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MET Levels

The Metabolic Equivalent of Task, or MET level, is the approximate amount of energy a person uses during physical activity. These levels are used as a reference point during cardiac rehabilitation. Patients who have had a heart attack or who have undergone open heart surgery are assisted to gradually return to normal activity levels, using MET levels as a guide to insure that activity does not exceed what the patient’s heart can tolerate. Following are some guides to help you learn the stages of cardiac rehabilitation, as guided by MET levels. Please carefully review them for your OT Exam prep.

New York Heart Association Functional Classification of Heart Failure

This system is used to classify heart disease according to the activity level that patient’s can tolerate.

  1. Class I – no limits to activity. MET 6.5
  2. Class II – Slight activity limit, comfort at rest, ordinary activity causes fatigue, pain, dyspnea, and palpitations. MET 4.5
  3. Class III – marked limitation, comfort at rest, less than ordinary activity-fatigue, palpitations, dyspnea, angina pain. MET 3.0
  4. Class IV – inability to carry out activities without discomfort. MET 1.5


Stage 1 (1.0-1.4 MET) Sitting – Self-feeding, wash hands, table games, light handwork, bed mobility, transfers, reading, table games, can exercise all extremities on supine and only neck and lower extremities in sitting
Stage II (1.4-2.0 MET) NO ISOMETRICS Sitting – Self-bathing, shaving, dressing, grooming, unlimited sitting, slow ambulation in room, crafts, exercises to all extremities, painting, sewing
Stage III (2.0-3.0 MET) Sitting – showering in warm water, ironing, homemaking tasks with brief standing periods, piano, typing, card playing
Stage IV (3.0-3.5 MET) Exercises starts to include mild resistance, treadmill, cycling, walking up stairs Standing – washing, dressing, shaving, grooming, showering in warm water, light vacuuming, dusting, sweeping, washing light clothes, light gardening, driving, light home management with energy conservation, canoeing, golf, putting, unlimited walking
Stage V (3.5-4.0 MET) Standing – washing dishes, washing clothes, ironing, hanging light clothes, making beds, swimming, light home repairs, increased home management, light carpentry, golfing
Stage VI (4.1 and above) Most home management, swimming (no advanced strokes), slow dancing, skating (slow), light calisthenics

*MET levels go over 10 (10 being quite strenuous, with activities including shoveling and running 6 MPH)

Phase 1
(inpt hospitalization/rehab) 5-14 days
Phase 2
Outpt rehab Up to 12 weeks post cardiac event
Phase 3
Maintenance/training May begin as early as 4 weeks
  • Patient education
  • Energy conservation/ simplification/breathing exercise/smoking cessation/risk factor education
  • If person is pain free, has no arrhythmias and has regular pulse 100 or less than can initiate activity program
  • Begin MET level 1-2
  • Avoid any isometric, muscle work, straining activities
  • Avoid overhead exercises. Avoid lateral arm movements that stretch/pull chest. If need to open door us both hands
  • V/S are monitored prior to each activity at peak of each activity, immediately upon cessation of activity and 4-5 mins post activity
  • BORG scale for exertion should be given to client to rate level of exertion to activity, given prior, upon cessation, and 3-5 mins post (high number higher exertion-goes up to 20)
  • Exercise must be stopped wh
    o Unstable angina
    o Uncontrolled arrhythmias
    o Recent DVT
    o Acute MI
    o Severe aortic stenosis
  • Pts are generally d/c to phase 2 when able to complete 3.5 MET
  • Begins at 4- 5 MET
  • Building up activity tolerance/exercise
  • Graded exercise and slow increase of weight
  • Weight training program can be started 2-4weeks post event
  • Continue with energy conservation: Pace self, monitor body position during activities, organize work arras, and delegate responsibilities. Risk factor education
  • Home evaluation, work site if applicable
  • BORG score should be around 11-15
  • Should get their MET level up to 5-6, but depends on person. Any increase such as 2 MET levels is good.
  • Can be referred to work-hardening program
  • Often located in community centers, school gyms or YMCA
  • Maintenance gym
  • program
  • Weight training to UE/LE
  • Cardiovascular training
  • Often not covered by insurance
  • Physician must refer pt usually stress test is done before


Pulse/HR parameters:

  • Normal adult: 60-80 BPM, 120/80 BPM, 12-18 breaths/min
  • Pediatric: newborn is 120 BPM, 75/50 BP, 40 breath/min
  • Tachycardia: 100+ BPM
  • Bradycardia: less than 60 BPM
  • Hypertension: above 140/90

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