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Designed for the Unique Needs
of Homecare Providers
This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.
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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978
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level 1
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Heart Failure
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Exercise
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| Best Practice: Homecare patients with HF should be encouraged to gradually increase their physical activity. The use of the six-minute walk is recommended before implementation of an exercise program and prior to discharge in order to demonstrate change in functional capacity. The goal for most people with HF is to accumulate at least 30 minutes of exercise per day on most days in a row in order to benefit. For example, patients can be active for three 10-minute blocks. |
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In the past, patients with HF were advised to avoid physical exertion in the hope that bed rest might minimize symptoms and in the belief that physical activity might accelerate the progression of left ventricular dysfunction. However, it is now understood that a reduction in physical activity leads to a state of physical deconditioning that contributes to the symptoms and exercise intolerance of patients with chronic HF. Limitations of activity not only may impair exercise capacity but also may produce adverse psychological effects and impair peripheral vasodilatory responses. Several controlled trials have shown that exercise training can lessen symptoms, increase exercise capacity, and improve the quality of life of patients with chronic HF. (AHA/ACC Practice Guidelines 2005)
The AHA/ACC Guidelines recommend physical reconditioning with the goal to maximize physical functioning independence and energy conservation.
References
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| Assess
(7 documents) |
| One of the most important ways people with heart failure can maintain their sense of well-being is to keep active. In order to design a progressive activity program, assess the patient’s current exercise or physical activity level and their risk for falling. A multidisciplinary approach provides for expertise from not only the nurse but also physical and occupational therapy if available. |
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| Plan (Exercise)
(4 documents) |
| The plan of care is based upon the patient’s level of cardiovascular stability, their current neuromuscular activity tolerance and balance, their safety, and their readiness for behavior change. Include specific, measurable patient goals in the plan of care. |
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| Implement
(26 documents) |
| When implementing an exercise program for patients with heart failure consider flexibility, strength as well as endurance. The goal is to improve the patient's functioning independence, energy conservation and safety. It is important that the patient be onboard with the exercise plan that is developed to ensure they can and will follow through with the plan. |
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| Evaluate
(5 documents) |
| The goals and interventions for exercise should be regularly evaluated and revised in order to achieve measurable outcomes. Use the considerations below to develop measurable outcomes. |
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Exercise
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