MET Levels & Cardiac Rehab Made Easy for Occupational Therapy

MET Levels Made Easy

Stages

Stages you should know go from 1 to 6 I to VI. To minimize confusion with the actual MET levels which are written in decimal format, the stages are written in roman numerals.

  • Stage I
  • Stage II
  • Stage III
  • Stage IV
  • Stage V
  • Stage VI

MET Level Ranges to Know

  • 1.0 – 1.4 (Stage I)
  • 1.4 – 2.0 (Stage II)
  • 2.0 – 3.0 (Stage III)
  • 3.0 – 3.5 (Stage IV)
  • 3.5 – 4.0  (Stage V)
  • 4.1+ (Stage VI)
Memorizing the MET ranges

The mnemonic to remember is “1.4 mirrored and the sum of 6”. 

1.4 mirrored gives you 4.1. This happens to be the beginning and end ranges for the MET levels mentioned above (bolded).

The MET level ranges also begin and end in approximately half decimal or whole decimal numbers, e.g. 0.4 ~> 0.5, 2.0, 3.0, 3.5, 4.0, etc.

Knowing that there are also six stages (similar to “sum of 6”) will allow you to remember to divide them up in approximate half or whole numbers starting from 1.0 (stage I).

Stage I = 1.0 -> 1.4 (“1.4 mirrored and the sum of 6″)
Stage II = 1.4 -> 2.0 (next whole number)
Stage III = 2.0 -> 3.0 (next whole number)

Stage IV… 3.0 -> 4.0 would not make sense because we still have 2 more stages to reach stage VI and know that we have to end on 4.1. So instead add 0.5 increment to end in 3.5 for stage IV.

Stage IV = 3.0 -> 3.5
Stage V = 3.5 -> 4.0 (next whole number)
Stage VI = 4.1+ – end on 4.1 (1.4 mirrored) by adding 0.1

Mathematically 1.4+0.5+4.0+0.1=6

1.4 (Stage I)
0.5 (for 3.5 in stage IV)
4.0 (Stage V)
0.1 (for 4.1 in stage VI)
= sum of 6.

Hope this helps. Practice writing or typing out the MET ranges into the VI stages starting from 1.0 and ending in 4.1.

“Sit to Stand”

So now we know the MET Level Ranges, the second pattern is “Sit to stand” or STS, like in therapy. This is because the first 3 stages are completed mostly seated and the second 3 stages are in standing.

Stage I – Seated activities
Stage II – Seated activities
Stage III – Seated to standing activities
Stage IV – Standing activities
Stage V – Standing activities
Stage VI – Standing activities

METs

Stage I – Sitting

1.0 – 1.4 METs

  • ADLs: Self-feeding, wash hands and face
  • Mobility: bed mobility, transfers
  • Leisure & IADLs: table games, reading/Kindle, radio/podcasts, light handwork
  • Exercise: all extremities in supine, neck & lower extremities seated.

Stage II – Sitting

1.4 – 2.0 METs

  • ADLs: seated shaving & grooming, seated sponge bath, dressing
  • Mobility: unlimited sitting, slow ambulation (in room as tolerated)
  • Leisure and IADLs: seated crafts, painting, sewing, knitting
  • Exercise: seated exercises to all extremities, no isometrics

Stage III – Sitting to Standing

2.0 – 3.0 METs

Technically, the client can stand briefly for light items and activities, as they are transitioning to stage IV which is the first stage in standing.

  • ADLs: seated showering in warm water
  • Mobility: wheelchair mobility, brief standing, walking limited distance ~2mph
  • Leisure and IADLs: begin very light chores tasks such as folding clothes. Piano/typing. Card playing
  • Exercise: light stationary biking, progressive ambulation on 0% grade/incline

Stage IV – Standing

3.0 – 3.5 METs

At 3.5, the client can discharge from Phase 1 of cardiac rehab from inpatient to outpatient. Driving and outdoor leisure can resume.

  • ADLs: same as stage III but in standing, including standing warm shower
  • Mobility: unlimited walking ~3mph, <2 flights of stairs
  • Leisure and IADLs: light chores – vacuuming, dusting, sweeping, laundry, light gardening, home management, driving. Slow canoeing, candlepin bowling, golf putting
  • Exercise: mild resistance, treadmill, cycling ~6mph

Stage V – Standing

3.5 – 4.0 METs

  • Mobility: walk ~3.5mph, cycle ~8mph, stairs as tolerated
  • Leisure and IADLs: medium chores – washing dishes, washing clothes, ironing, hanging clothes, making beds, home repair and home management. Golfing with bag cart, slow swimming
  • Exercise: increased extremity repetitions in standing, 7-10# seated weights, 2-4% grade on treadmill

Stage VI – Standing

4.1+ METs

  • ADLs: Standing hot shower. Sex can resume at 5.0 METs.
  • Leisure and IADLs: most chores – make beds, mopping, raking. Slow dancing and slow skating, swimming, volleyball, table tennis, golf carrying clubs
  • Mobility: walk ~4mph, cycle ~10mph, stairs
  • Exercise: 10-15# seated weights, 5-6% grade on treadmill

Higher METs

MET levels go over 10, but much of what you need to know for acute and inpatient rehab, e.g., for ADLs and IADLs are covered up to 4.1 METs.

5-7 METs “Heavy”

  • Brisk walking
  • Digging garden, shoveling, lifting 50-100#

7-10+ METs “Very Heavy”

  • Jogging (7-8 METs), Running (8-9 METs), Sprinting (10+)
  • Biking 12mph
  • Basketball
  • Digging ditches

Cardiac Rehab

Phase 1

  • Inpatient hospitalization or rehab
  • Up to ~5-14 days

Phase 2

  • Outpatient rehab
  • Up to 12 weeks post-cardiac event

Phase 3

  • Training and maintenance
  • May begin at 4 weeks