NPTE - CP Rehab Guidelines

Phase I of Cardiac Rehab

Setting: Acute care/IPR

Duration: hospital stay (3-5d)

Goals: prevent deconditioning, early mobilization

Phase II of Cardiac Rehabilitation

Setting: OP/supervised

Duration: 6-12wks

Goals: Improve aerobic capacity, monitor response

Phase III of Cardiac Rehab

Setting: Community-based

Duration: Long-term

Goals: Maintenance, lifestyle I

Key activities in Cardiac Rehab Phase I

Bed mobility

Transfers

Short hallway walks

Pt ed

Key activities in Cardiac Rehab Phase II

Monitored aerobic exercise

• treadmill

• bike

• UE ergometer

Key activities in Cardiac Rehab Phase III

I gym/home program

unsupervised but guided

Cardiac pt target frequency

3-5x/wk

Cardiac pt target intensity

40-80% of VO2max/HRR

RPE 11-14

Cardiac pt target time

20-60mins

Cardiac pt target type

Large mm groups

Rhythmic

Pulmonary pt target frequency

3-5x/wk

Pulmonary pt target intensity

RPE 11-13

may use dyspnea scale

Pulmonary pt target time

20-30mins initially

Pulmonary pt target type

Walking

Cycling

Arm ergometry

Karvonen formula for target HR (if not on beta-blockers)

[(HRmax-HRrest) x %intensity] + HRrest = target HR

HR response

Normal: increase 10-20bpm with exercise

Red flag: drop > 10bpm / bradycardia

BP response

Normal: SBP increase 10-20mmHg / MET

Red flag: drop in SBP > 10mmHg = STOP

SpO2

Normal: >90%

Red flag: <88% = STOP (esp in COPD pts)

RPE scale

Normal: 11-14 (light-mod)

Red Flag: >15 = too high for cardiac rehab

RR (resting)

Normal: 12-20 breaths/minute

Red flag: >35 at rest = abnormal

Absolute contraindications to exercise

Acute MI (<2d)

Unstable angina

Uncontrolled arrhythmias

Uncontrolled CHF

Severe aortic stenosis

Acute PE/DVT

Uncontrolled diabetes/HTN

Resting SBP > 200 / DBP > 110

Relative contraindications to exercise

Tachyarrhythmias

High-degree AV block

Orthopedic impairments limiting exercise

Recent surgery/wound dehiscence

Pursed lip breathing

Improves exhalation

Decreases air trapping (COPD)

Diaphragmatic breathing

Promotes efficient ventilation

Segmental breathing

Improves regional chest expansion

Postural drainage

Drain bronchopulmonary segments

Percussion and vibration

Loosen secretions

active cycle of breathing

control breath —> thoracic expansion —> huffing

Incentive spirometry

Prevent atelectasis post-op

6 minute walk test

Ftnal endurance

Pre/post comparison

Borg RPE and dyspnea scales

Monitor exercise intensity and breathing load

Tinetti, TUG, Berg

Fall risk and balance (especially Phase II/III)

CPET (VO2max)

Determines aerobic capacity (gold standard)

Pt education topics

Sternal precautions post-CABG

Importance of warm-up and cool-down

Early signs of angina, heart failure, and hypoxia

Energy conservation techniques (esp. pulmonary pts)

Smoking cessation, diet, stress management

Boards tips

Always check vitals before, during, and after therapy

Phase I HR limit post-MI: <120bpm / HRrest + 20bpm

Sternal precautions: no push/pull > 10lbs, no arms above shoulders for ~ 6wks

Use Borg RPE scale for patients on beta blockers

Monitor for orthostatic hypotension in early mobilization

SpO2 <88 = stop exercise for COPD (may require oxygen titration)

Inspiratory mm training: effective in CHF and COPD pts

Avoid isometric exercises in cardiac pts - increases afterload