1. Cardiac rehabilitation phase II
Dr. Rrhab F. Gwada

2. 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.

3. 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 .

4. 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

5. 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

6. The patient is monitored during Phase II with :
Blood pressure
Heart rate
Telemetry EKG
Anginal scale
Dyspnea scale
Borg scale

7. 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.

8. Exercise Testing Data is comprised of :
Resting HR
Resting blood pressure
Maximum exercise heart rate
Maximum exercise blood pressure
Maximum MET’s achieved.

9. exercise session phases (20-40min)Conditioning or training phase
Exercise protocol
exercise session phases
warm up(10 min)
Callisthenic
Stretching
(20-40min)Conditioning or training phase
Aerobic
Light isometric
cool down(10 min)

10. H/w
What is the Callisthenic ex., give examples, and explain its effect on cardiac patients?

11. 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

12. 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.

13. 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.

14. Exercise prescription
Exercise intensity should be individually prescribed so that target heart rate (THR) is 60-75% of its maximum heart rate.
Or 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

15. 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.

16. 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.

17. 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

18. Any Q?