Occupational Therapy MET Levels

How to Master MET Levels in Cardiac Rehab

Wondering why it is important for occupational therapists to know MET levels, or what they even are? Or perhaps you know how important MET levels are, but you don’t feel certain of how to incorporate using them in your occupational therapy sessions. 

It can be extremely intimidating going to see a patient post cardiac-related disorder or surgery, and not feel confident about what activity is appropriate for your patient and their current phase of rehabilitation. You might have that shaky feeling of being unsure of whether the activity you are currently facilitating may result in them exerting themselves more than they should! 

Have no fear, because this article is going to guide you through MET levels and their phase of rehabilitation, and help you feel more confident in knowing what activity is appropriate for your cardiac patient in your OT session. 

So, what is a MET level? 

A MET (metabolic equivalent) is defined as the amount of energy needed to engage in an activity. This is dependent on the oxygen consumption the activity requires.  As a result, it is used to describe the intensity of an activity, which is why it is crucial to consider in our cardiac patients. 

According to research by Myers et al., one MET increase in functional capacity results in a 12% decrease in all-cause mortality. This shows the significant correlation between the physical intensity of activities you engage in, and one’s mortality. It also reminds us how important it is to educate and counsel our patients in order to prevent cardiac diseases from progressing, and to promote health and well being. 

The MET level appropriate for your cardiac patient is dependent on what phase of cardiac rehabilitation they are in. So, let’s start with that:

Occupational Therapy MET Levels Table Phase 1 Phases 2 and 3 Phase 4 Stage of rehabilitation Acute stage (in patient rehabilitation/hospitalization). Acute heart condition-recovering from heart attack or heart surgery. Subacute stage (if subacute rehab indicated) Followed by outpatient rehabilitation Maintenance/community Time frame 5-14 days (depends on condition) Up to 12 weeks Can start as early as 4 weeks: dependent on patient MET level 1-2. Discharged at level 3.5 Roughly 3.5+ End of phase: Between 5-6 6+ Intervention Patient and family education on activities appropriate according to METs and the phase Counseling Teaching about fatigue management principles/energy conservation Gradually increasing their activity tolerance. E.g brushing teeth while lying in bed, and progressing to doing it in sitting. Patient and family education on activities appropriate according to METs and the phase Improving their activity tolerance gradually. Progressing them from activities that are 3.5 METS to 6 METS. Ongoing education on energy conservation in ADLs and IADLs Provide an individualized Progressive exercise program. Avoid isometric training. Home evaluation Work hardening Less intensive therapy Maintenance exercise program Facilitating return to leisure activities that involve vigorous activity, such as boxing, jogging, aerobic dancing, soccer etc.

Here is a condensed version of MET levels to make it easy to remember:

  • MET levels 1-3: Activities are done in sitting. Stage 1 involves very basic activities, such as washing hands, applying lotion and reading, and then progressing the intensity of activities in MET levels 2 and 3 (washing the body in sitting, and toileting with a commode). Brief standing can be done after MET level 2 for low intensity activities. This is in accordance with Phase 1.
  • MET levels 3+: Activities can be done in standing. Start off with less strenuous activities in standing, such as grooming tasks and showering, and then progressing in intensity. This is in accordance with Phase 2 and 3. 

A quick summary to keep in mind: Light activities are typically 1-3 METs, moderate activities are 3-6 METs, and vigorous activities are 6+ METs. We will share several comprehensive MET charts below as well.

Precautions to be aware of 

It is integral to be aware of precautions in Phase 1. No overhead activities, isometric strengthening or straining.

In every phase, we recommend that vital signs are checked pre-activity, at peak of activity, and post-activity.

Alert the nurses/doctor if your patient is experiencing any of the following in your session: 

  1. Unstable angina (chest pain caused by reduced blood flow to the heart) 
  2. Arrhythmia (irregular heartbeat)

It is therefore beneficial to understand the difference between a normal and abnormal heart rate.

These are the parameters:

  • Normal heart rate: 60-100 beats per minute
  • Tachycardia (fast heart rate): more than 100 beats per minute
  • Bradycardia (slow heart rate): less than 60 beats per minute

Cardiac Rehabilitation

The goal of patients engaging in cardiac rehabilitation is to improve their cardiovascular function to enable them to regain their independence. Occupational therapists play an important role in this, as we are the experts in activity analysis, and therefore we can guide our patients through what activity is appropriate for each stage of their rehabilitation. 

We can also guide family, nurses, and doctors on what MET level the patient is currently coping with. This in turn will give a good indication of when the patient is ready for a safe discharge. It is, therefore, important to document what MET activities your patient is managing to engage in. For example, “Mrs. Smith is currently coping with activities that require 2 METs, such as washing her body in sitting, and engaging in all grooming tasks in sitting.”

People with cardiac conditions often become fatigued quickly, decreased activity tolerance have decreased endurance and dyspnea (shortness of breath). All of these factors limit their activity participation. It is our job as OTs, to provide: activity modifications, suggest assistive devices, teach them about energy conservation/fatigue management and to recommend what activity is appropriate for them according to what phase of rehab they are in. 

It is important to have a good understanding of different heart conditions, common cardiac terminology and procedures, as well as the role of OT in cardiac rehab. You can gain more knowledge on this by reading the AOTA article on “The Role of Occupational Therapy in Cardiac Rehabilitation.” 

With there being such a wide variety of daily activities, you are not expected to learn every activity’s MET level. We would recommend keeping a copy of a list of activities and their respective MET levels for reference. You can consult this PDF for a more comprehensive list of MET levels in different ADLs. Or, this PDF for MET levels within recreational tasks. This website, on the other hand, is likely the most comprehensive on all self-care activities. Thank you to OT Dude for sharing the last one!

Outcome Measures to Use in Cardiac Rehab

We are frequently expected as health care practitioners to perform regular outcome measures. It is an excellent tool to guide the multidisciplinary team on your patient’s rate of  improvement. Furthermore, it provides your patient with the lens to examine his progress objectively, and track it during his rehabilitation.

The hardest part about doing outcomes measures is feeling uncertain about which are appropriate for your patient. Here is a list with some suggestions of outcome measures you can use in your OT session with your cardiac patient:

  1. FIM/FAM
  2. Barthel Index
  3. Borg Rating of Perceived Exertion Scale
  4. Canadian Occupational Performance Measure
  5. Modified Fatigue Impact Scale

_______________

Using MET levels in the different phases of cardiac rehabilitation serves as an important tool to guide OTs in their sessions to help their patients to progress, to prevent secondary complications, and to aid in planning a safe discharge. 

Be sure to print a document or save a link of a list of common activities and their respective MET levels as a reminder for yourself, and to use to educate your patient and their family. 

Use outcome measures to identify progress or deterioration in our patient’s condition. Most importantly of all, breathe a sigh of relief because you now have the knowledge of how to treat a cardiac patient using MET levels. Happy treating!

References

  1. Kokkinos, P , Myers, J , Franklin, B , Narayan, P, Lavie, C, Faselis, C. 2017, ‘Cardiorespiratory Fitness and Health Outcomes: A Call to Standardize Fitness Categories’, Mayo Clinic, Volume 93, Issue 3. 
  2. 2016, MET LEVELS, Available at:  https://passtheot.com/wp-content/uploads/2016/07/MET-Levels-and-cardiac-rehab.docx

 

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