Cardiac Rehabilitation Phase II - IV
Phase II
It begins after discharge from the hospital.
Goals Of Phase II Cardiac Rehab
Increase the patient’s work capacity through exercise conditioning
Teach the patient to monitor their own responses to exercise - monitor HR and learn to use subjective feelings to assess work intensity - use of the Borg Scale
Relieve anxiety and fear : reassure the patient that they can live a more normal life
Phase II continues to be a time for patient education - seminars on food preparation, medications, smoking cessation, sexual activity, cardiopulmonary anatomy, risk factor modification and what to do when symptoms return
The patient is monitored during Phase II with :
Blood pressure at rest should be less than 160 mm Hg at rest.
EKG rhythms that prevent exercise in Phase II :
3rd degree AV block
Anginal Scale
Dyspnea Scale
Borg Scale
The Exercise Program
Mode is also determined by the intensity or level of monitoring required for the patient’s well being.
Frequency
Duration Of Exercise Bout
Cool-down periods are important
When cool-downs are too short or non-existent, cardiac events are more likely to happen at the end of vigorous aerobic exercise.
Intensity
GXT Data
Rate of Progression
Using The GXT Data
Example GXT Data
Karvonen’s Formula
With Mrs. Springer’s Data...
Mrs. Springer’s exercise intensity will be no greater than 135 bpm for the first 1-2 weeks of Phase II cardiac rehab.
As she develops more aerobic capacity, stronger and more endurant musculature, then the intensity can be gradually increased.
A Reasonable Rate Of Progression
After 12-Weeks Of Phase II, What Next ?
Phase III Cardiac Rehab
Personnel present in a Phase III program are the exercise leader and a nurse with a crash cart
Monitoring may involve :
Fifteen minutes of stretching and light exercises will begin the exercise session
Cool-down is a much lower level of exercise activity decelerating to a slow, ambling walk and followed by a few minutes of stretching exercises.
In Phase III, the patient is largely responsible for self monitoring HR, subjective feelings and symptomatology.
Currently, re-imbursement from insurance is variable. Many times the patient must sustain the cost.
Phase IV Cardiac Rehab
Ray Blessey, PT runs a biking club where his Phase IV cardiac patients get together on Saturdays and ride 100 miles together…. a social event mixed with exercise.
The Phase IV club experiences could involve swimming, badminton, tennis, walk-jog, biking, hiking, Tai-Chi in the park, etc.
Email: David.Arnall@NAU.EDU , DAArnall@AOL.COM
Home Page: http://jan.ucc.nau.edu/~daa/heartlung/
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