1
T/F: Cardiac rehab results in reduced all cause mortality by 20-34%?
True
Which cardioprotective effect:
- Depression
- Stress
- Increased social support
Psychologic
What is the frequency of therapy for cardiac rehab?
2-3x/week for 6 weeks
Which cardioprotective effect:
- Myocardial O2 demand
- Coronary flow
- Decreased endothelial dysfunction
Anti-ischemic
- Pre-set daily mobility progression
- More outdated concept (surgical/non-surgical rx, research evidence, LOS)
Step wise approach
Which cardioprotective effect:
- Platelet adhesiveness
- Fibrinolysis
- Decreased fibrinogen
- Decreased blood viscosity
Antithrombotic
How many percentage of patients are eligible for cardiac rehab due to the area they live in or insurance?
15-25%
Which cardioprotective effect:
- Vagal tone
- Decreased adrenergic activity
- HR variability
Anti arrhythmic
Which cardiac phase?
Focus on walking, functional things you need to be able to do.
Phase I
How many METs is going to the bathroom?
3
Which cardioprotective effect:
- Lipids
- BPs
- Decreased adiposity
- Increased insulin sensitivity
- Decreased inflammation
Anti atherosclerotic
What is the average LOS in the hospital after open heart surgery?
3 days
Name the sternal precautions
1. No shoulder abduction/horizontal abduction
2. Shoulder flexion to tolerance
3. No pushing or pulling
4. No lifting more than 5-10 pounds
5. Missionary position only
6. No driving or being in the passenger seat
- Current approach (all phases)
- Usually MET based
Symptom limited approach
Which muscle will be extremely tight in phase II of cardiac rehab after having the sternal precautions for 6 weeks?
Pecs
Inpatient phase
- Involves PT, RN, aides, and pts family
- V.S monitoring is critical
- D/C goal: up to 4 MET tasks (55-65% HR max)
- RPE 2/10 or BORG 11-12 = "fairly light"
- 3-8 mins ther ex; 3-8 mins rest; 5-6 exercises
- Amb 5-10 mins in halls/2-3x a day
- Amb 4 stairs - 1 flight of stairs (limit trips/day)
- Patient education and independent on precautions and any AROM ther ex
- Teach/independence with self monitoring own pulse - esp. if A fib risk
- Independent with breaking devices (IS, acapella)
- Phase ends when patient is discharged or transferred
Phase I: Reduce risk ***
- Sleeping
- Watching TV
- Writing, desk work, typing
- Walking, 1.7 mph, level ground, strolling, very slow
- Walking, 2.5 mph
Light intensity activities (MET <3)
Upon hospital d/c, patient reached:
- 5 min activity tolerates 55-65% HR max
TO initiate phase II
- If s/p CABG, valve repair, or heart transplant
- Usually starts 3-4 weeks post op (no complications)
- Possibly 6 weeks out if complications/prolonged hospitalization
- If s/p MI (stent or not)
- Usually 1-2 weeks post onset
- Possibly 4 weeks out if extensive MI damage
Between phase I and phase II
Outpatient "self monitoring" phase
- May have cardiac rehab staff or be in a community center
- Only monitoring is that done by the individual
- Program goal: 7-8 MET activities
- 75-90% HRmax
- RPE 5-7 or 15-17 BORG = "hard -- very hard"
- 30 min sustained intensity
- Jogging @ 5 mph w/slide grade; cycling @ 12 mph
- Functionally: resume all recreational activities without limit
- Monthly fees; no insurance coverage
Phase III: increase activity
What (3) things happen from the time the patient went home from hospital to when they start cardiac rehab?
1. There should be exercise packet given from hospital
2. Usually active ROM exercises
3. No resistance exercises ** Heart needs to relax for a little while
Outpatient "monitored" phase
- Involves RN. LPN, Dietician, an/or exercise physiologist
- Initial v.s monitoring as based on risk stratifications
- Program goal: 6 MET activities
- 70-80% HR max
- RPE 3-4 or BORG 13-14 = "somewhat hard"
- 5 min progress to 30 min sustained aerobic ex
- Progression in intensity and duration
- Arm/leg bicycle, treadmill, stairmaster, free weights
- Functionally: 30 mins amb and 1-2 stair flights without SOB
- Phase lasts 6-12 weeks (depending on insurance/co=pays)
Phase II : reduce risk
Community based phase
- Optional phase
- At least 3 months s/p cardiac surgery or event
- No monitoring
- Focus is maintaining gains from previous stage
- 75-90% HR max (65-85% Vo2 max)
- > 7-8 METs +
- 30 up to 50 min sustained intensity as previous stage
- Swim laps; golf 18 holes without cart; cross country ski
- Monthly fees; no insurance coverage
Phase IV: Increase activity
- Jogging, general
- Calisthenics (EX: pushups, sit ups, pullups, jumping jacks) heavy, vigorous effort
- Running, jogging in place
- Rope jumping
- MET level reached
- Max RPE attained
- Maximum HR attained
- BP reading at max HR
- Total duration tolerated
- Any EKG findings/changes
- Signs/symptoms exhibited
- If graded testing was terminated
GXT information provided (interpreting GXT results)
- Bicycling, stationary, 50 watts, very light effort
- Walking 3.0 mph
- Calisthenics, home exercise, light or moderate effort, general
- Walking 3.4 mph
- Bicycling, <10 mph, leisure, to work or for pleasure
- Bicycling, stationary, 100 watts, light effort
Moderate intensity activities (MET 3-6)