Week 10 - Cardiac Rehabilitation Flashcards
Discuss exercise prescription and limitations for patients with Acute Coronary Syndrome
Have rescue medications available
Keep the intensity low, RPE 11-13?
Long, slow warm up and cool down
They may be on Beta-blockers
Discuss exercise prescription and limitations for patients with heart failure.
Low intensity, RPE 9-14
HRR 60-80%
Long warm up and cool down
Remember that they cannot increase their CO (because they can’t increase HR or SV very well)
What do beta-blockers do?
Slow the heart rate allowing the SV to increase
Open the blood vessels to treat hypertension/angina
Given post MI to prevent another one
Useful for cardiac arrythmias
Discuss exercise prescription and limitations for patients with pulmonary hypertension.
Lower intensity, 60% (of 6MWT speed?)
Borg Dyspnoea scale 3-4
Monitor leg fatigue
Interval training and rest days
List the non-modifiable (4), behavioural (4) and biomedical (4) risk factors for CVD.
NON-MODIFIABLE:
- Age
- Sex
- Ethnicity
- Family Hx
BEHVAIOURAL:
- Smoking
- Drinking
- Diet
- Inactivity
BIOMEDICAL -Obesity -High cholesterol -High BP Depression
Describe some things that should happen in phase 1, hospital care (4).
- Use first hospitalisation as a prompt for lifestyle change
- Educate patient and family about CVD disease prevention and management
- Offset the effects of bedrest
- Refer patient to a CVDPMP for phase 2
What happens in phase 1.5, immediately post acute (2-6 weeks at home before joining phase 2). (3 points)
- Education of how to keep the heart healthy and strong
- Monitoring the patient’s progress
- Low level exercise and instructions for resuming (or starting) an active lifestyle
What happens in phase 2, post acute? (4 points)
- Begin a safe, monitored exercise programme
- Increase exercise tolerance
- Educate patient to self-monitor
- Continue to educate
What is the broad structure of an outpatient cardio exercise program?
- Supervised outpatient program of 3-6 months
- Group based exercises + home based program
Describe the maintenance phase (phase 3) (3 points)
- lifetime maintenance program
- no supervision or medical interventions required, just exercise in community centres or at home
- aim to sustain a life long habit of activity and healthy behaviours
What are some absolute contraindications to exercise testing and training? (6 points)
- Deteriorating - exercise tolerance/dyspnoea getting worse
- Unstable angina/ischaemia at low intensities
- Hypoglycaemia
- Fever/illness
- New atrial fibrillation
- Resting HR >120
What are some relative contraindications/precautions to exercise training? (7 points)
- Increase in mass (2kg in 1-3 days)
- Decrease in systolic BP with exercise
- NYHA IV, or deterioration to a III
- Complex arrythmias at rest or appearing with exertion
- Resting HR >100
- BP >180/110
- BP
What are the maximal tests used for cardiopulmonary exercise?
EST - Exercise stress test - a graded test where you push someone until you induce an event (angina, arrythmia, exercise induced MI or abnormal BP)
CPET - Cardiopulmonary exercise test - list EST but attached to a mask so you can measure oxygen consumption. Useful for heart failure and to stratify for cardiac transplants.
What are the sub-max/field tests for cardio?
Submax bike or treadmill - terminated at a pretenrmined HR
6MWT
Shuttle test
Outline exercise prescription for cardiac patients: Mode Intensity Duration Frequency and progression.
Mode: Anything using the large muscle groups
Intensity: HRR of 0.6 to 0.8, or 11-13 on the RPE scale or 80% of 6MWT
Duration: 15 - 60 mins continuous. (3x5mins if needed)
Frequency: 3x/week, aiming for 5-7
Progress duration, the frequency then intensity.
