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ejection fraction and activity tolerance

How much physical/occupational therapy can a person w/ a EF of 20 - 25% tolerate....we have a new admit to LTCF w/ this dx and low tolerance to minimal activity.  We can monitor HR, bp and perceived exertion but obviously not ECG.  A nurse is telling me that EF of 20% is tolerant of rehab... My understanding is that an EF of this level is high risk.   I understand that EF can improve.  This gentleman has complicated hx w/ PVD, AKA, CHFetc...  Can you give me any guidelines re: therapy participation .
6 Responses
21064 tn?1309312333
I think it would be best to contact the patient's cardiologist.  If there is any doubt as to an appropriate therapy program, it is best to work directly with the patient's physicians.
63984 tn?1385441539
Certainly, Momto3's advice is rock solid.
As I understand it, EF changes.  I've had an EF rating of 29% and it changed to 40% with Coreg and ACE1 drug therapy and physical therapy, so it can be raised.  This has actually happened three times to me with each heart attack over the span of about ten years.  I was used to physical workouts prior to my MI's so I had strength and mindset on my side.  My Cardiac Doc maintains people with the same CHF and EF ratings have vastly different exercise capacity.  Go figure.
If the patient can exercise, I'm betting he will feel better about him/her self if even a modicum of progress can be made with gentle exercise and encouragement.  I'm a huge booster of the physical rehab program locally, I've been through it three times and I've experienced and witnessed big changes in attitude and subsequent improvement in heart health.  You folks do a wonderful service.

  

367994 tn?1304957193
As Flycaster states an EF reading is not exclusively the determinent for exercise tolerance.  Statistics indicate there are an estimated 26% of the heart population that is is in heart failure mode (EF less than 30%) don't have any symptoms and function very well and don't realize they have a failing heart.  Other parts of the system and the heart itself compensates very well to overcome a deficiency.

Ideally, a stress test with a cardiologist's overview is the best procedure to begin an exercise regimen.  The stress test can detect arrhythmias with exertion, ischemia, etc. and what degree of exercise measured in METs that is appropriate.

What is perceived exertion?  Does your new equipment measure duration and determine workload (METs)?.  For a perspective, a walking pace (level track) 2-3 mph is about 3-4 METS and if there are out-of- breath symptoms and/or fatigue that would be considered poor tolerance for exercise.  Heart rate is also a consideration.  Target heart rate with exercise is 220 minus age and additional 10 subtracted.  

I would agree with the nurse, if the exercise tolerance determined by level of exertion and maintaining an acceptable level of heart rate, that can be beneficial.

If one can pace at 4 mph (approx. 7 METs), that is a good workout 3X a week to improve EF.  That is what is recommended for me and of course heart rate has to be within acceptable range.  That and meds have increased my EF to 59% from a 13-29% EF 4 years ago.

The EF indicates the amount of blood pumped with each stroke.  When the EF is low and the system demands more blood/oxygen the heart rate will increase.  I believe the medical community would agree, if the HR is within normal limits and there is no pain or fatigue, the exercise will be beneficial and increase EF in time.

For your consideration: " cardiac stress test is used to assess the heart muscle's response to the need for additional oxygen, which occurs during increased physical activity. This procedure is most often done for the following reasons:

To evaluate if complaints of chest pain are related to the heart.
To determine if blockages or narrowing exist in a coronary artery or arteries supplying the heart with oxygen-rich blood (coronary heart disease or CHD).
To identify an irregular heart rhythm that only occurs during activity.
To monitor the heart's response to cardiac treatment or a procedure to open a coronary artery.
To determine a safe level of participation before the start of an exercise regimen.
To plan the pace and intensity of rehabilitation after a heart attack.
To screen for the presence of asymptomatic CHD in certain high-risk people.
One or more of the following may constitute a positive stress test, which may indicate CHD:

ECG changes characteristic of low oxygen supply to the heart muscle
Angina (chest pain produced by low oxygen supply to the heart muscle) or severe shortness of breath, especially if associated with characteristic ECG changes
Thallium results which may indicate areas of the heart which are not receiving enough oxygen during exercise, but which may not cause angina
Failure to adequately increase heart rate and/or blood pressure during exercise

Avatar universal
I was reading your reply which is as much applicable to my disease. Just one clarification, when you say pacing at 4 mph(7METs), what is the duration. Is it one hour or can be less at speed of 4 mph. And also when you say heart rate to be within acceptable limits during this exercise, what can be the likely upper limit?? is it (220 bpm minus age)x0.85?? I would appreciate if you could clarify these issues.

Thankyou so much for helping the heart community.
367994 tn?1304957193
The duration for me is approx. 30 miinutes 3x a week.  Duration does not figure into the metric other than it indicates the ability to sustain a level of endurance measured in METs (metobolic equivalent task) without SOB, fatigue, etc.  A stress test will record the METs achieved prior to stopping the test or the tolerance sustained measured in METs for the completion of the test.  METs can be crossed reference to a chart that will compare the METs to a level of activity on an every day basis.

For instance if the stress test is stopped at 4 METs (abnormal EKG signs or symptoms) that would indicate one is not able to walk up flight of stairs without losing their breath and the level of activity for exercise should not be more than 2-4 METs.  My 7 METs indicates I can walk 4 miles an hour without signs or symptoms. I feel I could go on for hours, but 30 mins. is for exercise.:)

The upper limit is 220 minus age.  And some people chose to take 90% of that calculation as the top limit.  Beta blocker medication keeps my hr well within the acceptable range, but I get some leg fatigue if I increase the METs while walking fast.  I do not have any physical limitations for every tasks so I don't have any concerns.

Sorry for not being clear.
Avatar universal
Thanks for clarifying.
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