1. EXERCISE PRESCRIPTIONS FOR CARDIAC PATIENTS To offset physiological and psychological effects of bed rest Medical surveillance of patients Identify patients with compromises that may affect prognosis Enable patients to return to daily living Prepare patients and support system for return to home

2. PHASES OF CARDIAC REHABAB PROGRAMS Phase1-inpatient Phase 2-supervised exercise with ECG monitoring Phase 3-supervision with variable ECG monitoring Phase 4-limited supervision with no monitoring Length of Phases is patient dependent and highly variable

3. INPATIENT PROGRAMS Includes risk factor assessment, activity counseling and patient and family education Usually lasts 3-5 days following referral Activities in first 48 hrs limited to self care, ROM and postural change Activity classifications from class 1 to class 6

4. OUTPATIENT PROGRAMS Must monitor patient so that feedback be given for appropriate medical management Effort to return patient to premorbid status Help patient to exercise and recreate safely Maximize secondary prevention

5. INTENSITY, FREQUENCY, AND DURATION Intensity-Based on THR, ischemic threshold, RPE, and abnormal symptoms Frequency-2-3 times per week--yet more yields greater health benefits Duration-inverse to intensity, 20-60 min.--can be accumulated via several shorter workouts rather than one longer workout

6. RESISTANCE TRAINING Very necessary in people where strength in occupational and recreational pursuits exists Usually can begin about 3 weeks post event

7. SPECIAL PATIENT POPULATIONS Silent Ischemia CHF Pacemakers Cardiac Transplants Various Meds

8. A COMPREHENSIVE TREATMENT APPROACH MUST BE USED Exercise Cardiac Rehab Services Risk Factor Modification Medical Surveillance Psychosocial and Vocational Counseling

9. PULMONARY PATIENTS Exercise is of primary importance Shown to increase exercise capacity, functional status, and improved quality of life Individualization of program is of paramount importance

10. MODE, FREQUENCY, INTENSITY AND DURATION Mode-large muscle groups, done indoors or out Frequency-depends on functional capacity-aim for 3-5 days/wk Intensity-50% of peak O2 uptake or Symptom Limited Duration-Usually intermittent, short sessions at beginning

11. OTHER Pursed Lip Breathing and Supplemental Oxygen Need upper body resistance training Ventilatory Muscle Training Program design and supervision dependent on multiple factors

12. MONITORING Pulse Oximeter Self-Palpation Dyspnea Rating Scale