Cardiac Rehabilitation Phase II - IV

10/6/99


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Cardiac Rehabilitation Phase II - IV

Phase II

It begins after discharge from the hospital.

Goals Of Phase II Cardiac Rehab

Increase the patientís 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 patientís 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

Karvonenís Formula

With Mrs. Springerís Data...

Mrs. Springerís 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 togetherÖ. 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.

Author: Microsoft Corporation

Email: David.Arnall@NAU.EDU , DAArnall@AOL.COM

Home Page: http://jan.ucc.nau.edu/~daa/heartlung/

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