education as in Phase I
Practice work simplification and energy conservation techniques
-Gradual graded exercise
-Gradual graded weight training
-Home evaluation
-Work site evaluation if applicable

-May be referred to a work hardening program if needed
-Continued monitoring of vital signs during and after activity
May use perceived exertion scale. Target for BORG scale 11-15.

Question 13

normal blood pressure adult

Answer 13

110-135

Question 14

normal pulse ox adult

Answer 14

60-100 bpm

Question 15

normal respiration adult

Answer 15

12-18

breaths/minute