Transcript Cardiac rehabilitation phase II

Cardiac rehabilitation phase II
Dr. Rrhab F. Gwada
Phase II
• Phase II is the next stage in cardiac rehabilitation for
the patient.
• It usually occurs in a hospital setting where the patient
can be constantly monitored.
• Supervised outpatient program 12 wks
• Patient education on HR, exercise, symptoms
• encourage a gradual increase in overall exercise
performance.
Safety
It obtains through:Selection of appropriate patients.
Proper monitoring.
All professional exercise personnel must be
able to do basic life support, including
defibrillators.
Emergency procedures must be specified.
Warm up and cool down are required .
Goals
 Increase the aerobic
capacity of the patient so
improve stress tolerance.
 Lower HR and SBP at the
same
sub
maximal
workload.
 Reduce exercise induced
extra systoles.
 Decrease total body fat.
 Reduce occurrence &
frequency of angina and
cardiac symptoms.
 Reduce depression.
 Improve quality of life
Parts of Phase II
Educational sessions. (food preparation,
medications, smoking cessation, sexual
activity, cardiopulmonary anatomy, risk
factor modification and what to do when
symptoms return)
 Exercise sessions.
Home program.
Others as indicated
The patient is monitored during
Phase II with :
Blood pressure
Heart rate
Telemetry EKG
Anginal scale
Dyspnea scale
Borg scale
Pre-requisites
symptom-limited exercise
Testing Prior to starting
program
to determine maximal
HR(MHR)
to exclude important
ischemia, symptoms, or
arrhythmia that would
alter the therapeutic
approach.
Exercise Testing Data is comprised of :
• Resting HR
• Resting blood pressure
• Maximum exercise heart rate
• Maximum exercise blood pressure
• Maximum MET’s achieved.
Exercise protocol
exercise session phases
warm
up(10 min)
Callisthenic
Stretching
(20-40min)Conditioning or training
phase
Aerobic
Light
isometric
cool
down(10
min)
Callisthenic
Stretching
H/w
• What is the Callisthenic ex., give examples,
and explain its effect on cardiac patients?
The benefits of warm up :
For gradual circulatory adjustment.
To decrease the incidence of arrhythmia.
To modify the muscle temperature to prepare
the muscles for more vigorous ex.
To minimize oxygen deficit and lactic acid
accumulation
Cool down benefits :
To maintain the systemic blood flow at a level
that doesn't increase the myocardial O2 demand.
Allow adequate circulation to enhance removal of
lactic acid so hastens recovery.
Enhancing venous return by the massaging effect
of contracting and relaxing muscles on the veins.
The ventricle filling increased and stroke volume
is augmented in accordance with frank. Starling
law.
sudden stop of vigorous ex can lead
to
Increase the myocardial O2 demand by creating
left ventricle volume overload.
Venous Pooling in L.L.
Decrease venous return to heart and
compensatory increase of H.R.
Hypotension and decrease blood flow to brain.
Light headedness and dizziness are possible.
The possibility of muscle soreness following ex.
Exercise prescription
• Exercise intensity should be individually prescribed
so that target heart rate (THR) is 60-75% of its
maximum heart rate.
• Or 10-15 beats/min below the heart rate at which
any exercise-induced symptoms may occur.
• An alternative approach is to describe training heart
rate at 40-65% of heart rate reserve (HRR)
HRR= MHR-RHR
THR= (MHR-RHR) X exercise intensity+ RHR
Maximum Heart Rate
• Estimated as 220 minus the age in years
(predicted MHR).
• Maximum heart reached at peak exercise
during a symptom-limited exercise tolerance
test.
Exercise prescription
• Mode ( aerobic dynamic or light isometric)
• Determined by the patient’s pathology stationary bike, treadmill ,…..
• Frequency: Usually 3 times per week for 12
weeks.
• Duration: at least 20 minutes and preferably
30 to 40 minutes of aerobic activity.
Contraindication for resistance
training
Abnormal hemodynamic responses with
exercise
Ischemic changes during graded exercise
testing
Poor left vent. Function
Uncontrolled hypertension or arrhythmia
Exercise capacity less than 6 METs
Any Q?