Christine Alongi MS, RD, LD
Expanded Indications of
CAD & PVD for Cardiac Rehab
GOALS of SET PAD
• Goals of program• Reduce overall pain while walking
• Increase walking distance without limiting pain
• Ultimate goal• Walk at 3mph on a 15% grade for 15 minutes
SET PADThe SET program must:
• 36-sessions over a 12-week period• Sessions must last 30-60 minutes• Conducted in a hospital outpatient setting or a physicians office• Be delivered by qualified auxiliary personnel who are trained in exercise
therapy for PAD• Be under the direct supervision of a Physician, PA, APN
*Patient must have face-to-face with physician treating PAD to obtain referral for SET. Patient must receive information regarding CVD and PAD risk factor reduction.
ACSM Guidelines for Exercise Testing and Prescription, 2017 Hirsch AT et al. J Am Coll Cardiol. 2006;47:1239-1312.https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=287
PAD to CAD64 y/o male
HT: 5’10”
WT: 231 lbs
BMI: 33.14
Peak BP: 220/70
MET: 4.19
Peak BP: 210/90
MET: 8.67
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Treadmill PAD Protocol
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Treadmill PAD Protocol
2mph – 6% grade – 6 minutes3mph – 12% grade – 18 minutes
PAD SUPERSTAR
• 58 y/o male
• Wt: 155
• BMI: 22.89
• BP: Rest 167/85, peak 180/83
• HR: Initial: rest 76, max 91
• PMH: Old MI
Coronary Stent
HTN
Dyslipidemia
CAD
PAD
Smokes 1 ppd
Initial Evaluation
• 6 minute walk test 905 feet
• Peak BP 180/83
• HR 91
• MET 2.3 (walk 2mph)
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Progression
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Discharge Evaluation
INITIAL DISCHARGE
Smoking 1 pack ½ pack per day
Weight 155 151
BP – rest 167/85 142/70
BP - max 180/83 189/84
HR – max 91 126
Discharge Evaluation
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Duration
Exercise duration 24 minutes
MET 2.3 – 6.5BP 189/84 HR 126
CAD & PAD
After the initial diagnosis of PAD in those without known CAD, the risk of having CAD morbidity or mortality in the next five years is about 50 percent, which highlights the need for surveillance for new onset of cardiac symptoms during exercise and the need to include
education and counseling about vascular risk factors, when appropriate, during exercise programs for participants with PAD.
Russellville