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(3) Cardio-Pulmo-Renal Rehabilitation > S3 L1: Cardiac Rehabilitation Part 1 > Flashcards

S3 L1: Cardiac Rehabilitation Part 1 Flashcards

1
Q

Process by which patients with cardiac disease are encouraged and supported to achieve and maintain optimal physical and psychosocial health.

A

Cardiac Rehabilitation

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2
Q

Cardiac Rehabilitation is the process of restoring an individual to the __ compatible with the functional capacity of his heart

A

Maximum level of activity

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3
Q

Cardiac Rehabilitation is the process of ___ for cardiac diseases for healthy individuals

A

preventing risk factors

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4
Q

Cardiac rehabilitation programs are designed to do the following, except:
a. Limit the physiologic and psychological effects of cardiac illness
b. Reduce the risk of sudden death or reinfarction
c. Control cardiac symptoms
d. Stabilize or reverse the atherosclerotic process
e. Enhance the psychosocial and vocational status of selected patients
f. None of the Above

A

f. None of the Above

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5
Q

T/F: Cardiac disease may not only create new emotional issues but also enhance some that might have existed before the cardiac event.

A

True

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6
Q

T/F: It is not all cases where the primary patient care remains the responsibility of the referring physician.

A

False.
In all cases, primary patient care remains the responsibility of the referring physician.

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7
Q

Heads the Cardiac Rehabilitation Team

A

Cardiologist

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8
Q

Rehabilitation Doctors

A

Physiatrist

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9
Q

Aims for functional and movement capacity of the patients

A

Physical Therapist

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10
Q

Assist the individual in a return to work, or in counseling and referral for training for a different career.

A

Vocational Counselor

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11
Q

A physician responsible for overall effectiveness and safety of the program.

A

Medical Director

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12
Q

Who oversees all team personnel and facilities. Responsible for developing and revising policy, procedures, and budgets; selects needed equipment; and responsible for coordinating and supervising staff.

A

Program Coordinator

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13
Q

Knowledgeable in exercise physiology, pathology, exercise training techniques, monitoring equipment, arrhythmia recognition, cardiopulmonary resuscitation, and Advanced Cardiac Life Support

A

Exercise Training Professional

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14
Q

Registered nurses and exercise physiologists fill this role in many programs.

A

Exercise Training Professional

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15
Q

Skilled in behavioral evaluation and counseling techniques who is familiar with coping mechanisms, family patterns of interaction, and available community resources

A

Behavior Specialist

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16
Q

Screening healthy people to identify and treat risk factors before illnesses develop (Preventing the development of cardiac disorders)

A

Primary Prevention (IDENTIFY)

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17
Q

Candidates for primary prevention are those individuals who are at what level of risk of developing CVD?

A

Moderate or high risk

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18
Q

Number-one most preventable cause of disease, disability, and death

A

Cigarette Smoking

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19
Q

Assessment for cardiovascular risk factors should begin at age __ and be repeated every ___

A

Age 20 & Every few years

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20
Q

Specific Components of Primary Prevention

A
  1. Therapeutic exercise
  2. Dietary Counseling
  3. Stress Management
  4. Smoking Cessation
  5. Pharmacological Management
  6. Education and self-management
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21
Q

What precaution must be taken before any individual initiates an exercise program?

A

Administering an activity readiness screening tool, such as the PARQ or PAR-Q+, is a good way to assess general safety or determine whether a physician referral is necessary before beginning exercise

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22
Q

To improve heart disease risk factors and limit further morbidity and mortality

A

Secondary Intervention (ADDRESS)

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23
Q

Components of Cardiac Rehabilitation

A

Patient Education
Risk Factor Modification
Exercises
Nutrition
Psyxhological Status
Family Relationship
Stress Management
Vocational Adjustment

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24
Q

ACSM’s Guidelines for Exercise Testing and Prescription that addresses inactivity or sedentary lifestyle

A

Exercise Training

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25
Q

ACSM’s Guidelines for Exercise Testing and Prescription component with proper patient education

A

Risk Factor Modification

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26
Q

ACSM’s Guidelines for Exercise Testing and Prescription component for psychologists and vocational counselors

A

Psychosocial/Vocational Counseling

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27
Q

ACSM’s Guidelines for Exercise Testing and Prescription component for cardiologists and physiatrist

A

Medical Surveillance/Emergency Support

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28
Q

Patients that suffer from Angina Pectoris may be suffering from ?

A

Myocardial Infarction

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29
Q

Appropriate goal for pts with Angina Pectoris

A

use the training effectively to improve the efficiency of exercise performance below the anginal
threshold.

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30
Q

D/t poor LV function, these patients have increased complications compared to CABG or post-MI population

A

Cardiomyopathy

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31
Q

T/F: In HF pts, normal physiological response to exercise
is often absent, and there can be a decline in ejection fraction, a decrease in SV, with resultant exertional hypotension, and syncope

A

True

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32
Q

In the most severe cases of HF, CO may not increase sufficiently to generate a __ at all

A

dynamic exercise response

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33
Q

These are patients who underwent surgery to replace blood vessels of the heart

A

Coronary Artery Bypass Graft

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34
Q

T/F: CABG pts are poor candidates for cardiac rehabilitation

A

False. They are excellent candidates

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35
Q

These are benefits of a CABG pts who will undergo cardiac rehabilitation, except:
a. Increased ischemic threshold
b. improved left ventricular function
c. decreased coronary collaterals
d. improved psychological status
e. NOTA

A

C. Decreased Coronary Collaterals

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36
Q

Why is cardiac rehabilitation easier in Coronary Angioplasty than post CABG pts?

A

No significant postoperative recovery

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37
Q

These patients have issues on their conduction system

A

Pacemaker Implant

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38
Q

This must be done to patients with stenosed valves or regurgitated valves

A

Valvular Replacement

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39
Q

Patient with replaced hearts

A

Cardiac Transplant

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40
Q

one of the risk factors for development of cardiac disorders

A

Age

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41
Q

T/F: Pulmonary patients are also candidates for cardiac rehabilitation

A

True

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42
Q

Set up for unstable conditions, close monitoring, pre & post-surgery

A

In-patient Setup

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43
Q

Set up for stable conditions

A

Outpatient Setup

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44
Q

Patients may be treated at home (eg: Home therapy)
or facility they belong with. Therapist will visit the patient.

A

Home/Facilities

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45
Q

Statement 1: Patients with a diagnosis of stable chronic heart failure who have recently been discharged from the hospital are not eligible to enter cardiac rehabilitation until 6 weeks after discharge from the hospital
Statement 2: But they are candidates for a home-based program with physical therapy and nursing monitoring their weight, symptoms, and perceived exertion with activities.

TF
FT
TT
FF

A

TT

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46
Q

Setup for healthy individuals

A

Wellness Centers

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47
Q

The ultimate goal (not just for cardiac rehabilitation, but for any condition that physical therapists treat)

A

Increase the functional capacity of the patient

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48
Q

In preventive stage, ___ is the main goal

A

reversing the pathological processes

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49
Q

Exercises also contribute to retarding the atherosclerotic formation as it allows

A

proper blood flow, control of blood pressure

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50
Q

comprises the parameters for the interventions for patients and clients

A

FITT Principle

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51
Q

Recommended Warm Up

A

5-10 min of light-to-moderate intensity cardiorespiratory and muscular endurance activities

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52
Q

transitional phase that allows the body to adjust to the changing physiologic, biomechanical, and bioenergetic demand

A

Warm up

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53
Q

T/F: A static flexibility exercises is superior to dynamic, cardiorespiratory endurance exercise warm-up

A

False. A dynamic, cardiorespiratory endurance exercise warm-up is superior to static flexibility exercises

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54
Q

Recommended duration for conditioning

A

20-60 min of aerobic, resistance, neuromotor, and/or sports activities

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55
Q

Recommended duration and exercise for cool-down

A

5-10 min of light-to-moderate intensity cardiorespiratory and muscular endurance activities

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56
Q

Purpose of the cooldown

A

to allow for a gradual recovery of heart rate (HR) and blood pressure (BP) and removal of metabolic end products from the muscles used during the more intense exercise conditioning phase.

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57
Q

Prevent pooling of the blood in the extremities by:

A

continuing to use the muscles to maintain venous return.

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58
Q

Prevent fainting by:

A

increasing the return of blood to the heart and brain as cardiac output and venous return decreases.

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59
Q

What happens if the patient immediately engages in endurance properly without performing warm-up?

A

Sudden rise/increase of the heart rate of vital signs = not good for the patients as it is difficult to control

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60
Q

What happens when warm-up is done prior to endurance proper?

A

Heart rate or vital signs will gradually increase the intensity up until the grey area is reached

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61
Q

At least 10 min of stretching exercises performed
after the warm-up or cool-down phase

A

Stretching

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62
Q

Goal: to increase ROM in the major muscle/tendon groups according to individualized goals

A

Flexibility Exercises

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63
Q

This can be improved by engaging in flexibility exercises, especially when combined with resistance exercise

A

Postural Stability and Balance

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64
Q

T/F: More effective when muscle temperature is increased through warm-up exercises

A

True

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65
Q

Form of exercise that is made with gross motor movements

A

Calisthenics

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66
Q

This exercise is recommended for sedentary adults (walking leisurely, cycling, aqua-aerobics, slow dancing)

A

Endurance activities

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67
Q

This type of exercise is recommended for physically active adults (jogging, running, aerobics, fast dancing)

A

Vigorous intensity endurance activities requiring minimal skill

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68
Q

Exercise recommended for adults with aquired skill (under training) like swimming and skating

A

Endurance activities requiring skill

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69
Q

Exercises recommended for adults with regular exercise (Basketball, soccer, hiking)

A

Recreational Sports

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70
Q

Design of a training program needs to consider the activities and muscle groups exercise based on the needs of the particular patient, based on known vocational and recreational activities

A

Law of Specificity of Conditioning

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71
Q

Determinants of Intensity/Parameters/Methods

A

Heart Rate Method
Oxygen Consumption

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72
Q

Target HR (THR) = [(HRmax/peak − HRrest) × % intensity

A

HRR Method

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73
Q

Target VO2R = [( VO2max/peak − VO2rest) × % intensity desired + VOrest

A

VO2R Method

74
Q

Target HR = HRmax/peak × % intensity desired

75
Q

Target VO2 = VO2max/peak − % intensity
desired

A

VO2 Method

76
Q

Target MET = [( VO2max/peak) / 3.5 mL · kg−1 · min −1] × % intensity desired

A

MET Method

77
Q

The commonly accepted range of training heart rate is

A

70% to 85% of maximal heart rate or 50% to 85% of maximal oxygen consumption

78
Q

How to compute using the Heart Rate Method

A
  1. Monitor the pulse
  2. Compute Target Heart Rate (THR) using Karvonen’s
    Formula
79
Q

When using this method, the prescribed intensity should
be between 60% to 70% of the VO2max
● Equivalent to HRmax
● 60-70% VO2max = HRmax

A

Oxygen Consumption Method

80
Q

HRmax = 220 – age
● 60-80% (HRmax) for normal individuals
● <60% (HRmax) for cardiac patients

A

Maximum Heart Rate

81
Q

HRR = HRmax – HRrest
0-60% (HRR) for cardiac patients
60-80% (HRR) for normal individuals

A

HEART RATE RESERVE (HRR/HRReserve)

82
Q

Most preferred
% = tells the exercise intensity

A

TARGET HEART RATE (KARVONEN’S FORMULA)

83
Q

T/F: Exercise prescription is NOT effective if the patient is NOT reaching the THR

84
Q

THR Rating

THR = 80-95% (HRR) + HRrest

a. Normal
b. Athletes
c. Cardiac Patients

A

b. Athletes

85
Q

THR Rating

THR = 60-80% (HRR) + HRrest
a. Normal
b. Athletes
c. Cardiac Patients

86
Q

THR Rating

THR = 40-60% (HRR) + HRrest
a. Normal
b. Athletes
c. Cardiac Patients

A

c. Cardiac Patients

87
Q

Amount of oxygen consumed by the body to perform a physical activity at a given time

A

METABOLIC EQUIVALENT (MET)

88
Q

1 MET =

A

3.5 ml of O2 / kg of BW / min

89
Q

Cardiac Patient = –% of the maximally achieved METs on a graded exercise test

90
Q

MET Equivalent

Lying Quietly

91
Q

MET Equivalent

Walking 1 mph

92
Q

MET Equivalent

Sitting, writing

A

1.9 – 2.2

93
Q

MET Equivalent

Heavy housework

A

3.0 – 6.0

94
Q

MET Equivalent

Standing at ease

A

1.4 – 2.0

95
Q

MET Equivalent

Light housework

A

1.7 – 3.0

96
Q

MET Equivalent

Sitting at ease

A

1.2 – 1.6

97
Q

Adjunct to HR monitoring

A

RATE OF PERCEIVED EXERTION (RPE)

98
Q

In term of exercise prescription, if pt is still within this range of RPE (11-13) = –% of HRmax

99
Q

To improve aerobic and anaerobic capacity of the
body, progress RPE to?

A

Progress: RPE (14-16) = 70-90% of HRmax

100
Q

For athletes (Higher intensities = more challenging exercises) thus progress RPE to?

A

For athletes: RPE (17-20) = 90-100% of HRmax

101
Q

Most adults are recommended to accumulate
1. [?] min of moderate intensity exercise
2. [?] min of vigorous intensity exercise daily (or combination of moderate and vigorous intensity exercise)

A
  1. 30-60mins
  2. 20-60mins
102
Q

Exercise duration may be accumulated in one session or __ over the course of the day

A

in bouts of >10 min

103
Q

T/F: For weight management and individuals with sedentary lifestyles, longer duration of exercise (~60 min) may be needed

A

False
(>60-90 min)

104
Q

Statement 1: A 20- to 30-minute session is generally optimal at 60% to 70% maximum heart rate.
Statement 2: Intensity is below the heart rate threshold, a 45-minute intermittent exercise period may provide the appropriate overload.

a. TF
b. FT
c. TT
d. FF

A

a. TF
Continuous exercise

105
Q

Statement 1: With high-intensity exercise, 10- to 15-minute exercise periods are adequate
Statement 2: Three 5-minute daily periods are effective in some deconditioned patients

a. TF
b. FT
c. TT
d. FF

106
Q

Dependent on intensity & duration
↑ intensity or ↑ duration = ↓

107
Q

Aerobic exercise is recommended on __ for most adults, with the frequency varying with the intensity of exercise

A

3–5 d · wk−1

108
Q

Statement 1: Frequency may be a more important factor than intensity or duration in exercise training.
Statement 2: Optimal frequency of training is generally three to four times a week.

a. TF
b. FT
c. TT
d. FF

A

b. FT
Less important factor

109
Q

Frequency for in-patients

A

Daily (usually bid)

110
Q

Frequency of outpatients

111
Q

Frequency for exercise >5 METs

112
Q

Frequency for exercise <5 METs

A

Multiple daily sessions (usually bid)

113
Q

Moderate intensity aerobic exercise done at least __

A

5 d · wk−1

114
Q

Vigorous intensity aerobic exercise done at least

A

3 d · wk−1

115
Q

T/F: Duration is increased first before the intensity

116
Q

Progress intensity if:

A

HR is lower than THR
RPE is lower
Sx of ischemia do not appear

117
Q

Muscular strength may be maintained by training muscle groups as little as 1d * wk-1 as long as __?

A

The training intensity or the resistance lifted is held constant

118
Q

Using the FITT-VP, what is the recommended frequency for moderate exercise?

A

≥5 d * wk

119
Q

Using the FITT-VP, what is the recommended frequency for vigorous exercise?

120
Q

Using the FITT-VP, what is the recommended frequency for combination of moderate and vigorous exercise?

A

≥3-5 d * wk

121
Q

Using the FITT-VP, what is the recommended intensity for most adults?

A

Moderate and/or vigorous intensity

122
Q

Using the FITT-VP, what is the recommended intensity for deconditioned inviduals?

A

Light-to-moderate intensity exercise

123
Q

Using the FITT-VP, what is the recommended time for a purposeful moderate exercise?

A

30-60 min * d

124
Q

Using the FITT-VP, what is the recommended time for a purposeful vigorous exercise?

125
Q

Regular, purposeful exercise that involves [1] and is [2] in nature is recommended.

A
  1. major muscle groups
  2. continuous and rhythmic
126
Q

Target Volume recommended

A

≥500-1000 MET-min * wk

127
Q

T/F
Exercise may be only performed in one continuous session to reach the desired duration and volume of exercise per day.

128
Q

Phase in Cardiac Rehab

Requires closer monitoring
Checking if condition is really stable already

129
Q

Phase in Cardiac Rehab

Maintenance (lifetime)

130
Q

Phase in Cardiac Rehab

No longer in hospitals (out-pt set up)
Pt is already stable and D/C from the hospital

A

Phase 2 & 3

131
Q

Phase in Cardiac Rehab

Early Post-discharge

132
Q

Phase in Cardiac Rehab

Late Recovery Phase; Training and Maintenance Phase (Sustain)

133
Q

Phase in Cardiac Rehab

Long-term maintenance of exercise and other lifestyle changes

134
Q

Upon admission until discharge averagely lasts for?

135
Q

Name at least 3 Main Goals for Phase 1

A
  1. Offset the deleterious physiologic & psychological
    effects of bed rest
  2. Provide medical surveillance / monitoring
  3. Evaluate and prepare patients to safely return to ADLs within the limits
  4. Prepare the patient and support system at home or in a transitional setting
  5. Facilitate physician referral and patient entry into an outpatient cardiac rehabilitation program
136
Q

What are the indications for modifying the program?

A
  1. Large infarction
  2. Resting tachycardia (>100 bpm) or inappropriate HR increase with self-care ADLs
  3. BP failing to rise or decrease with self-care ADLs
  4. ECG revealing >6-8 PVC/min or progressive heart block with self-care ADLs
  5. Angina or undue fatigue with self-care ADLs
137
Q

What the contraindications for the program?

A
  1. Severe Pump Failure
  2. Recurrent malignant arrhythmias
  3. Angina at rest
  4. 2nd-3rd degree heart block
  5. Persistent hypotension (<90 mmHg) even with vasopressors (meds)
  6. Rapid atrial rhythm
  7. Unstable angina pectoris within 24 hours
138
Q

Whenever one of the following occurs, the event should be documented appropriately:

A
  1. Unusual HR increase
  2. BP indicative of HTN
  3. Drop in systolic BP
  4. Signs of pallor, cold sweat, ataxia
  5. Changing heart sounds/lung sounds with activity
  6. ECG abnormality,
139
Q

General Exercise Guidelines

Low intensity exercises (2-3 METs) → _ METs by discharge

140
Q

What is given prior to discharge and determines the maximum capacity of the pt?

A

Exercise Tolerance Test

141
Q

FITT Recommendation for Inpatients

Frequency

A

Mobilization: 2-4x.day for the first 3 days

142
Q

FITT Recommendation for Inpatients

Intensity for MI

A

Seated or standing HRrest +20 bpm

143
Q

FITT Recommendation for Inpatients

Intensity for Heart Surgery

A

Seated or standing HRrest + 30 bpm (with upper limit of ≤120 bpm

144
Q

FITT Recommendation for Inpatients

Time

A

Goal 2:1 exercise/rest ratio; can begin with 1:2, then 1:1, then 2:1

145
Q

FITT Recommendation for Inpatients

Type

A

Walking
Can be bedside ambulation then progress to hallway ambulation

146
Q

FITT Recommendation for Inpatients

Progression

A

Continuous exercise (10-15 min) Increase intensity (based on HR and RPE)

147
Q

In Cardiac ICU care, unconsious patients are recommended what exercise?

A

passive exercise

148
Q

In Cardiac ICU care, consious patients are recommended what exercise?

A

Acitve Assitive Exercises

149
Q

one of the most common problems in the ICU

A

Orthostatic Hypotension

150
Q

In Post-PTCA, when will exercise be appropriate?

A

Exercise after 2 weeks to allow inflammation process to subside

151
Q

In Post-CABG, what should be limited?

A

Limit UE exercise while sternal wound is healing (up to 90° shoulder elevation only)

Wound healing will take about 8-12 weeks

152
Q

In Post-CABG, what should be avoided?

A

Lifting, pushing, pulling or 4-6 weeks post-op

153
Q

CHF: Slight limitation in physical activities (up to 4.5 METs)

154
Q

CHF: Unable to carry-out functional activities without any discomfort or Sx

155
Q

CHF: Marked limitation in physical activities (up to 3.0 METs)

156
Q

CHF: Mild; slight limitation in physical activities (up to 6.5 METs)

157
Q

For Class 1-3 CHF, prescribe mostly __?

A

active exercises depending on the METs of the pt

158
Q

If FBG (fasting blood glucose) is > 250 mg/dL, exercise should be avoided until __?

A

blood glucose levels are controlled

159
Q

If FBG falls to <100 mg/dL, exercise should be __?

A

avoided and ask pt to take carbohydrate snack

160
Q

An insulin reaction in the acute stage due to abnormal low level of the blood glucose

A

Hypoglycemia

161
Q

Common symptoms of Hypoglycemia

A

confusion, sudden generalized weakness, irritability

162
Q

For CAD patients, non-pharmacologic management (PT exercises are included) is initiated if __?

A

LDL-C is >100 mg/dL

163
Q

For non-CAD patients, non-pharmacologic management is initiated if __?

A

LDL-C is >160 mg/dL

164
Q

Duration of Early Post-Discharge

A

2-12 weeks of out-patient program

165
Q

Goals in Early Post-Discharge

A
  1. Improve cardiovascular fitness to levels that allow resumption of usual activities
  2. Develop and assist the patient to implement a safe and effective formal exercise and lifestyle physical activity program
  3. Provide adequate supervision and monitoring
  4. Provide on-going medical surveillance data to the patient’s health care providers
  5. Return the patient to vocational and recreational activities or modify
  6. Provide patient and family education
166
Q

When to do Strength Training in Phase 2

cardiac rehabilitation

A

After 3 weeks cardiac rehabilitation

167
Q

When to do Strength Training in Phase 2

post MI

A

After 5 weeks

168
Q

When to do Strength Training in Phase 2

post CABG

A

After 8 weeks

169
Q

How to do Strength Training in Phase 2

A

Use elastic band and light weights (1-3 lbs initially)
12-15 reps, 1 set

170
Q

Usual exercise during Phase 2

A

Endurance exercises with the use of a treadmill, bicycle

Can also do strengthening and flexibility exercises

171
Q

FITT Recommendations for Phase 3

Frequency

A

At least 3 days per week

172
Q

FITT Recommendations for Phase 3

Intensity

A

HR below the ischemic threshold

173
Q

FITT Recommendations for Phase 3

Time

A

Warm-up/cool-down: 5-10 min
Exercise proper: 20-60 min

174
Q

FITT Recommendations for Phase 3

Type

A

Aerobic exercise (rhythmic, large muscle group activities)
Aerobic Internal Training (AIT)

175
Q

FITT Recommendations for Phase 3

Progression

A

Individualized

176
Q

Duration of Phase 3 (Late Recovery Phase)

A

Lasts up to 4-6 months
Less direct supervision

177
Q

PHASE III: LATE RECOVERY PHASE
Goals

A
  1. Increase exercise capacity further
  2. Reinforce steps for risk factor modification
  3. Provide fun and recreation
  4. Provide social interaction and support
178
Q

PHASE III: LATE RECOVERY PHASE
Done at the 6th month (To check for any changes on how the body reacts)

A

Exercise Tolerance Test

179
Q

PHASE III: LATE RECOVERY PHASE
Prescription

A

● RPE: 12-14
● 50-75% of functional capacity
● 20-45 min, lesser time because exercises are more
intense and advanced
● 3-5x/week

180
Q

PHASE IV: MAINTENANCE
Duration

A

Lasts indefinitely as the patient maintain a hearty and healthy lifestyle and dietary habits

181
Q

PHASE IV: MAINTENANCE
Goals

A

Patients will expend at least 1000 kcal/week (equivalent to 20 min walk everyday) with exercise for the development and maintenance of a desirable functional capacity

182
Q

In obesity, once an individual gains weight we can intervene by __

A

increasing their activity level

(3) Cardio-Pulmo-Renal Rehabilitation (34 decks)

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