rehab guidelines

7/23/2019 Rehab guidelines

1/32

1

Guideline .. 2539 reviseguideline references

guideline

cardiac rehabilitation guideline cardiac rehabilitation

cardiac rehabilitation

( )


2/32

2

1. 5

-

-

-

2. 9

3.1 () 11

4.2 () 16

- 3 () 19

5.Resistance training 20

6. 23

7. Heart Failure 25


3/32

3

.. 2552


4/32

4

..2553


5/32

5

(Cardiac Rehabilitation Guideline)

1.

(coronary heart disease)

(physiological conditions) (psychological conditions)(social conditions)(vocational conditions)

2. (Director) /

(Staffs)- - - - - --


6/32

6

3. - - - -

4.

5.

6. -

- (defibrillator)-


7/32

7

- (ECG telemetry)-

(stationary bicycle or arm ergometry) (treadmill)

7. 1. Stable angina

2. Post myocardial infarction3. Controlled congestive heart failure

4. Post percutaneous coronary intervention (PCI)

5. Post cardiac surgery including heart transplantation

6. Patient with high risk for coronary artery disease

7. Patient with peripheral vascular disease

8. Others

8. 1 2 8-12

3 4 3

9. 1. Unstable angina

2.3.


8/32

8

4. 5. Recent pulmonary embolism severe pulmonary arterial

hypertension

6.(thrombophlebitis)7.> 200 .

> 100 .8. > 20 .

9. ST displacement > 3 .

10.11. 12. Third degree A-V block

13.14. 15.16. Hypertrophic obstructive cardiomyopathy

10. 1. 2. 3. 4. 5. Supraventricular tachycardia 6.ST displacement > 3 . (horizontal down

sloping)

7. Ventricular tachycardia

8. Left bundle branch block


9/32

9

9. second third degree A-V block10. R on T PVCs

11. Multifocal PVCs (30% of the complexes)

12.13.(220

110 .)14. 10 /

11. (Risk stratification) (Monitoring)

(left ventricular ejectionfraction) (arrhythmias)

(risk stratification) (1)

1.

2. 3.

3.1

3.2

3.3


10/32

10

Degree of Supervision

1. (home program)(low risk)

2.

(supervised cardiac exercise program)

2.1

(Borgs rate of perceived exertion)

2.2

2.2.1

2.2.2

defibrillator


11/32

11

12.

1 (Phase 1)(Inpatient Phase)1

1.2.3.

4.

(METs)


12/32

12

1.2.3.

(mode) calisthenic exercise (intensity)

(post-myocardial infarction)

20

30 (duration)

5-10 20-30 (frequency)2

1 5 METs

(3)


13/32

13

ICU

CCU

ICU

CCU


14/32

14


15/32

15

1.

2.

3.

4.

5.EKG (

)

-

-13

-120 /--20 -30 /

-10/

-

200/100 .--20 ..

- Supraventricular tachycardia- ST

displacement (3 mm.)-Ventricular

tachycardia-Left bundle branch

block- 2-3 degree AV-block-PVC

-

-

-

-

- ST segment

-PVC3 -R on T PVC-Multifocal

PVC (30%)


16/32

16

2 (Phase 2)

(Outpatient Phase)2

8-12

1.

2.3.

4.

5.

2 (monitoring) 1 (ECG telemetry)


17/32

17

8-12

3 3(Mode)

4-6 post-MI, post-PCI 8 post cardiac surgery

resistance trainingdumbbell

(intensity)Exercise Stress Test

20-30 70 /70+30 = 100

KarvonenMethod

( ) x 0.4 0.85 +

= 220 ()

(moderate intensity) 0.4 0.6


18/32

18

Borg (Rating of Perceived Exertion Scale)

(2)11-13

Exercise Stress Test

Karvonen Method (exercise stress test -) x 0.4 0.85 +

[VO2max

] 40-85% VO

2max

(moderate intensity) 40-60%Borg (Rating of Perceived Exertion Scale)

11-13

(Duration)60

stretching, warmup, aerobic /resistance training,cool down stretching aerobic exercise20-30

(Frequency)3-5


19/32

19

(Progression)

intensity (intensity)

3 (Phase 3)

3 2 3 2

3

33

1.2 6 2.2

5 METs

3. (selfmonitor)

31.3 3-6

32.8 METs

intensity


20/32

20

3.4.

Resistance trainingResistance training1.

2.Exercise stress test ischemic response3.

-congestive heart failure -valvular heart disease -(> 160 .

> 100 . )

-- Aerobic capacity 5 METs-(LVEF < 0.35)

Resistance training1.myocardial infarction CABG 6

PCI 4 2.resistance training

resistance training

3. resistance training 2(2 )3 resistance training

resistance training 2


21/32

21

4.resistance training

aerobic (/RPE Scale)5.

resistance training6.resistance training

aerobic training 7.8.

biceps

9.dumbbell 10.1 11.

resistance training

Resistance training(Mode) dumbbell (Intensity)

1.21 (

)2.3 2

1 repetition maximum (1 ) 90% repetition maximum 2-3 30-50% 1 repetition maximum

3. RPE Scale


22/32

22

(Duration)- 12-15 2 2-3

(Progression)- 12-15

2 3 12-15 1

13.

1. warm upcalisthenic exercise 10 10

2.

(Borg scale) 5 - 2 10

- 3 15

- 4 15


23/32

23

- 15

20 3. cool down

cool down 5-10

1.2.300 ..3.4.5.() 100 /

200/100 .

6.7.8.

- 1-2

- - - -

-


24/32

24

- ()

- - -

-

- 20-30

- 30 3-5

1.2.50 3., 4.5.(

)

1.(warm up) 10


25/32

25

2.3.(cool down)

10 1.2. 3. 4. 5. 6.

-

- - - - -

14. supervised exercise(interval training)

..


26/32

26

neurohormone

1 24 1.8 1-3

dobutamine continuous intermittent New York Heart Association Functional Class IV

Complex ventricular arrhythmia 100 (Pre-existing co-morbidities)

(compensated heart failure)

3 30

110 (less than moderate

fatigue)

Cardiac index of 21 min-1.m

-2(for invasively monitored patients)

Central venous pressure of < 12 mmHg (for invasively monitored

patients)


27/32

27

(RPE 14) 40 S

3pulmonary rales

pulmonary rales second component second sound (P

2)

Poor pulse pressure (

< 10 .) 10 .

supraventricular ventricular ectopy

10-60 3-7 5


28/32

28

(VO

2peak) submaximal exercise capacity

6 minute walk test

ventilatory threshold

1. American Association of Cardiovascular and Pulmonary Rehabilitation.

Guidelines for cardiac rehabilitation and secondary prevention programs

4thedition. Champaign, IL: Human Kinetics ; 2004

2. Goble AJ. Worcester MUC. Best Practice guide lines for cardiac

rehabilitation and Secondary prevention, 1stedition. Melbourne.

Department of Human Services 1999:52-6

3. Guidelines for cardiac rehabilitation and secondary prevention programs,

Human Kinetics Publisher3rd edition , 1999 ,39-52

4. Pashkow FJ, Dafoe WA: Clinical cardiac rehabilitation-A Cardiologists

guide 2ndedition :Baltimore; Williams@Wilkins: 1999:458-66

5. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha

BD, et al. Exercise and Heart Failure: A statement from American


29/32

29

Heart Association Committee on exercise, rehabilitation, and prevention.

Circulation 2003;107:1210-1225

6. Pollock ML, Ward A, Foster C. Exercise Prescription for rehabilitation

of the cardiac patient In: Pollock ML, Schmidt DH. Editors. Heart Disease

and Rehabilitation. Boston: Houghton Mifflin 1979: 415-20

7. Rees K, Taylor RS, Singh S, Coats AJS, Ebrahim S. Exercise based

rehabilitation for heart failure(Review). The Cochrane Database of

Systematic Review 2004, Issue 3

8. Whellan DJ, OConnor CM, Lee KL, Keteyian HJ, Cooper LS, Ellis SJ,

et al. HF-ACTION Trial Investigators. Heart failure and a controlled trial

investigating outcomes of exercise training (HF-ACTION): design and

rationale. Am Heart J 2007;153:201-11

9. Working group on Cardiac Rehabilitation & Exercise Physiology and

Working Group on Heart Failure of the European Society of Cardiology.

Recommendations for exercise training in chronic heart failure patients.

European Heart Journal 2001;22:125-135

10. , , .

1.

, 2546: 141-148


30/32

30

-(left ventricular ejection fraction> 0.5)

-

ST(ST displacement)

--

-6 METs 3

- ( leftventricular ejection fraction 0.31 0.49)

- 5-6 METs 3

--

ST 1-2 . (1-2 mm.ST depression)

11.


31/32

31

- (left ventricular ejectionfraction < 0.3)

-

-15 .

--

(complex ventricular arrhythmias)-

ST 2 . (2 mm. ST depression)


32/32

32

3

6. NOTHING AT ALL 7. VERY VERYLIGHT 9. VERY LIGHT 11. LIGHT 12.

13. SOME WHATHARD 15. HARD 16.

17. VERY HARD 18.

19. VERY VERY HARD ()20.

2Borg

(Borgs rating of perceived exertion) RPE

rehab guidelines

Documents