CARDIAC PRECAUTIONS FOR NONACUTE INPATIENT SETTINGS

Activity progression of persons with physical disabilities and accompa nying cardiovascular disease in medical rehabilitation centers is trad itionally based on cardiac precautions derived from acute care setting s. Concern that these guidelines were too conservative and restrictive led to exercise testing and evaluation of 64 physically disabled male patients with a history of coronary artery disease. The sample had a mean age of 62.4 years. The exercise test was an adaptation of the Sch wade Arm Ergometer Protocol with blood pressure measured at baseline, immediately after each 2 minutes of exercise, peak exercise and each m inute for 6 minutes after peak exercise. Heart rate was monitored cont inuously. Patients achieved a mean peak heart rate of 115 beats per mi nute, mean peak systolic pressure of 169 mm Hg and mean peak diastolic pressure of 89 mm Hg. Ischemic electrocardiographic changes occurred in four of the 64 patients. Based on the achieved ranges of values of heart rate, systolic and diastolic pressures and comparison of these r esults with baseline (pre-exercise) values, more liberal guidelines fo r prescribing activity in the non-acute inpatient setting are provided .