OT MIRI: Cardiac Rehabilitation and MET Levels

At what MET level are patients discharged from phase 1 cardiac rehab?

MET levels 1-3

discharged at 3.5 METS

MET level

(The Metabolic Equivalent for Task) refer to the amount of energy it costs to complete a task as indicated by the amount of oxygen it requires

-OT must compare the exertion required for different activities to determine the appropriate level and progression of intervention

What type of training/muscle activation should be avoided for phase 2 cardiac rehabilitation?

Isometric training because it increases oxygen demand

At what MET levels should phase 2 cardiac patients be working?

4-5

MET Level 1 activities

rest

waking up

MET Level 1.5-2 activities

Transfers

Playing cards

Sitting while on computer

Standing

Walking slowly

Bed mobility

Bathing, grooming, feeding while seated

Card games, sewing, desk work, knitting, drawing.

MET Level 2-3 activities

Seated sponge bath (only warm)

Dressing/Undressing

Dusting

Light wood working

Washing dishes

Play instruments like guitar

Seated showers (temperature control)

Dressing!!!!

Washing the dishes, dusting, preparing a light meal.

Why should patients avoid raising arms during cardiac rehab

Raising the arm is more intense then LE movements, so avoid over head movements for longer periods of time until pt. Progresses.

MET level activities 3-4

standing to take a shower

making the bed

sweeping

mopping

-ADL: Standing warm shower, bowel movement on the toilet, climbing up the stairs.

-IADL: Light gardening, making a bed, sweeping, mopping, cleaning windows.

At what MET level can a patient take a hot shower

4-5

MET level activities 4-5

Hot standing shower

Golf, carrying your own clubs

Badminton

Table tennis

Dancing

Light carpentry

changing bed linens

raking/weeding garden

Walk up stairs

Mop

Garden

Ride a bike

Use a normal toilet

At what MET level can sexual activity resume

5-6

MET level activities 5-6

Can have sex at this level

Make your own bed, change linens

Shoveling/digging

MET level activities 6-7

brisk walking

MET level activities 7-8

Jogging

MET level activities 8-9

running

MET level 10

fast running

phases of cardiac rehab

3 phases

cardiac rehab: phase 1

acute inpatient rehab/hospitalization (begins after cardiac event/surgery)

1) vital signs

2) patient + family education

-energy conservation

-work simplification

-cardiac + postsurgical precautions

-guidelines for appropriate activity levels

3) improve self care activities (ADL)

-low level activities

4) discharge to phase II at MET 3.5

cardiac rehab: phase 2

outpatient rehab/convolasence (3.5+ MET); once patient has left hospital

1) build up activity tolerance

2) improve IADL

3) graded exercise program

4) improve ability for occupational roles + work activities

*avoid isometric training or anything that requires breath holding

*continue to educate on energy conservation/work simplification

cardiac rehab: phase 3

maintenance: community exercise programs

1) less intense, monitored exercise program

2) not covered by medicare

3) eg. support groups, community-based programs

4) IADLs, work, and community reintregration

5) continue education on energy conservation and work simplification for lifelong maintenance