Progressive Cardiac Exercises (PCE’s)

PCE's should be done by all cardiac surgery patients and other cardiac patients, as ordered by the physician. Vital signs should be taken before and after exercise, once daily while in the hospital.

Please note that the activities and exercises are divided into levels. Each level is assigned its equivalent METS, which is representative of the amount of energy expended in performing the activities at that level. One MET is equivalent to the amount of energy used when sitting quietly. Patients should be advanced from one level to the next based upon vital signs, monitoring, and tolerance.

Level 1: 1.0-1.5 METS

Position: SUPINE

Exercises:

1. Passive ROM (range of motion) to all extremities 5-7 times each.
2. Active ankle rotations and foot flexion & extension 5-7 times each.
3. Assist with flexion & extension of hip & knee, one side at a time, 5-7 times each
4. Active wrist rotation & hand flexion & extension
5. Diaphragmatic breathing.
   Use of incentive spirometer every hour for surgical patients.

Activities:

1. Feed self
2. Turn self
3. Wash face & hands
4. Commode
5. Sit on edge of bed with feet supported 10-15 minutes, 1-2 times a day as tolerated
6. Insure one hour rest between activities

Ankle Rotations
Circle each foot clockwise and then counterclockwise.

Hip & Knee Flexion & Extension
Bring each knee, alternating, to chest

Wrist Rotation
Circle wrist clockwise, then counterclockwise

Foot Flexion & Extension
Point toes toward your trunk, then away.

Hand Flexion & Extension
Raise hands up, then down.

Shoulder Flexion
Slide arm away from body 90 degrees, then back toward body.

Level 2: 1.5 - 2.5 METS

Position: SUPINE

Exercises:

1. Continue diaphragmatic breathing exercises
2. Continue active exercises 7-10 times each
3. Active flexion & extension of hip & knee 1-10 times each
4. Active shoulder flexion to 90 degrees 7-10 times
5. Diaphragmatic breathing.
   Use of incentive spirometer every hour for surgical patients.

Activities:

1. Sit in chair, for meals as tolerated
2. May bathe entire body, with assistance for back & legs
3. Insure rest between activities
4. Commode
5. Sit on edge of bed with feet supported 10-15 minutes, 1-2 times a day as tolerated
6. Insure one hour rest between activities

Level 3: 2.5 - 3.5 METS

Position: SITTING

Exercises:

1. Continue diaphragmatic breathing with surgical patients


Warm Up Exercises:


2. Continue active flexion & extension of foot 7-10 times each
3. Active flexion & extension of knee 7-10 times
4. Active shoulder flexion to 90 degrees 7-10 times each
5. Neck side to side 7-10 times
6. Walk 100-150 feet each time you walk, gradually increasing the distance. A minimum of 3 walks per day is desired.

Activities:

1. Uses bathroom
2. May wash at sink
3. Shaves or applies makeup
4. Up in room as tolerated
5. Insures rest between activities
6. Begins discharge planning

Foot Flexion & Extension
Raise both feet up, then point towards the floor

Shoulder Flexion - 90 Degrees
Raise arm from shoulder to 90 degrees, then relax down.

Knee Flexion & Extension
Straighten one leg to hip level, then relax to floor. Repeat on other leg.

Neck Side to Side
Tilt neck towards shoulder then towards opposite shoulder, slowly.

Level 4: 3.5 - 4.5 METS

Position: STANDING

Exercises:

1. Continue diaphragmatic breathing exercises with surgical patients


Warm Up Exercises:


2. Alternate flexion & extension of hip & knee (Marching in place 10 times)
3. Trunk rotation, 10 repetitions
4. Trunk bends side to side, 10 repetitions
5. Elbow circles, 10 repetitions
6. Shoulder flexion to 90 degrees, 10 repetitions
7. Walk 150-250 feet, 3 times a day

Activities:

1. May shower if permitted (surgical heart patients shower 7th day if incision dry & intact & there are no stitches or staples)
2. Continue previous activities
3. Insure rest periods between activities

Hip & Knee Flexion and Extension
Alternately lift one leg, then the other. March in place.

Shoulder Flexion
Bring arms to level of shoulder and relax down other side.

Trunk Bends
Slowly bend from waist to one side, stand up straight, then bend to the other side.

Trunk Rotations
Place hands on hips & slowly rotate from side to side.

Elbow Circles
Bring hands to shoulders and circle arms in one direction.

Level 5: 4.5 - 5.5 METS

Position: STANDING

Exercises:

1. CONTINUE LEVEL IV WARM-UPS
2. Walk 250 - 350 feet three times a day
3. Down and up 10 steps slowly with pause every fifth step
   Walks should be timed!

Activities:

1. Continue previous activities
2. Finalize discharge plans