Specificity of testing in a cardiac rehabilitation setting resulting in a patient's return to high-intensity outdoor activity following aortic dissection repair

Abstract

A 66-year-old man who had undergone aortic dissection repair a year earlier sought to assess the feasibility of returning to the high-intensity outdoor activities he had long enjoyed. In response to his inquiry, the cardiac rehabilitation staff at Baylor Hamilton Heart and Vascular Hospital designed a comprehensive testing plan that simulated the specific movements and anticipated cardiac requirements associated with his goal activities. The activities included 1) lifting and manipulating a 50-pound suitcase, 2) hiking to the top of Half Dome in California's Yosemite National Park, and 3) scuba diving. To illustrate our approach, we describe some of the tests that were performed and report the results. After analyzing the detailed physiological data collected during testing, we provided the patient with an exercise prescription and specific guidelines that he could use to gauge his level of physical exertion during his outdoor adventures. Within approximately 6 months of testing, he successfully performed the goal activities without adverse symptoms.

Figures

Figure 1.

Half Dome hiking tests and outcome: (a) a 45-degree cable pull to measure strength; (b) the stair-climber metabolic stress test, designed to simulate the cable ascent to the summit of Half Dome in Yosemite National Park, California; and (c) the patient nearing the summit approximately 6 months after testing.

Figure 2.

Scuba diving tests and outcome: (a) exiting the pool after a simulated diving sequence; (b) staff members measuring vital signs; and (c) the patient diving in Cozumel, Mexico, approximately 5 months after testing.