Cardiac Outcomes 2024 PDF

Exercise HEIDI TYMKEW PT, DPT, MHS Testing & BOARD CERTIFIED CLINICAL SPECIALIST Functional IN CARDIOVASCULAR & PULMONARY PHYSICAL THERAPY Assessments Monitoring Vitals signs – before,...

Exercise HEIDI TYMKEW PT, DPT, MHS Testing & BOARD CERTIFIED CLINICAL SPECIALIST Functional IN CARDIOVASCULAR & PULMONARY PHYSICAL THERAPY Assessments Monitoring Vitals signs – before, Rate Pressure Product Rating of Perceived during and after (RPP) Exertion (RPE0 exercise (HR, BP, SpO2) Observe the patient Skin color EKG Angina Changes in coordination Level of alertness/cognition Lightheadedness/dizziness Normal Response to Exercise F L E TCHER E T A L , CI RCU L AT ION, 2 0 0 1  Excessive increase in heart rate Flat or Decrease in heart rate Abnormal Hypertensive BP response (SBP > 210 mmHg and/or DBP > 110 mmHg) Response to Exercise A progressive decrease in SBP by 10-15 mmHg with activity Failure of SBP to increase with increase of activity A significant change in cardiac rhythm Signs & Symptoms of Exercise Intolerance Moderately severe or increasing angina Marked dyspnea Dizziness, light-headedness or ataxia Cyanosis or pallor Excessive fatigue Leg cramps or claudication Heart Rate Recovery ▪ A measure of the heart’s ability to return to normal after exertion ▪ Heart Rate Recovery = Peak HR – Resting HR (after 1 minute) ▪ Good heart rate recovery is 12-18 beats or higher ▪ 17 seconds have 30% greater risk of hospitalization (Cesari, 2009)  30 Second Chair Stand Test ▪ Measures endurance and LE strength Normal Scores (# of stands) (Rikli & Jones, 1999) ▪ Number of times an individual can stand from a chair with no assistance in Age Women Men 30 seconds 60-64 12-17 14-19 ▪ Hands should be crossed across the 65-69 11-16 12-18 chest 70-74 10-15 12-17 ▪ If arms are needed to stand, stop the test and record the score of 0 75-79 10-15 11-17 ▪ Count the number of times the 80-84 9-14 10-15 individual comes to a full standing 85-89 8-13 8-14 position 90-94 4-11 7-12 https://www.youtube.com/watch?v=qkV0UvjXgcs  30 Second Chair Stand Test Kobayashi et al, 2024 ▪ 30 Sec Chair Stand Test was shown to be independently associated with peak VO2 in people with Stage A/B heart failure ▪ Developed cutoff scores for low exercise tolerance  Short Physical Performance Battery (SPPB) Helps define physical impairment https://geriatrictoolkit.missouri.edu/SPPB-Score-Tool.pdf Tonet et al., Aging Clinical and Experimental Research, 2023  Short Physical Performance Battery (SPPB) ▪ Individuals with heart failure who have lower SPPB scores (5-7) tend to have: ▪ More severe heart failure symptoms ▪ Higher risk for adverse events (death, readmissions) ▪ Cutoff point for frailty ▪ > 10 – non-frail ▪ 7-9 – Mild frailty ▪ < 6 –Severely frail ▪ MCID for SPPB in older patients attending cardiac rehab > 1 point (Rinaldo, 2022)  Principal movement impairment → decreased endurance due to insufficient movement of the body Unable to participate in activity for prolonged period of time Hypoactivity Syndrome Good vs poor potential Treatment: Increase movement/activity to improve endurance  Lab 1. Perform a 6MWT and determine % predicted Reference equation for predicted 6MW distance (in meters) ◦ Men = (7.57 x height in cm) – (5.02 x age) – (1.76 x weight in kg) -309 ◦ Women = (2.11 x height in cm) – (2.29 x weight in kg) – (5.78 x age) + 667 2. Perform 2 MST Monitor vital signs before and after 3. Perform the Seated Step Test Determine your partner’s % of max HR at each phase of the test 4. Perform the SPPB test on your partner