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CARDIAC SYSTEM 65

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Figure 1-1 1 . Physical therapy actIVity exammattOll algonthm. (AROM =

actIve range of motlO11; L£ = lower extrenltty; PROM = passive range of

motio,,; Ut:.= upper extremtty.)

(work) level. Figure 1-1 1 provides a general guide to advancing a

patient's activity while considering his or her response ro activity.

Physical therapy intervention should include a warm-up phase to prepare the patient for activity. This is usually performed at a level of activity that is lower than the expected exercise program. For example, it may

consist of supine, seated, or standing exercises. A conditioning phase fol-

66

AClITE CARE HANDBOOK FOR PHYSICAL THERAI'ISTS

lows the warm-up period. Very often in the acute care hospital, this conditioning phase is part of the patient'S functional mobility training. With patients who are independent with functional mobility, an aerobic-based

conditioning program of walking or stationary cycling may be used for

conditioning. Finally, a cool-down or relaxation phase of deep breathing

and stretching ends the physical therapy session.

Listed below are various ways to monitor the patient'S activity tolerance.

1 . HR: HR is the primary means of determining the exercise

intensity level for patients who are not taking beta-blockers or who

have non-rate-responsive pacemakers.

• There is a linear relationship between HR and work.

• In general, a 20- to 30-beat increase from the resting value during activity is a safe intensity level in which a patient can exercise.

• If a patient has undergone an exercise stress test during the hospital stay, a percentage (e.g., 60--80%) of the maximum HR achieved during the test can be calculated to determine the exercise intensity.52