(ExRx) CHAP 7- Clinical Exercise Programming

• Benefits

  • Functional capacity improvements

    • 10%-30% cardiorespiratory fitness

  • Disease-related behaviors

  • Reduced subsequent heart-related serious events

    • Approximately 30%-40% reduction in risk of serious clinical event for each 1 MET increase in fitness

  • Reduced risk of death

• High-intensity interval training

• Participation

  • Referral rate high

  • Enrollment and adherence rates low

• Discussion of diet, stress, exercise and medications with pts

• High intensity interval training, if able to handle it and offered

cardiac rehab program effectivness

How many phases are there for cardiac rehabilitation?

3

Whats phase 1 of cardiac rehab? (5 key points)

• inpatient

• discussion with physician

• visit from staff (clinical exercise physiologists, nurse or pt)

• referral to phase 2

• ambulation and education in preparation for discharge

Whats phase 2 of cardiac rehab? early outpt (6 key points)

• outpatient (hospital or clinc)

• intake assessment

• individualized treatment plan (ITP) developed and implemented

• exercise 2-3 times/wk

• ECG telemetry monitoring as needed

• education about risk factor modification and other secondary prevention

Whats phase 3 of cardiac rehab? maintenance (4 key points)

outpatient (hospital, clinic or fitness center)

continuation of risk factor modification and prevention

encouragement and reinforcement of independence

ECG telemetry not used

what are the phases of cardiac rehab? (4 keypoints)

pt has cardiac event then referred by physician

pt is evaluated and ITP developed by CR team, physician signs off of it

pt participates in program and ITP is updated every 30 days

physician approved ITP until program ends

• Typically referred after cardiac event requiring hospitalization

• Insurance requires a diagnosis

  • Exercise Prescription developed and updated regularly

  • Signed monthly by physician

  • Part of medical record

• Daily discussions

• Individuals with cardiac disease benefit from participation in regular exercise and lifestyle change. 

• Cardiac rehabilitation (CR) is commonly used to deliver exercise and lifestyle interventions.

  • reduce risk for future events, 

  • foster healthy behaviors and compliance to these behaviors, reduce disability, and promote an active lifestyle for patients with cardiovascular disease (CVD)

• Have to have a diagnoses

• Stress testing may catch heart disease

cardiac rehabilitation program policies

• Acute Coronary Syndromes (ACS)

  • Angina, MI, or sudden death

• Cardiovascular Disease (CVD)

  • Involves heart and/or blood vessels

  • Hypertension, CAD, PAD.  Includes but not limited to atherosclerotic arterial disease.

• Cerebrovascular disease (Stroke)

  • Disease of blood vessels that supply brain

• Coronary Artery Disease (CAD)

  • Disease of arteries of heart (usually atherosclerotic)

• Myocardial Ischemia

  • Temporary lack of coronary blood flow to myocardial O₂ demands. Often manifested as angina.

• Myocardial Infarction (MI)

  • Injury/death of muscular tissue of heart

• Peripheral Artery Disease (PAD)

  • Disease of blood vessels outside heart and brain

conditions and procedures covered by insurance

angina, MI, or sudden death

Acute Coronary Syndromes (ACS)

• Involves heart and/or blood vessels

• Hypertension, CAD, PAD.  Includes but not limited to atherosclerotic arterial disease.

Cardiovascular Disease (CVD)

Disease of blood vessels that supply brain

Cerebrovascular disease (Stroke)

Disease of arteries of heart (usually atherosclerotic)

Coronary Artery Disease (CAD)

Temporary lack of coronary blood flow to myocardial O2 demands. Often manifested as angina.

Myocardial Ischemia

Injury/death of muscular tissue of heart

Myocardial Infarction (MI)

Disease of blood vessels outside heart and brain

Peripheral Artery Disease (PAD)

• The myocardium relies on ATP for contraction.

• In the heart, 40% of the muscle cells are mitochondria.

• At rest, the body extracts 25% of the oxygen present in arterial blood.

• Even at rest, the heart muscle extracts 75% of the O2 delivered to it.

heart disease and stroke pathophysiology

• Early outpatient (phase 2)

  • 2-3 days/wk

  • Aerobic machines

  • Single-lead ECG

  • Some may have a stress test prior to participation

  • “Rule of thumb” heart rate: 20-30 beats over rest or RPE

  • Sandwich bouts of exercise (10-20 min) between warm-up and cool-down

  • Evaluated daily for intensity

• Maintenance (phase 3)

• % HR reserve

cardiac rehabilitation program structure and process