Cardiac Rehab (week 5/6)

cardiac rehab phase 1

acute phase

cardiac rehab phase 2

healing and conditioning phase

cardiac rehab phase 3/4

maintenance / life long habits phase

general goals for phase 1 of cardiac rehab

prevent / reduce deconditioning, allow safe low normal functional activity progression, ensure appropriate response to exercise, basic understanding of educational components

when does deconditioning begin

after just 1 day of bed rest

how can you monitor a pt who needs cardiac rehab

look at signs and symptoms, RPE, and follow surgical precautions

what is the FITT exercise prescription method

frequency, intensity, time, and type

what is the general goal of phase 1.5 in cardiac rehab

improve function and endurance to allow discharge home or to no longer be home bound

where may phase 1.5 take place

post acute inpatient or home health rehab

where may phase 2 take place

outpatient setting

what are the general goals of phase 2 of cardiac rehab

improve level of CV functioning, modify CV risk factors, independent self-monitoring, recognition of safe activity limits, and improve awareness of CV disease

what providers may work with a patient in phase 2 of cardiac rehab

rn, exercise physiologist, PT, OT, MSW, with cardiologist supervision

what are eligibility requirements for cardiac rehab

MI in the last 12 months, coronary bypass surgery in the past 6 months, stable angina pectoris, heart valve repair in the past 6 months, coronary angioplasty or stent in the past 6 months, heart / combined transplant or LVAD, PAD< stable chronic heart failure

how much cardiac rehab can people do

36 sessions. Typically 2-3 per week for 12-18 weeks

what are education components in cardiac rehab

self monitor with exercise, diet / cooking, stress management, risk factor reduction, medications, energy conservation

where does phase 3/4 take place

outpatient or in the community

what are the goals for phase 3/4

introduction of independent aerobic endurance training program, adopt a lifestyle of physical activity and healthy lifestyle habits

CPET

helps to accurately diagnose etiology of exercise intolerance, measure outcomes, measures disease severity and progression, assess physiological response to physical stress, prescribe an exercise training program

key measures during CPET

ECG response, vital sign response, limiting symptoms, workload at symptom onset, peak VO2, anaerobic threshold, METs

what is a MET

a metabolic equivalent that is a unit of measure for physical work / exercise capacity, expressing workload in terms of oxygen consumption relative to rest

what intensity is aerobic training generally at

60-80%, RPE 12-16

what intensity is anaerobic / HIIT training generally at

>95%

what does isometric exercise do to pressures on the heart

it increases stress on the heart

does UE or LE exercises put more strain on the heart

UE

what does the HF CGP say about HIIT

physical therapist should use HIIT exercise with parameters in patients with stable HFrEF with NYHA class 2-3 sx.

what are the parameters for HF CPG HIIT

35+ minutes, 90-95% of peak VO2 or workload, 2-3x per week for 2-3 months, on the treadmill or cycle ergometer

what were the found benefits of HIIT

improved peak VO2 of 1.0-2.14 mL/kg/min above that achieved with moderate to vigorous intensity continuous exercise training and reduced mortality rate

key issues of HIIT

safety, patient selection, setting should be supervised

what is the rule of thumb for UE exercise

start at 50% of LE

why may UE exercise cause exaggerated response

it requires trunk isometrics for stabilization and typically gripping which increases strain on the heart and results in greater sympathetic stimulation.

UE exercise at an equivalent CO

greater HR with reduced SV due to reduced venous return because there is less muscle mass pumping

should you do cardiac rehab after the patient has had a meal

probably not since 70% of blood goes to the gut after eating so there is less blood to go to the existing muscles.

what should you consider with diabetics in cardiac rehab

ensure glucose levels are above 90, consider med/ timing/ and meals. watch for signs of hypo/hyperglycemia

why should you consider cold temperatures in cardiac rehab

there is vasoconstriction to retain heat which increases blood pressure

what should you consider in hot temperatures in cardiac rehab

there is vasodilation to dissipate heat which inceases CO to compensate for reduced BP

how should you educate cardiac patients about sex

there is no elevated risk of angina, MI, or arrhythmia during sexual activity in those with stable CVD since sex is only around 3-4 mets

what is a cardiac enhanced external counterpulsation

an LE + abdomne BP cuff distal to proximal during diastole where BP cuffs squeeze and force blood into the coronary arteries to improve coronary blood flow and reduce angina

how can bed rest impact PT treatment

there is a fluid shift and fluid decreases when we don't need it to so there may be a decrease in plasma volume and orthostatic function. Also risk for DVT/PE and deceased ventilation / perfusion.

what are some long term effects of bed rest

decreased exercise capacity, decreased orthostatic tolerance, decreased muscle strength, decreased GI function, and insulin resistance

what has the highest impact on physiology

mobilization and exercise training

when is cardiopulmonary physiologic function

when the patient is upright, against gravity, and moving

from highest to lowest what has the best stimulatory effect on oxygen transport

mobilization and exercise training, body positioning, active airway clearance, inspiratory muscle training, relaxation and energy conservation, postural drainage, suctioning

what is mobilization

utilizing the acute physiological responses to physical activity to prevent the effects of immobilization and inactivity

dosing of mobilzaition is

response dependent

how does mobilization impact the pulmonary system

increases distribution of ventilation and perfusion with associated increased diffusion. Increased mucociliary transport.

how does mobilization impact cardiovascular

increase HR/SV/CO?myocardial contractility, increase venous return, decrease peripheral resistance, increase organ and tissue perfusion

how does mobilization impact MSK

gravitational load or greater is needed to prevent bone and muscle mass loss

what is the purpose of exercise training

enhancing oxygen transport through physiologic adaptions to progressive, long-term activity

exercise training can help to

increase ventilatory muscle strength / endurance, myocardial function / efficiency, vagal / parasympathetic tone, muscle strength, aerobic capacity, anaerobic threshold, delay of onset of lactic acids

overall what does exercise training do

increase work capacity with decrease in actual and perceived CVP effort / response

what type of things are involved in exercise training

moderate to high intensity aerobic, anaerobic, or resistance exercise which seeks to induce long term effects and adaptions

why should strength training be included in cardiac rehab

to address biomechanical inefficiencies and increase the oxygen demand associated with a given activity

why does body position matter

the use of a gravitational stimulus can help to maximize hemodynamic and v/q responses

upright positioning can help

increase functional reserve capacity, improve tidal volume, greater AP diameter of chest wall, increased neural drive to breathe, decreased area of lung dependency, improved distribution of secretions in the airways, prevention of deconditioning effects. Overall decreased airway closure which improves ventilation and improved ability to mobilize secretions.

what is closing capacity

the lung volume at which alveoli collapse

low functional reserve capacity leads to

increased closing capacity and risk for atelectasis