Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement

Abstract

A 30-year-old male roughneck worker on an oil rig underwent aortic valve replacement and subsequently enrolled in the Baylor Heart and Vascular Hospital exercise-based cardiac rehabilitation (CR) program. He expressed a strong desire to return to his physically demanding job. Based on his unique job requirements, CR staff designed and implemented comprehensive tests and a 5-week specific physical training program that included 6 exercises simulating his job functions. The selected exercises are not typically prescribed in traditional CR programs but mimicked the muscular strength/endurance required to perform his job. The goals set for each of the 6 specific exercises were accomplished and resulted in the patient rapidly regaining his muscular strength through the specially designed training program. The exercise regimen was successfully completed without adverse signs or symptoms and enabled the patient to return to work within approximately 2 months of completion.

Keywords: Cardiac rehabilitation; occupation-specific training; return to work; task-specific training program.

Figure 1.

(a) Task 1: Pulling up 75 lbs of a drill pipe slip. (b) The patient performed a one-arm low-pulley pull on a Hoist Multi-station system at a prescribed weight and volume. (c) Task 2: Racking back the pipe on the rig board pulling 80 lbs. (d) The patient performed a mid-row with a rope on the Hoist Multi-station system for a prescribed amount of weight and volume. (e) Task 3: Racking back the pipe on the rig board pulling 80 lbs. (f) The patient performed a standing stacked grip chest press on a fence post attached by an ankle cinch strap to the Hoist Multi-station system. (g) Task 4: Climbing flights of stairs with a 50-pound load. (h) The patient started with a 12-lb kettle bell and climbed 3 flights of stairs, and peak heart rate was recorded. (i) Task 5: Operating 50-pound tongs. (j) The patient performed a single-arm standing chest press with an initial weight load of 15 lbs. Movement was facilitated by a straight bar attached to the Hoist Multi-station system at its end. The patient pushed the opposite side of bar. (k) Task 6: Picking up 100-lb bags of mixing mud. (l) The patient performed a deadlift and maneuvered a weighted bag to the top of a box, with a weight of 21 lbs. The bag was filled with 1 lb weights until it became too stressful on the wrists; thereafter, a 60-lb kettle bell was used, and peak heart rate was recorded.

Figure 2.

Progression toward goal load on the 6 task-specific training exercises over the 5-week cardiac rehabilitation program.