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Exercise Prescription for Cardiac Patients

Exercise Prescription for Cardiac Patients. Inpatient Programs. Benefits:. Risk Factor Modification Activity Counseling Patient and Family Education. Major Components of Cardiac Rehab:. Assessment of functional tolerance to activities of daily living

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Exercise Prescription for Cardiac Patients

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  1. Exercise Prescription for Cardiac Patients

  2. Inpatient Programs

  3. Benefits: • Risk Factor Modification • Activity Counseling • Patient and Family Education

  4. Major Components of Cardiac Rehab: • Assessment of functional tolerance to activities of daily living • Emphasis on patient counseling and Education

  5. Activities during the first 48 hr. following MI or Cardiac Surgery • Self Care Activities • Arm and leg range of motion movement • Low Resistance activities

  6. Optimal Dosage of Exercise Depends on: • Medical History • Clinical Status • Symptoms • Patients should not have ischemia during exercise

  7. Intensity: • RPE less than 13 • To tolerance of asympotamic • Duration: • Intermittent bouts of 3-5 min. • Rest periods shorter than exercise bout • 20 Min total duration

  8. Frequency: • 1-3 days after the surgery, exercise 3-4 times per day • On day 3, exercise 2 times per day • Progression: • Increase to 10-15 min of continuous exercise, then increase intensity

  9. Goal: Exercise Capacity of 4-5 METS by hospital discharge.

  10. Before Discharge, Patient should have knowledge of: • Activities that are inappropriate or excessive • a safe progressive plan of exercise • optimal risk reduction

  11. Outpatient Programs

  12. Goals of Outpatient Program • Provide appropriate patient supervision to ensure detection of problems. • Return patient to pre-morbid vocational and/or recreational activities. • Develop and help patient implement safe and effective home exercise program and lifestyle. • Provide patient and family education.

  13. Onset of angina or other symptoms Plateau or decrease in systolic blood pressure Systolic >240mmHg Diastolic >110mmH Radionuclide evidence of LV dysfunction Increased frequency of ventricular arrhythmias Significant ECG disturbances (2 or 3 degree AV block, atrial fibrillation, etc.) Other signs/symptoms of intolerance to exercise Some Signs and Symptoms..

  14. Determining Amount of Exercise • Plot the exercise test data to determine relationships between VO2, HR, and RPE • Know when myocardial ischemia occurs during exercise so patient can exercise below the anginal or ischemic threshold • Peak exercise HR 10 bpm below the threshold is appropriate • Consider medication effects and characteristics that place patient at risk

  15. Increase in exercise every 1 to 3 weeks Goal of achieving 20 to 30 minutes of continuous exercise before progressing intensity Those with PVD should aim for 10 to 15 min. continuous ex. Goal of 5 METS at hospital discharge For those with lower exercise capacity, use intermittent exercise programs Outpatient Rate of Progression

  16. Types Of Outpatient Programs • Goal: Progression toward an independent self-managed program • Some patients may need to stay in a clinically supervised program • Most patients should participate in a clinically supervised program at least 3 months • Phase 2 and Phase 3 programs

  17. Functional Capacity 8 Mets or greater Appropriate hemo- dynamic response to exercise Appropriate ECG response at peak exercise Cardiac symptoms stable or absent Adequate management of risk factor intervention strategy and safe exercise participation Demonstrated know-ledge of the disease process, signs, etc. Demonstrated compliance Guidelines for Progression to Independent Exercise

  18. Resistance Training • May not be appropriate for those with: *Congestive Heart Failure *Severe Valvular Disease *Uncontrolled Arrhythmias *significant left ventricular dysfunction

  19. Start 4-6 weeks into supervised cardiorespiratory endurance exercise program Use elastic bands, light handweights, or resistive tubing to add variety Monitor heart rate and ECG continually When should you use resistance training?

  20. Exercise Endpoints • Rate Pressure Product should not exceed that during prescribed endurance exercise or that achieved during a Graded Exercise Test • Endpoints should be consistent with those outlined in ACSM Guidelines (p.97) for termination of a GXT

  21. Four to six weeks after Myocardial infarction One to two weeks following PTCA or other revascularization procedure without MI Four to six weeks in supervised aerobic program or completion of phase II Diastolic blood pressure <105mmHg Peak exercise capacity of > 5 METS Indications for Resistance Training for Outpatients

  22. CABG or valvular surgery PTCA, MI, or angina Silent ischemia Severe LV dysfunction and CHF Pacemakers Heart transplant Special considerations:

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