MYOCARDIAL INFARCTON
Phase-1 protocol
Level 1: (Complete Bed Rest — Day of admission)
Relaxation
Breathing exercises
Active range of motion exercises (Ankle foot movements and finger and wrist movements)
performed five times, thrice daily.
Level 2: (Partial Bed Rest — Days 1 and 2)
a. Sitting (1 – 2 hours / day) and self-feeding
Relaxation
Breathing exercises
Active range of motion exercises to hip and knee (five repetitions, thrice day)
Sitting — arm bending / stretching up / bending (five repetitions, thrice a day)
b. Level 2 (a) — progress sitting time (3 – 4 hours / day)
Independent in toileting (bedside)
Alternate heel drags
Static quadriceps and glutei (do not hold breath)
Static + spinal extension (five repetitions, thrice a day)
Level 3: (Up and About — Days 3 – 5)
a. STOP relaxation
Level 2(b)— progress exercises to 10 repetitions
*
Walk within room (thrice a day)
Standing — Upper limb flexion (five repetitions thrice a day)
b. Level 3(a)
Walk-standing — lower limb flexion (five repetitions thrice a day)
Stride-standing — hip and knee flexion (five repetitions thrice a day)
*
Walking outside the room (thrice a day)
c. Level (3b)
Bend standing — elbow circling
Trunk bending
*
Walking outside the room with arm swings
Climbing one flight of steps
How Do I Get Started?
For many people, exercise is an enjoyable part of the recovery process. You will feel good about your exercise program
you are sure it is safe for your heart, which is why you need a personal exercise prescription. Your prescription will cov
four important aspects of an exercise program:

Mode or type of exercise that you will do

Frequency or how often you should exercise

Duration or how long you should exercise

Intensity or how hard you should exercise
Mode
The type of exercise you do is called the mode. As was discussed earlier, aerobic exercise is best for improving
cardiovascular fitness and preventing heart disease. The CHAMPS staff member will tell you what kind of exercise to d
This may include walking or stationary biking at home and using a treadmill, stationary bicycle ergometer, Air Dyne
bike, arm ergometer, recumbent stepper, or elliptical trainer in our exercise laboratory. The staff will instruct you in how
to correctly use the equipment.
Frequency
Exercise must be done regularly in order for you to receive the benefits discussed earlier. You should exercise at least 5
times a week, up to 7 days per week for cardiovascular fitness and weight loss. You can allow your muscles one or two
days a week to rest. Try not to miss more than one day at a time.
_________ times per day or week
Duration
Your exercise prescription will include how long you should exercise. You may start exercising only a few minutes a
day. As you get stronger, you can build up to 30-60 minutes of continuous exercise. The duration will include a warm u
training, and cool down.
Warm up.
Warm up is a term used to describe a variety of activities that prepare the body for exercise. It can include stretching an
light exercise and should last 5-10 minutes.
Training.
This is the period of exercise which you will be working your hardest in your target heart rate zone. The duration of
training will last from 20-45 minutes.
Cool down.
The cool down phase of exercise prevents blood from pooling in the lower extremities, which can reduce blood return t
the heart. Such a reduction can cause a drop in blood pressure, lightheadedness, fainting and abnormal heart rhythms.
Cool down exercises also allow circulation to be maintained, promoting the removal of waste products associated with
the development of muscle soreness. Cool down should last 5 to 10 minutes.
Intensity. The intensity can be based on your heart rate or a certain level of exertion.
Target Heart Rate
There is a certain intensity or vigorousness of exercise which is enough to condition the heart muscle and cardiovascula
system leading to physical fitness, but is not overly strenuous. This is a target zone. Your target heart rate may be based
on the results of your treadmill test or your exercise tolerance evaluated in the exercise laboratory.
How to Check Your Heart Rate or Pulse
Once you start exercising, check your pulse regularly. Practice this before you start your exercise program.

Place your first two fingers on the thumb side of the wrist.

Count your pulse for ten seconds; begin counting with zero.

Multiply by six to get your heart rate per minute or look at the chart below. You will be asked to take your pulse
at rest and during peak exercise.
Warnings of Exercise Intolerance

Excessive fatigue

Chest discomfort

Shortness of breath

Irregular pulse

Nausea or vomiting

Lightheadedness

Pain in teeth, jaw, neck, shoulders, arms, or back

Headache

Dizziness

Unusual joint or muscle pain
If you develop any of these symptoms during exercise or activity, stop for a while. If you are at home, discontinue
exercising and, if symptoms persist, inform your physician. You should not exercise if you have forgotten to take your
medication, if you are ill, or have a fever.
Exercising with a fever places an unnecessary strain on your heart. When you exercise, more than 70 percent of your
energy is changed into heat. To keep your body from totally overheating, your heart must pump large amounts of blood
from your overheated muscles to your skin, where the heat is released.
Another major problem to contend with is dehydration, one of the major unpleasant effects of a fever. Exercising under
these conditions can drive your body temperature up even further. This can lead to fatigue, symptoms of heat exhaustio
including dizziness, nausea, blurred vision, and even stroke. The unconditioned or inexperienced exerciser can be
especially susceptible to the harmful effects of a fever.
METS
METs
Exercise
Recreational
Occupational
Activities of DL
Strolling 1-1.5 mph
1.5-2.0 1 miles in
Knitting; Playing cards;
METs
Sewing; Watching TV
40-60min
Desk work; Driving
auto/truck; Sitting
doing light assembly;
Typing; Using hand
tools; writing
Brushing hair/teeth, Light
housework, Making bed; Partial
bath; Polishing furniture;
Washing clothes
Walking, level 2.02.5 mph,
2.0-3.0
1 mile in 24-30min
METs
Cycling, level
outdoors-5mph
Bartending; Crane
operation; Standing
doing light or medium
assembly;
TV/auto/car repair;
Working heavy lever
Cooking; Driving car; Ironing;
riding lawn mower; Scrubbing
floor; walls, cars, windows;
Showering; Sweeping; Tub bath
Walking 3.0-4.0
Billiards; Bowling; Canoeing;
mph,
3.0-4.0 1 mile in 15-20min Croquet; Fly fishing; Golf
METs Cycling, outdoors (pulling cart); Shopping;
Volleyball (non-competitive)
5.5 mph
Baling hay; Driving
heavy truck; heavy
machine assembly;
Janitorial work; Light
welding; Operating
large levers;
Plastering; Plumbing;
Stocking shelves
Cleaning windows; Climbing
stairs (slowly); General House
work; Kneeling; Light work;
Packing/unpacking; Power lawn
mowing (light); Sexual
intercourse; Stocking shelves;
Vacuuming
Walking 3.5-4.0
mph
1 mile in 15-17 min
4.0-5.0
Cycling, 8 mph
METs
Calesthenics
Swimming (20
yd/min)
Building interior of
house; Carrying
trays/dishes; Farm
work (sporadic);
House painting,
Lifting, carrying
objects(20-40 lb);
Light carpentry;
Mechanic work
Raking leaves, shoveling light
loads
Canoeing (4m/hr);
Walking
Gardening (digging); Skating
5.0-6.0 4.0-4.5 mph
(ice/roller); Social/square
METs 1 mile in 13-15 min
dancing; Softball/baseball
Biking, 10 mph
(non-game); Stream fishing
Handyman work
(moving, shoveling);
Heavy Carpentry;
Putting in sidewalk
Raking leaves, shoveling light
loads
Walking/jogging,
4.0-5.0 mph
6.0-7.0 1 mile in 12-13 min
METs Biking, 11 mph
Swimming
(breaststroke)
Backpacking (light);
Badminton; Hiking; Hunting;
Horseback riding (trot),
Skiing (cross country 2.5
mph); Skiing (light downhill);
quare dancing; Tennis
(singles)
Exterior home
building; Lifting,
carrying objects (4564 lb); Shoveling
(10/min, 9 lb);
Splitting wood
Lawn mowing (push mower);
Snow shoveling (light snow)
Walking, 5 mph
1 mile in 12 min
Biking (outdoors)
7.0-8.0
12 mph
METs
Swimming
(backstroke), 40
yd/min
Badminton (competitive);
Basketball (non-game);
Canoeing (5 mph); golf
(carrying bag); Horseback
(gallop); Skiing (downhill,
vigorous)
Ascending stairs with
17 lb load; Lifting,
carrying (65-84 lb);
Moving heavy
furniture; Sawing
Horseback riding (walk);
Light golf (power cart);
Playing musical instrument;
Shuffleboard; Woodworking
Ballet; Dancing; Gardening
(how, weeding, digging),
Golf (carrying clubs); Table
tennis; Tennis (doubles);
Volleyball
Jog/run 5.5 mph
Biking (outdoors)
13 mph
Swimming
8.0-9.0
(breaststroke) 40
METs
yd/min
Rowing machine;
Rope jumping (6080 skips/min)
Lifting, carrying (85100 lb); Moving
Basketball (non-game);
heavy furniture
Handball/squash/racquetball;
(moving van work);
Mountain climbing; Soccer
Shoveling (14 lb
(non-team); Touch football;
scoops, 10
Tour skiing
scoops/min); Using
heavy tools
9.010.0
METs
Jog/run, 6 mph
1 mile in 10 min
Football (competitive);
sledding/tobogganing
11.0+
METs
Run 7 mph (11.5
METs)
8 mph (13.5
METs)
Competitive sports:
Basketball, Handball,
Racquet, Rowing
Heavy labor;
Lumberjack;
Shoveling (16 lb
scoops)
Ascending stairs carrying 54 lb
A MET, which stands for metabolic equivalents, is the amount of energy used by the body to
perform an activity. One MET corresponds to the amount of energy used when sitting at rest.
The intensity of exercise can be based on a certain MET level. MET values increase as more
strenuous activity is performed. The CHAMPS staff will tell you what MET level you should be
able to tolerate for exercise, work and recreation.
A MET or metabolic equivalent is the amount of energy used by the body to perform a physical
activity or daily task. At rest, the average person has an oxygen consumption of 1 MET (or 3.5
ml/kg-min). MET values increase as more activity is performed.
Any activity in the ______ MET category you should tolerate easily.
1. For an 8 hour work day, you shouldbe able to perform activities in the _____ MET
occupational category.
2. For exercise, recreation and activities of daily living (ADL) lasting one jour or less, you
should be able to tolerate activities in the _____ MET category.
3. Lifting, pushing or pulling may cause a rapid increase in your heart rate and blood pressure.
Do not lift more than _____ pounds. Do not strain or hold your breath at any time. In general,
activity involving the arms is more stressful to your cardiovascular system than leg exercise
because your arm muscles are smaller and less efficient than your leg muscles.