cardiac rehab

--Total oxygen consumption (VO2) = oxygen consumption of entire body
--Myocardial oxygen consumption (MVO2) = oxygen consumption by heart, can be measured by cardiac cath
--Rate Pressure Product (RPP) = SBP x HR = work required of heart
--Cardiac Output (CO) = HR x stroke volume
--MET: 1 met = 3.5 ml O2 consumed per kg wt per minute

--Benefits of cardiac rehab: improved exercise tolerance, symptoms, and cholesterol, reduction of smoking, stress reduction, reduced mortality

--Absolute contraindications to exercise training:
• Unstable angina
• Resting SBP > 200, DBP > 110
• Significant drop (20) in SBP
• Mod to severe aortic stenosis
• Acute illness
• Uncontrolled atrial or ventricular arrhythmia
• Uncontrolled tachycardia
• Symptomatic CHF
• 3rd degree heart block w/o pacemaker
• Active pericarditis/myocarditis
• Recent embolism
• Thrombophlebitis
• Resting ST displacement > 3mm
• Uncontrolled DM
• Orthopedic restrictions

--Activities to avoid during acute period of rehab (CCU): isometrics (increases HR), valsalva (causes arrhythmia), raising legs above heart (increases preload)

--Graded exercise stress tests (GXT) = assesses ability to tolerate increase stress  functional rather than diagnostic tool, can give risk stratification and limits for therapy
--For GXT, heart rate limit is 130-140 BPM
--Most ADLs in home require < 4 mets
--Benefits of cycle ergometer over treadmill: less space, less cost, minimized movement of arm and thorax for better recording, but treadmill is more physiological
--Arm ergometer used in LE amputees
--Bruce Protocol: exercise testing on treadmill with stages of 2-3 mets each

Cardiac Functional Classification:
--Class I: can do >= 7 mets
--Class II: can do >= 5 mets, < 7 mets
--Class III: can do >= 2 mets, < 5 mets
--Class IV: can do < 2 mets only

--Exercises for cardiovascular conditioning: isotonic, rhythmic, aerobic
--Small isometric component for cardiac patients
--Resistance exercises are safe and effective for improving strength and CV endurance in low risk patients  increases aerobic capacity of both Type I and Type II fibers
--Contraindications to resistance exercises: CHF, uncontrolled arrhythmia, severe vascular disease, uncontrolled HTN, SBP>160, DBP>100, aerobic capacity < 5 mets
--Optimum O2 consumption during exercise: 55-65% max VO2, 70% max HR  exercise 20-30 mins
--Borg scale: rating from 6-20 of perceived exertion

--Heart transplant: higher resting heart rate, lower peak exercise heart rate
*Monitor ECG changes during exercise testing b/c no angina

--Greatest % increase in energy for ambulation for amputees is for bilateral AK with prostheses (280%): 3 mets to 11.4 mets
--50% increase for no prosthesis with crutches
--50% increase for hemiplegic ambulation

--For >7 mets maximum work load, patient can do any job
--For >5 mets, patient can return to sedentary job and household chores