In cardiac rehabilitation, clinicians should individualize initial assessments by choosing their own progressive increments (gradient, resistance, or speed) and setting personalized stopping points based on signs, symptoms, or fatigue (such as a capped RPE), rather than strictly following standardized protocols that only produce numbers or provoke symptoms without guiding personalized exercise prescription.
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Individualise your cardiac rehab assessmentAdded:
Just Be Better Ben episode two. And the topic this week is individualizing your initial assessment. It has occurred to me that in cardiac rehab, we judge clinician based on how well they can follow assessment protocol. But, I recently start to have a different opinion on this. I think tweaking your initial assessment protocol is probably the best thing to do for patient-centered care. Because, look, the most commonly used cardiovascular tests, like the 6-minute walk test or step tests, they're designed to obtain a specific number or to provoke symptoms.
But, they kind of missed the point of an assessment, which is to guide personalized exercise prescription.
That's why now in my clinical practice, there are two adjustments that I would make for each patient. Number one, the test needs to be progressive, but you choose your own increments. That could be gradient, resistance, or speed. Two, you choose your own stopping point. This could be based on signs, symptoms, or fatigue, like setting a cap RPE. So, remember, you have free will.
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