Physical activity during hospitalization post TAVI - an important part of patient rehabilitation What does the literature say and what do we do in clinical practice and what should we do in clinical practice Physical activity during hospital stay post TAVI - an important Bach Marianne W Nørgaard, Klinisk sygeplejespecialist, 1
Purpose of literature study Identifying evidencebased knowledge regarding the effect of a structured rehabilitationprogram for the patient during admission post-tavi Identifying components which should be included in a rehabilitationprogram post-tavi And initiating nursing actions in clinical practice Bach Marianne W Nørgaard, Klinisk sygeplejespecialist, MVO. Card.Lab 2
Background Most patients have significantly reduced level of acitivity prior to admission Physical inactivity during admission has great consequences for the elderly patient Immobilisation leads to reduced functioning and loss of ADL functions Mobilisation during hospital stay is adamant in preventing bedrest complications Activities of Daily Living Gill TM, Allore H, Guo Z, 2003. Brown CJ, Friedkin RJ, Inouye SK, 2004. OUH, Projekt ortogeriatrisk afsnit, MTV-rapport 2010 Bach Marianne W Nørgaard, Klinisk sygeplejespecialist, MVO. Card.Lab 3
The patients Elderly patients >70 years High level of comorbidities Musculoskeletal disorders Fatigue Dyspnoea and/or chest pains Functional decline at admission Bach Marianne W Nørgaard, Klinisk sygeplejespecialist, MVO. Card.Lab 4
The Danish National Board of Health; recommendations for the Elderly Medical Patient All patients should be offered training acitivity adjusted to their level of functioning during hospitalization Identification and description of functioning - and planning individual needs regarding ADL Involving both patient and relatives Rehabilitation plan when discharged for all patients Sundhedstyrelsen. Styrket indsats for den ældre medicinske patient fagligt oplæg til national handlingsplan, 2011. 5
Results of literature study Benefits of structured training activity: Increased walking distance with 6MWT Improved functioning (Barthels index, Elderly Mobility Scale) Improved QOL, HADS status quo Shorter hospitalization Improved lung function (Fev1) No complications related to training 6 Minutes Walk Test, Quality Of Life, Hospital Anxiety and Depression Scale, Forced Expiratory Volume in one second. Völler H, Salzwedel A (2014). Russo N, Compostelle L et al (2014). Kawauchi T S, Almeida et al ((2013). Nolan J, Thomas S (2008). Jones C T, Lowe A J (2006). Eder B, Hofmann P et al (2010). 6
Training activities Walking, yes it does make a difference! Training sessions sitting or standing Stretching and relaxation exercises Borgs scale to help determine level of intensity Borg, G (1998). Tool meant to quantify subjective sensory experiences on a scale from 0-10, i.e. dyspnoea or exhaustion. Völler H, Salzwedel A (2014). Russo N, Compostelle L et al (2014). Kawauchi T S, Almeida et al ((2013). Nolan J, Thomas S (2008). Jones C T, Lowe A J (2006). Eder B, Hofmann P et al (2010). 7
Conclusion It is safe and plausible with an early training effort The lower the patient is functioning when commencing training the greater outcome of training Structured training effort shows better outcome 8
What do we do now for the patient admitted for TAVI treament at the Cardiac department at Rigshospitalet ADL/functioning assessment at admission 5 Meter Gait Speed Test: > 6 seconds particular attention to plan mobilization and traning Acquiring needed aids: walking frame, easy access to rest rooms, bathing bench etc. All patients are referred to rehabilitation at discharge 9
What is the minimal effort? The bed is only for sleeping in, not a place to be during daytime All patiens must have plan for mobilisation and training during hospitalization All patients must participate actively in ADL Patients must be offered a traning activity in the ward Patient and relatives must be informed about the necessity of training during and after hospitalization 10
Training possibilities at the ward 150 meter marked walking route around the ward Excercise bicycle, pedals for use when sitting in a chair or in bed Tv with excercise program in every patient room Maps of walking routes near the hospital 11
Little effort big impact Presentation of literature review change of attitude Priming posters in the department motivation for patient and nurses Written plans for each patient helps maintain and structure the training effort Doctors have to address the issue of rehabilitation helps increase patient impact 12
The patient won t benefit from the treatment alone Early excercise and rehabilitation is not only safe and effective But also necessary after TAVI treatment Pictures: Google march 2015. Grum M (2015). Andersen T W (2014) 13
For every week without physical activity, it takes 3-4 weeks to regain the normal muscle strenght For every 3 weeks in bed without exercise, the body loses muscle power equivalent to aging 20 years Pictures: Google march 2015. Grum M (2015). Andersen T W (2014) 14
Patient comments: I m so tired Patient Feedback Nobody checks if i have done any excercise today, so why bother Why is it important Poster: 3 weeks in bed equals +20 years oh dear, then I better get moving 15
Grum M (2015) 16
What is next Excercise room at the ward Joint training excercise locally in the ward Training diary further developing Yoga/Tai chi Wii Völler et als (2014). Eder et als (2010). Anna Strömberg et al (2015). 17
Get fit keep moving Thank you for listening 18