Cardiac rehabilitation

30 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Cardiac rehabilitation, part of Cardiopulmonary Physiotherapy. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Which of the following is an absolute contraindication to exercise testing?

   1. AMild asthma that is stable on a reliever inhaler
   2. BUnstable angina that has not been stabilised by medical therapy
   3. CA previous myocardial infarction that occurred 6 months ago
   4. DStable, well-controlled hypertension on regular treatment

   Show answerHide answer

   Answer: B · Unstable angina that has not been stabilised by medical therapy

   Unstable angina, acute myocardial infarction within 2 days, uncontrolled symptomatic arrhythmia, acute pulmonary embolism and severe symptomatic aortic stenosis are absolute contraindications. In these states the stress of exercise can trigger infarction or fatal arrhythmia.

   • A: Mild stable asthma is not a contraindication.
   • C: An old infarct does not prevent testing.
   • D: Stable hypertension may still permit testing.

   Remember this

   Unstable angina, recent MI, uncontrolled arrhythmia and severe aortic stenosis are absolute contraindications to exercise testing.

2. Question 2 · Medium

   A patient with an implantable cardioverter-defibrillator has a shock threshold of 170 beats/min. What is the safest training heart rate limit?

   1. A10-20 beats/min above the programmed shock threshold
   2. B10-20 beats/min below the programmed shock threshold
   3. CExactly at the programmed shock threshold of the device
   4. DNo heart rate limit is needed in these patients

   Show answerHide answer

   Answer: B · 10-20 beats/min below the programmed shock threshold

   Training should stay clear of the rate at which the device delivers therapy, so a safety margin of 10-20 beats/min below it is used. Exceeding it can cause an inappropriate shock. The cardiology team should confirm the setting.

   • A: A heart rate above it would trigger a shock.
   • C: Training at the threshold risks a shock.
   • D: Limits are needed for safety.

   Remember this

   With an ICD, keep training heart rate 10-20 beats/min below the shock threshold.

3. Question 3 · Hard

   A 55-year-old on bisoprolol has a resting heart rate of 55/min and a peak heart rate of 120/min on a test while on the drug. What is a reasonable target at 50-70% of heart rate reserve?

   1. A150 to 165 beats/min
   2. B110 to 130 beats/min from the predicted maximum
   3. C55 to 60 beats/min
   4. D88 to 100 beats/min, based on the measured peak, not 220 minus age

   Show answerHide answer

   Answer: D · 88 to 100 beats/min, based on the measured peak, not 220 minus age

   Using the measured peak of 120 on the beta-blocker, the reserve is 120 minus 55, which is 65. Fifty to 70 per cent of 65 is 33 to 45, so the target is about 88 to 100 beats/min. Predicted maxima would give unsafe, higher targets.

   • A: These values are above the measured maximum.
   • B: Predicted maximum is not valid on beta-blockers.
   • C: These rates are barely above rest.

   Remember this

   On beta-blockers, use the measured peak heart rate, not 220 minus age.

4. Question 4 · Medium

   A patient with chronic stable heart failure (NYHA class II) is entering a rehabilitation programme. Which statement is most accurate?

   1. ATraining should be at maximal intensity for the best effect
   2. BTraining improves capacity and quality of life when the patient is stable
   3. CExercise is contraindicated in every patient with chronic heart failure of any kind
   4. DOnly strict bed rest is recommended for these patients

   Show answerHide answer

   Answer: B · Training improves capacity and quality of life when the patient is stable

   Supervised aerobic training in stable heart failure improves peak oxygen uptake, symptoms and hospital admission rates. Decompensated failure, rapid weight gain and unstable arrhythmia are the exceptions. Intensity is moderate and progressive.

   • A: Maximal intensity is not recommended.
   • C: Stable heart failure is an indication for rehabilitation.
   • D: Bed rest causes deconditioning.

   Remember this

   Stable heart failure improves with supervised aerobic exercise; decompensation is the exception.

5. Question 5 · Medium

   A patient in cardiac rehabilitation develops chest pain during exercise. He has a GTN spray. What is the correct sequence?

   1. AKeep exercising gently, as angina usually passes if he continues
   2. BStop, sit down and use the GTN; call an ambulance if pain persists 5 minutes after a second dose
   3. CUse the GTN, then return to the same workload at once
   4. DLie him flat, raise his legs and wait 20 minutes before using GTN

   Show answerHide answer

   Answer: B · Stop, sit down and use the GTN; call an ambulance if pain persists 5 minutes after a second dose

   Angina during exercise means stopping and resting, ideally sitting. GTN is taken and repeated after 5 minutes if needed; if the pain has not eased 5 minutes after the second dose, an ambulance is called for possible acute coronary syndrome. The programme is reviewed before he exercises again.

   • A: Continuing exercise prolongs ischaemia.
   • C: Returning to the same workload provokes ischaemia again.
   • D: Lying flat is not needed, and waiting 20 minutes delays treatment.

   Remember this

   Angina in rehabilitation: stop, sit, GTN, repeat after 5 minutes, then call an ambulance if not relieved.

6. Question 6 · Medium

   During an exercise session in a Dubai rehabilitation unit, a patient's systolic blood pressure falls by 15 mmHg as the treadmill speed is increased. What is the most appropriate response?

   1. AIncrease the speed to improve circulation
   2. BGive a fizzy drink and carry on
   3. CContinue and recheck after 10 minutes
   4. DStop the exercise, cool down slowly and inform the cardiologist

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   A patient completes a six-minute walk test and covers 280 m with a saturation drop from 96% to 90%. How is this result best used?

   1. AAs a reason to prescribe maximal-intensity exercise at once
   2. BAs a baseline of functional capacity to set goals and track progress
   3. CAs a test that makes the diagnosis of heart failure
   4. DAs proof that the patient has a normal exercise tolerance

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   Which of the following findings in an exercise test is a recognised criterion for stopping because of ischaemia?

   1. AHorizontal or downsloping ST depression of 2 mm or more with symptoms
   2. BA rise in heart rate together with a rise in blood pressure
   3. CA feeling of warmth in the legs during the walk
   4. DSweating and flushing after the maximal effort

   Answer and explanation in LearnFree account

9. Question 9 · Easy

   Which phase of cardiac rehabilitation takes place in hospital after an acute cardiac event or surgery?

   1. APhase IV, the lifelong follow-up phase
   2. BPhase II, the supervised outpatient phase
   3. CPhase III, the community maintenance phase
   4. DPhase I, the inpatient phase

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    A man 3 weeks after coronary artery bypass grafting asks how to cough safely. What is the best advice?

    1. AHug a firm pillow against the sternum while coughing
    2. BHold the breath and strain hard during the cough to get it out
    3. CAvoid coughing altogether until the sternum has fully healed
    4. DPush up from the chair using both arms to save the legs

    Answer and explanation in LearnFree account

11. Question 11 · Easy

    Why is a gradual cool-down of 5-10 minutes included at the end of each exercise session in cardiac rehabilitation?

    1. ATo replace the warm-up that is normally done on the next day
    2. BTo prevent venous pooling and a sudden fall in blood pressure
    3. CTo burn extra fat after the session has finished
    4. DTo raise the maximum heart rate for the next training session

    Answer and explanation in LearnFree account

12. Question 12 · Medium

    Which patient is the most appropriate for starting supervised resistance training with light weights in phase II?

    1. AA patient with unstable angina and recent rest pain
    2. BA patient whose blood pressure is uncontrolled at 200/115 mmHg
    3. CA patient with decompensated heart failure and obvious fluid overload
    4. DA stable patient with no ischaemia, heart failure or arrhythmia

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A patient is taking a beta-blocker, so his exercise heart rate is blunted. How should intensity be monitored?

    1. AAim for a heart rate of 85% of 220 minus age
    2. BUse the RPE scale with the talk test instead of heart rate alone
    3. CUse the age-predicted maximum heart rate
    4. DIgnore symptoms and follow blood pressure only

    Answer and explanation in LearnFree account

14. Question 14 · Hard

    Using the Karvonen method, what is the training heart rate at 70% intensity for a 45-year-old with a resting rate of 65 beats/min (maximum estimated as 220 minus age)?

    1. A153 beats/min
    2. B142 beats/min
    3. C123 beats/min
    4. D77 beats/min

    Answer and explanation in LearnFree account

15. Question 15 · Easy

    One metabolic equivalent (1 MET) is the resting oxygen consumption, which is approximately:

    1. A10 mL of oxygen per kg per minute
    2. B35 mL of oxygen per kg per minute
    3. C0.35 mL of oxygen per kg per minute
    4. D3.5 mL of oxygen per kg of body weight per minute

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    A 58-year-old patient in Muscat wants to walk outdoors in the afternoon in July. What is the best advice during cardiac rehabilitation?

    1. AExercise at midday in the sun to obtain vitamin D
    2. BIncrease the intensity so that he sweats more and burns more calories in hot weather
    3. CExercise indoors or early in the morning, hydrate well and lower intensity
    4. DAvoid drinking fluids so as not to stress the heart

    Answer and explanation in LearnFree account

17. Question 17 · Hard

    A treadmill test shows that a patient reached a peak workload of 7 METs. What is his approximate peak oxygen consumption?

    1. A2.45 mL/kg/min
    2. B10 mL/kg/min
    3. C49 mL/kg/min
    4. D24.5 mL/kg/min

    Answer and explanation in LearnFree account

18. Question 18 · Medium

    Which statement about exercise frequency and duration for aerobic training in cardiac rehabilitation is correct?

    1. AEvery day for 3 hours from the first week
    2. BThree to five days a week, building to 20-60 minutes per session
    3. COnce a month for 2 hours
    4. DOnly on weekends for 10 minutes

    Answer and explanation in LearnFree account

19. Question 19 · Medium

    Which patient is classified as low risk for exercise participation in cardiac rehabilitation?

    1. AEjection fraction of 30% with a fall in blood pressure on exertion
    2. BA recent episode of cardiac arrest that needed resuscitation
    3. CEF above 50%, no ischaemia, no complex arrhythmia, good capacity
    4. DComplex ventricular arrhythmia already present at rest

    Answer and explanation in LearnFree account

20. Question 20 · Easy

    The talk test is a simple way to check exercise intensity. Which finding suggests moderate intensity?

    1. AThe patient cannot breathe through the nose
    2. BThe patient can sing easily
    3. CThe patient cannot say more than one word
    4. DThe patient can talk but not sing during exercise

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    Which measurement is used to describe myocardial oxygen demand during exercise?

    1. ADiastolic pressure minus the pulse pressure
    2. BHeart rate divided by respiratory rate, taken from the bedside monitor
    3. CMean arterial pressure divided by the heart rate
    4. DRate pressure product: heart rate multiplied by systolic pressure

    Answer and explanation in LearnFree account

22. Question 22 · Hard

    Six weeks after a myocardial infarction, a man of 58 complains of exertional dyspnoea. His resting heart rate is 82/min and SpO2 97%, and on exercise he develops chest pain with 2 mm ST depression at 5 METs. What is the best course of action?

    1. AAdd resistance training to improve his strength
    2. BContinue progressive training up to 7 METs as originally planned in the programme
    3. CDischarge him to unsupervised walking at home
    4. DStop exercise, refer to cardiology and train below the ischaemic threshold

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    A patient had a stent placed through the femoral artery 2 days ago. Which advice is appropriate during early mobilisation?

    1. AMassage the puncture site to reduce bruising
    2. BDo deep squats to restore leg strength quickly and rebuild fitness
    3. CAvoid straining and deep hip flexion; report groin swelling
    4. DCycle at a high resistance to rebuild fitness

    Answer and explanation in LearnFree account

24. Question 24 · Hard

    Using the ACSM walking equation, VO2 = 3.5 + 0.1 x speed + 1.8 x speed x grade (speed in m/min), estimate the oxygen cost of walking at 80 m/min on a 5% incline.

    1. AAbout 11.5 mL/kg/min (3.3 METs)
    2. BAbout 15.2 mL/kg/min (4.3 METs)
    3. CAbout 26.7 mL/kg/min (7.6 METs)
    4. DAbout 18.7 mL/kg/min (5.3 METs)

    Answer and explanation in LearnFree account

25. Question 25 · Medium

    A man arrives for a supervised session in a Dubai unit with no symptoms but a resting blood pressure of 212/118 mmHg. What is the best action?

    1. APostpone the session and refer for medical review of his blood pressure
    2. BStart with a long warm-up and monitor as usual, with the blood pressure rechecked mid-session
    3. CGive extra fluids and begin with the usual programme
    4. DHalve the duration and go ahead with the session

    Answer and explanation in LearnFree account