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MET Levels and Cardiac Rehabilitation

Functional Classification of Heart Failure– New York Heart Association

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

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Stages of Activity

These are the stages used during cardiac rehabilitation to present activities to patients.
MET levels are used to ensure that the activities do not exceed the patient’s activity tolerance.

Stage	MET Level Range	ADL Restrictions	Recreational Restrictions	Exercise Restrictions	Pictures
I	1.0 – 1.4	Sitting up is allowed for short periods. Self-feeding, washing hands and face, bed mobility, transfers.	Sitting: Reading, radio, non-competitive table games, light handwork.	Can exercise all extremities in supine (10-15x, at a time). Can only sit to exercise neck and lower extremities.
II	1.4 – 2.0	Sitting up is allowed as tolerated – no limitations to sitting. Sitting: Self-bathing, shaving, dressing, grooming.	Sitting: Crafts, painting, knitting, sewing, mosaics, embroidery.	May exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed. AROM to all extremities, progressively increasing number of repetitions. Walking at slow pace in room, as tolerated
III	2.0 – 3.0	Sitting: Showering in warm water. Sitting: Ironing, housekeeping tasks with brief standing periods to transfer light items.	Sitting: card playing, crafts, piano, machine sewing, typing.	Sitting: wheelchair mobility limited distances Standing: AROM exercises to all extremities, progressively increasing number of reps. May include: balance exercises, light mat work with no resistance Walking on a zero gradient and comfortable pace is allowed.
IV	3.0 – 3.5	Standing: showering in warm water, self, dressing, shaving, grooming, Light housekeeping tasks while standing, using energy conservation – light vacuuming, dusting, sweeping, washing light clothing.	Bowling, slow canoeing, golf putting, light gardening -planting, driving.	Standing: all previous exercise, progressively increasing number of reps and speed. May include balance and mat exercises with light resistance. Walking: unlimited, zero gradient, progressing speed/duration for up to 15-20 min or target HR reached. May begin walking on a treadmill at 1 to 1.5 mph, at a 1-2% grade. Stairs: May begin slow stair climbing up to 2 flights. Cycling: up to 5 mph with no resistance.
V	3.5 – 4.0	Standing: washing dishes, washing clothes, ironing, hanging light clothes, making beds.	Slow swimming, light carpentry, golfing, light home repairs.	Sitting: More resistance may be added to exercises completed while sitting, up to 10 lbs. Standing: continue with previous exercises, progressively increasing number of reps and speed. Walking: Unlimited, increasing speed up to 2.5mph, on level surfaces. Stairs: Increase tolerance. Cycling: up to 8 mph with no resistance.
VI	4.0 and above	Standing: showering in hot water, hanging/wringing clothes, mopping, stripping and making beds, raking.	Swimming-no advanced strokes, slow dancing, slow  ice or roller skating, volleyball, badminton, table tennis, light calisthenics.	Sitting: Exercising upper and lower extremities, up to 10-15 lbs. Walking: increase speed to 3.5 mph. Cycling up to 10 mph, no resistance.

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Phases of Cardiac Rehabilitation

These phases are used as a basic protocol when providing cardiac rehabilitation services to patients.

Phase I: This phase begins during the patient’s inpatient hospital stay. It usually continues for up to 14 days after the patient’s initial procedure or cardiac event.

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Phase II: This phase begins when a patient is able to tolerate an activity level at 3.5 MET. It is completed through outpatient rehabilitation and can last up to 12 to 18 weeks after the patient’s initial cardiac event.

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Phase III: This phase of cardiac rehabilitation involves maintenance of the gains made in phases I and II. It may begin as early as 4 weeks after the initial cardiac event, depending on the patient.
Phase III cardiac rehabilitation programs are usually provided in community exercise facilities, such as the YMCA. A physician must refer a patient to a Phase III cardiac rehabilitation program. Since these programs are community based, insurance may not cover the cost.

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MET LEVELS IN DETAIL

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Reference: https://www.bronsonhealth.com/app/files/public/744/BronsonCardiaRehabHomeExerciseBook.pdf

           2011 Compendium of Physical Activities

The Compendium of Physical Activities was developed to enhance the comparability of results across studies using self-report physical activity (PA) and is used to quantify the energy cost of a wide variety of PA. The 2011 Compendium retains the previous coding scheme to identify the major category headings and specific PA by their rate of energy expenditure in MET values. The Compendium is used globally to quantify the energy cost of PA in adults for surveillance activities, research studies, and, in clinical settings, to write PA recommendations and to assess energy expenditure in individuals. The 2011 Compendium is an update of a system for quantifying the energy cost of adult human PA and is a living document that is moving in the direction of being 100% evidence based.

Follow this link to download/view the compendium.
http://download.lww.com/wolterskluwer_vitalstream_com/permalink/mss/a/mss_43_8_2011_06_13_ainsworth_202093_sdc1.pdf

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Normal Vital signs