Exercise Prescription

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Exercise Prescription for Cardiac Patients
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Inpatient Programs
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Benefits

• Risk Factor Modification
• Activity Counseling
• Patient and Family Education

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Major Components of Cardiac Rehab

• Assessment of functional tolerance to activities
  of daily living
• Emphasis on patient counseling and Education

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Activities during the first 48 hr. following MI
or Cardiac Surgery

• Self Care Activities
• Arm and leg range of motion movement
• Low Resistance activities

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Optimal Dosage of Exercise Depends on

• Medical History
• Clinical Status
• Symptoms
• Patients should not have ischemia during exercise

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• Intensity
• RPE less than 13
• To tolerance of asympotamic
• Duration
• Intermittent bouts of 3-5 min.
• Rest periods shorter than exercise bout
• 20 Min total duration

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• Frequency
• 1-3 days after the surgery, exercise 3-4 times
  per day
• On day 3, exercise 2 times per day
• Progression
• Increase to 10-15 min of continuous exercise,
  then increase intensity

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Goal Exercise Capacity of 4-5 METS by
hospital discharge.
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Before Discharge, Patient should have knowledge
of

• Activities that are inappropriate or excessive
• a safe progressive plan of exercise
• optimal risk reduction

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Outpatient Programs
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Goals of Outpatient Program

• Provide appropriate patient supervision to ensure
  detection of problems.
• Return patient to pre-morbid vocational and/or
  recreational activities.
• Develop and help patient implement safe and
  effective home exercise program and lifestyle.
• Provide patient and family education.

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Some Signs and Symptoms..

• Onset of angina or other symptoms
• Plateau or decrease in systolic blood pressure
  Systolic gt240mmHg Diastolic gt110mmH
• Radionuclide evidence of LV dysfunction

• Increased frequency of ventricular arrhythmias
• Significant ECG disturbances (2 or 3 degree AV
  block, atrial fibrillation, etc.)
• Other signs/symptoms of intolerance to exercise

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Determining Amount of Exercise

• Plot the exercise test data to determine
  relationships between VO2, HR, and RPE
• Know when myocardial ischemia occurs during
  exercise so patient can exercise below the
  anginal or ischemic threshold
• Peak exercise HR 10 bpm below the threshold is
  appropriate
• Consider medication effects and characteristics
  that place patient at risk

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Outpatient Rate of Progression

• Increase in exercise every 1 to 3 weeks
• Goal of achieving 20 to 30 minutes of continuous
  exercise before progressing intensity
• Those with PVD should aim for 10 to 15 min.
  continuous ex.

• Goal of 5 METS at hospital discharge
• For those with lower exercise capacity, use
  intermittent exercise programs

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Types Of Outpatient Programs

• Goal Progression toward an independent
  self-managed program
• Some patients may need to stay in a clinically
  supervised program
• Most patients should participate in a clinically
  supervised program at least 3 months
• Phase 2 and Phase 3 programs

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Guidelines for Progression to Independent
Exercise

• Functional Capacity 8 Mets or greater
• Appropriate hemo- dynamic response to exercise
• Appropriate ECG response at peak exercise
• Cardiac symptoms stable or absent

• Adequate management of risk factor intervention
  strategy and safe exercise participation
• Demonstrated know-ledge of the disease process,
  signs, etc.
• Demonstrated compliance

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Resistance Training

• May not be appropriate for those
  with Congestive Heart Failure Severe
  Valvular Disease Uncontrolled
  Arrhythmias significant left ventricular
  dysfunction

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When should you use resistance training?

• Start 4-6 weeks into supervised cardiorespiratory
  endurance exercise program

• Use elastic bands, light handweights, or
  resistive tubing to add variety
• Monitor heart rate and ECG continually

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Exercise Endpoints

• Rate Pressure Product should not exceed that
  during prescribed endurance exercise or that
  achieved during a Graded Exercise Test
• Endpoints should be consistent with those
  outlined in ACSM Guidelines (p.97) for
  termination of a GXT

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Indications for Resistance Training for
Outpatients

• Four to six weeks after Myocardial infarction
• One to two weeks following PTCA or other
  revascularization procedure without MI

• Four to six weeks in supervised aerobic program
  or completion of phase II
• Diastolic blood pressure lt105mmHg
• Peak exercise capacity of gt 5 METS

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Special considerations

• CABG or valvular surgery
• PTCA, MI, or angina
• Silent ischemia

• Severe LV dysfunction and CHF
• Pacemakers
• Heart transplant