Cardiac Rehab Phase 2 Outpatient Exercise sessions are

Cardiac Rehab Phase 2: Outpatient • Exercise sessions are individualized and goal-focused • Compared to standard median time from hospital discharge (35 days), enrolling patients into cardiac rehabilitation 10 days after discharge significantly improved patient attendance. Quinn R. Pack, Mouhamed Mansour, Joaquim S. Barboza, et al. 2012.

Old Exercise Prescription Example (Relative) • • • Resting HR = 80 bpm Maximal exercise HR = 180 Resting BP = 120/80 Maximal exercise BP = 180/90 Maximal METs obtained = 4 METs (walking) Cardiovascular (aerobic) Exercise Only

Using all of our Tools • Rate Pressure Product (RPP) – HR x Systolic BP = RPP • • Borg’s RPE Scale (6 -20) *Beta-blockers Respiratory Rate (Pulmonary patients) 180 Method vs APMHR Karvonen Formula – Target HR = Resting HR + (0. 6 [Maximum HR -Resting HR]). • EKG & Symptomatology 92 pound, 67 -year old LVAD patient at Baylor boxing

New Exercise Prescription Example (Subjective) • Maximal RPP of 36, 000 (ex: HR 180, Systolic BP 200) as cutoff during Aerobic Exercise: Bike, Treadmill, Row, Elliptical, etc. • Goal: 8 METs; Stretch Goal: 10 METs (i. e. dancing, racquetball) • Resistance Training: – RPE 11 -15 ; 6 -15 reps; 2 -3 sets utilizing major muscle groups – In minimum of 2 out of 3 weekly sessions • Goal-oriented exercise and functional training

©Baylor Jack and Jane Heart and Vascular Hospital

Intensive Cardiac Rehab (ICR) • • Exercise + Education in EACH session of CR Improved compliance Improved outcomes May be unrealistic for some CR centers – i. e. scheduling, cost, staff availability

Peripheral Artery Disease • Medicare covered diagnosis for Supervised Exercise Therapy 2017 • 36 sessions, may be approved for more if still symptomatic (intermittent claudication) • i. e. Progressive Treadmill Protocol • No physician supervision required

Updated Pulmonary Rehab Dx • Sarcoidosis of lung • • Cystic Fibrosis • Unspecified acute lower respiratory • • infection • • Chronic bronchitis • • Coal workers pneumoconiosis • Chronic respiratory conditions due to chemicals Pulmonary manifestations due to radiation Alveolar proteinases Acute bronchospasm Pulmonary fibrosis Lung transplant • Need PFT & COPD Diagnosis

Congestive Heart Failure • • In 2014, CHF was added to the list of Medicare covered diagnoses for outpatient cardiac rehab Exercise is proven to decrease symptoms associated with CHF – **Largely attributed to a delay in blood lactate accumulation – Functional capacity significantly increases with effective cardiac rehab Arena R, Myers J, Williams MA. 2007. Pina IL, Apstein CS, Balady GJ. 2003.

Creative Rehab Programs • “Prehab” Concept • Resolutions Program (Phase 3) • Scholarship Program for all Transplant/VAD patients

Looking to the Future • • Research – Publication in STS journal this year – AACVPR national poster presentation October, 2017 – TACVPR, presentation 2017 – University Medical Center & Calgary, Canada in-services 2017 – Rome, Italy 2018 Inpatient Cardiopulmonary Exercise Lab – • Post PTCA sub-maximal exercise testing and improvement of phase 1 CR strategy Implementation of “Keep Your Move in the Tube” world-wide

Thank you very much for your time! • Program info available via Email: JShannon@MHS. net