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