INPATIENT PHASE
TOTAL DURATION :-6-14 DAYS
1 to 7 in ICCU and 8 - 14 in the wards.
Need to maintain ROM of all joint and to avoid problems associated with orthostatic hypotension and thromboembolism.
Before starting the rehabilitation program evalaution and patients education is necessary.All viatls should be stable.Any change in systolic and diastolic pressure during exercise.systolic drop greater than 10mmHg or increase in pressure greater than 30 mmHg immediately stop the exercise.Check for HR changes and complaints like dizzeness,sightedness or angina.
Haemodynamic monitering necessary before and after exercises.
LEVEL 1:-1.5 METs
Essentially Bed rest and bed exercises.
Arm movement and ankle pumps.
Introduction and education of cardiac rehabilitation program.
SLR,heel slides.
LEVEL 2:-1.5-2 METs
Limited Room Abulation activities are allowed.
Sitting 15 - 30 min ,2-4 times /day.
Leg exercise -ankle pumps,SLR,heel slides.
Knee extention in sitting,sit to stand.
ADLs like shaving,ambulation til toilet attached to room.
Identification of CAD risk factors.
LEVEL 3:-2-2.5 METs
Limited Hall Ambulation are allowed
Independent or assisted walking continue slowly upto 5 mins are allowed for 3-4 times a day.
Continuining the bed exercise and ADL.
Bathroom privileges allowed.
Borg's scale used by P.T. for rating of Perceived Exertion and appropriate parameters with activity.
LEVEL 4:-2.5-3 METs
Progressive Hall Ambulation
Walking for 5-7 min as tolerated 3-4 times /day.
Standing trunk exercises optimal.
Reinforce benefits of outpatient cardiac rehabilitation.
LEVEL 5:-3-4 METs
Hall ambulation 8-10 min as tolerated.
Arm exercises optional.
Limeted stair climbing .
LEVEL 6:- 5 METs
Stair climing progressive .
OUTPATIENT PHASE
After discharge patient are allowed to go to home and to do ADLs and progressive exercises but before discharge patient has to undergo a low level graded exercise test which are often terminated if
1)patients HR increases to 120/130 beats / min.
2)patients HR reaches to HRmax.
Patient are allowed to do exercise to 60% to its HRmax and adviced not to do atatic,exertive,isometric activities and to take adequate rest and to follow proper diet.
Till the 6 weeks after discharge the phase is conditioning phase.
Till 3 months after discharge its convalescent phase which is a phase of improvement during which exsercise level is gradually increased
After about 6 weeks patient has to follow and undergo ETT and SL-GXT.
The last phase is the maintaining phase which starts mostly after 6 months after discharge.
TOTAL DURATION :-6-14 DAYS
1 to 7 in ICCU and 8 - 14 in the wards.
Need to maintain ROM of all joint and to avoid problems associated with orthostatic hypotension and thromboembolism.
Before starting the rehabilitation program evalaution and patients education is necessary.All viatls should be stable.Any change in systolic and diastolic pressure during exercise.systolic drop greater than 10mmHg or increase in pressure greater than 30 mmHg immediately stop the exercise.Check for HR changes and complaints like dizzeness,sightedness or angina.
Haemodynamic monitering necessary before and after exercises.
LEVEL 1:-1.5 METs
Essentially Bed rest and bed exercises.
Arm movement and ankle pumps.
Introduction and education of cardiac rehabilitation program.
SLR,heel slides.
LEVEL 2:-1.5-2 METs
Limited Room Abulation activities are allowed.
Sitting 15 - 30 min ,2-4 times /day.
Leg exercise -ankle pumps,SLR,heel slides.
Knee extention in sitting,sit to stand.
ADLs like shaving,ambulation til toilet attached to room.
Identification of CAD risk factors.
LEVEL 3:-2-2.5 METs
Limited Hall Ambulation are allowed
Independent or assisted walking continue slowly upto 5 mins are allowed for 3-4 times a day.
Continuining the bed exercise and ADL.
Bathroom privileges allowed.
Borg's scale used by P.T. for rating of Perceived Exertion and appropriate parameters with activity.
LEVEL 4:-2.5-3 METs
Progressive Hall Ambulation
Walking for 5-7 min as tolerated 3-4 times /day.
Standing trunk exercises optimal.
Reinforce benefits of outpatient cardiac rehabilitation.
LEVEL 5:-3-4 METs
Hall ambulation 8-10 min as tolerated.
Arm exercises optional.
Limeted stair climbing .
LEVEL 6:- 5 METs
Stair climing progressive .
OUTPATIENT PHASE
After discharge patient are allowed to go to home and to do ADLs and progressive exercises but before discharge patient has to undergo a low level graded exercise test which are often terminated if
1)patients HR increases to 120/130 beats / min.
2)patients HR reaches to HRmax.
Patient are allowed to do exercise to 60% to its HRmax and adviced not to do atatic,exertive,isometric activities and to take adequate rest and to follow proper diet.
Till the 6 weeks after discharge the phase is conditioning phase.
Till 3 months after discharge its convalescent phase which is a phase of improvement during which exsercise level is gradually increased
After about 6 weeks patient has to follow and undergo ETT and SL-GXT.
The last phase is the maintaining phase which starts mostly after 6 months after discharge.
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