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7/23/2019 Rehabil
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Rehabilitation for Patients with
Cardiovascular Disease
Asistent universitar
Ala Soroceanu
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Background
18 ~ 65 years old healthy adults need1. Moderate-intensity activity at least 30
minutes on 5 days per wee !r
"i#orous-intensity aero$ic activity at least %0minutes on 3 days per wee
%. &esistance trainin# involvin# the ma'or
muscle #roups at least % days per wee
()ercise is also recommended *or theelderly or people with illness!
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Cardiac Rehabilitation
1. +ntroduction o* ,ardiac &eha$ilitation
%. isease-Speci*ic (**ects on hysiolo#ic &esponsesand /itness
3. Scienti*ic and hysiolo#ic &ationale *or ()ercise
herapy in atients with eart isease
2. Mor$idity Mortality and Sa*ety o* ,ardiac
&eha$ilitation
5. ()ercise rescription and ro#rammin#
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Definition
Cardiac Rehabilitation, and
secondary prevention
Cardiac rehabilitation can be defined as the effort
toward cardiovascular risk factor reduction designedto lessen the chance of a subsequent event, to slow,
and perhaps stop the progression of cardiovascular
disease process. Multifactorial and multidisciplinary
approach is imperative to meet such challenges.
Long term comprehensive cardiac care programinvolves a close follow up, risk factor modification,
patient education, and psychological guidance
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Indication of Cardiac Rehabilitation
,ardiac reha$ilitation pro#rams are indicated *or
patients recoverin# *rom recent MI, following
coronary bypass, valve surgery or coronary
angioplasty, cardiac transplantation, patients
with stable angina or patient with compensatedchronic heart failure. traditionally cardiac
reha$ilitation has $een provided to some what
lower ris patient who could e)ercise without
#ettin# into trou$le.
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Contraindication of Cardiac
Rehabilitation
cardiac reha$ilitation services are
contraindicated in patients with severe
residual angina, uncompensated heartfailure, uncontrolled arrhythmias, poor
left ventricular out flow tract, and
unstable concomitant medical problems
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Goals
&estore patients to their optimal medical physical psycolo#ical social emotional se)ual vocational
and economic status compati$le with the severity
o* their heart disease
revention o* heart disease
4 rimary: screen healthy people to identi*y and treat
ris *actors 4 Secondary: to improve heart disease ris *actors and
limit *urther mor$idity and mortality
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Cardiac Rehabilitation
1. +ntroduction o* ,ardiac &eha$ilitation
%. isease-Speci*ic (**ects on
hysiolo#ic &esponses and /itness
3. Scienti*ic and hysiolo#ic &ationale *or ()ercise
herapy in atients with eart isease2. Mor$idity Mortality and Sa*ety o* ,ardiac
&eha$ilitation
5. ()ercise rescription and ro#rammin#
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Cardiovascular Response during Exercise
Heart Rate
4 Normal
Achievin# & within % standards deviationso* an a#e-predicted ma)imum value
ecreasin# & to $aseline *airly uicly
durin# recovery
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Cardiovascular Response during Exercise
Heart Rate 4 Abnormal
,hronotropic +ncompetence /ailure to achieve 857 predicted ma)imum &
without medication e**ect9: redict ,A and associated with increased riso* Mortality;Mor$idity
A$normal & recovery
W alin#< decrease in & = 1% $pm ; 1 minuteSupine< decrease in & = %% $pm ; % minutes: redict *uture cardiac mortality
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Cardiovascular Response during Exercise
Blood ressure
4 Normal >< ,onstant or sli#htly decrease
S>< +ncrease pro#ressively a$out 8~1%
mm#;M( with a plateau at pea e)ercise
4 Abnormal +n patients with ,A S> durin# e)ercise may
respond normally or may disproportionately
increase or inappropriately decrease
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Cardiovascular Response during Exercise
Blood ressure
4 Abnormal
()ertional hypertension< S> ? %50 mm# or> ? 115 mm#
()ertional hypotension<
,ompare to restin# > S> decrease 10mm#≧
: ()ertional systolic hypertension;hypotension would
increase cardiac event ris
+ncrease > 10mm#≧
: !*ten a marer *or *uture hypertension
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Cardiovascular Response during Exercise
!ardiac "utput and "#ygen upta$e
4 @ormal: ea "!%< 30~25 ml;#;min
4 ,A patient: ea "!% reduction %07≧ ue to ,ardiac !utput
,ardiac !utput B eart &ate ) Strove volume
4 eart &ate: ,hronotropic incompetence
4 Strove "olume: Ce*t ventricular dys*unction
◎Dith ()ercise rainin# : "!%E15~307
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Oxygen Consuption
1 M( Meta$olic
(uivalent9
B !)y#en consumption at
restin#B >asal meta$olic rate
At rest F0# man !%
consumptionB 3.5ml o)y#en; minute; G#
o* >D
>raddom /i#ure 32-1
&elationship $etween o)y#en
consumption and intensity o*
wor $ein# per*ormed.
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Cardiac Rehabilitation
1. +ntroduction o* ,ardiac &eha$ilitation%. isease-Speci*ic (**ects on hysiolo#ic &esponses and
/itness
3. Scienti*ic and hysiolo#ic &ationale *or
()ercise herapy in atients with eart
isease
2. Mor$idity Mortality and Sa*ety o* ,ardiac &eha$ilitation
5. ()ercise rescription and ro#rammin#
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!scheic cascade
he temporal seuence o* cellular hemodynamicelectrocardio#raphic and symptomatic
e)pressions occurrin# durin# ischemia<
+m$alance $etween Myocardial o)y#en supply and demand
:+schemic event
:A$normalities in iastolic *unction
:A$normalities in Systolic *unction
:(GH chan#es such as S-se#ment depression
:atient may or may not e)perience An#ina
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!scheic cascade
A*ter the myocardial o)y#en supply anddemand im$alance is corrected at the
cellular level the process is reversed<
An#ina resolves
:(GH chan#es
:+mprovement in Systolic *unction:@ormaliIation o* iastolic *unction
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!scheic cascade
atients with ,A studied durin# ischemia 4 emodynamic a$normalities: nearly all
4 &adionuclide evidence o* #lo$al or re#ional wall motiona$normalities: 807
4 (GH: 507
4 Symptomatic evidence o* ischemia: 307
Some patients such as M or under#one cardiactransplant e)perience S-se#ment depression withoutan#ina i.e. silent an#ina9 whereas others may e)perience
an#ina without S-se#ment depression.
>er#er J &eduto CA Johnstone ( et al. Hlo$al and
re#ional le*t ventricular response to cycle e)ercise in
coronary artery disease< assessment $yuantitative
radionuclide an#iocardio#raphy Am J Med. 1KFKL 66< 13-%1
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"yocardial Oxygen Deand
+ncrease myocardial o)y#en demand: increasin# &increasin# le*t ventricular preload and increasin#
myocardial contractility
Myocardial o)y#en consumption can $e relia$lyestimated $y
&ate –ressure roduct B & ) Systolic >
ou$le product9
he normal ma)imal e)ercise response results in a rate –
pressure product o* %5000 or hi#her
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"yocardial Oxygen #upply
/our *actors a**ect myocardial !% supply:1. ,oronary artery stenosis with endothelial dys*unction
%. Microvascular dys*unction
3. A$normalities o* the autonomic nervous system
2. A$normalities o* coa#ulation and *i$rinolytic systems
◎ (ndothelial dys*unction: arado)ical vasoconstriction iso$served in patients with ,A or chronic heart *ailure
may$e due to decreased production o* nitric o)ide
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A!%M’s TABLE 35-2. Pathophysiologic Effects of Exercise and Exercise Training
Pathophysiologic Variale Ac!te Exercise "hronic Exercise Training
Vasc!lar
Vascular stenosis !artial regression "#$$%% kcal&wk'()
Coronary collaterals
*ndothelial dysfunction +
Capillary flow
A!tono#ic ner$o!s sy#pto#s
!arasympathetic +
-ympathetic +
%e#ostatic
ibrinogen +
actor V//
!latelet aggregation +
ibrinolysis +
Viscosity +
=1000 cal per wee e)perienced the #reatest amount o* disease pro#ression
?1200 cal per wee showed improved cardiopulmonary *itness
?1500 cal per wee demonstrated the slowest rate o* disease pro#ression
?%%00 cal per wee showed re#ression o* ,A
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Cardiac Rehabilitation
1. +ntroduction o* ,ardiac &eha$ilitation%. isease-Speci*ic (**ects on hysiolo#ic &esponses
and /itness
3. Scienti*ic and hysiolo#ic &ationale *or ()ercise
herapy in atients with eart isease
2. Mor$idity Mortality and Sa*ety o*
,ardiac &eha$ilitation
5. ()ercise rescription and ro#rammin#
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"orbidity$ "ortality$ and #afety of Cardiac
Rehabilitation
otal cardiovascular mortality are reduced in patients *ollowin# myocardial in*arction who participate in cardiac reha$ilitation e)ercise
trainin# 4 he 1KK5 A#ency *or eath ,are olicy and &esearch A,&9
,linical ractice Huidelines *or ,ardiac &eha$ilitation
,ardiac reha$ilitation reduced all-cause mortality $y appro)imately %57 4 aylor &S >rown A ($rahim S et al. ()ercise-$ased
reha$ilitation *or patients with coronary heart disease< systematicreview and meta-analysis o* randomiIed controlled trials. Am J Med . %002L116<68% –6K%.
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Classification of Cardiac Rehabilitation
+npatient phase MinimiIe the de-conditionin# time
(ducation a$out ris *actors and li*estyle modi*ication
(arly outpatient phaseMaintenance phase
/ollow-up phase
i**erin# $ased on e)tent o* supervision andmonitorin# su$'ect independence and time *rom the
event
+mprove e)ercise per*ormance and modi*y cardiac ris
*actors
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Phase I of CRP begins when the patient is
admitted to the hospital and ends on
discharge .The goals of exercise in this phase are
to avoid the deleterious effect of bed rest b
ma!ing a gradual transition from passive rang of
motion to active range of motion with low
intensit" short duration exercise and ambulation
hase + o* ,ardiac &eha$ilitation
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The patient" who has completed hospitali#ation" has to undergo
through a pre discharge exercise tolerance test to determine his
functional capacit" before he can begin phase II of CRP" where
the phsician and cardiac rehabilitation staff members formulate
the level of exercise to meet an individual patient$s needs" based
on the result of exercise test. An exercise training usuall are
scheduled at a rehabilitation facilit with a constant medical
supervision including exercise electrocardiograms .In addition toexercise" counseling" and education about stress management"
smo!ing cessation" nutrition" and weight loss also incorporated
in this phase which ma last three to six months
hase ++ o* ,ardiac &eha$ilitation
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0he main goals of phase // C1! are to improve functional
capacity, progress toward full resumption of habitual andoccupational activities and to promote positive life style
changes .*2ercise training in phase // is generally
administered three to four times per week. 3uration range
from as low as (% to (4 minutes per session, and graduallyincreasing up to 5% to 6% minutes per session as the level
of fitness improve. !rograms may offer a single mode of
training or a circuit mode of training in which the patient
spends a prescribed amount of time at one e2ercise station
before moving into the ne2t "e.g. treadmill, cycle ergo
meter ,arm ergo meter, weight.)
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Cardiovascular response to workduring training session is
monitored by number of factors,
including heart rate, blood
pressure, rhythm disturbance,
rate of perceived e2ertion andsign of e2ertional intolerance
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7fter performing another stress or cardiopulmonary
e2ercise test, !hase /// C1! "maintenance phase) is
usually initiated for individual who participated in phase/ and phase // "typically 6 to ($ weeks after
discharge) .0his phase is designed to continue for
patient8s life time, aiming for maintaing patient function,
promoting life long commitment to physical fitness andphysical health management. /n this phase, individuals
are e2pected to progress from supervision to self
regulation of their programs and the activities consist of
the type of e2ercise that the patient en9oys such as
walking bicycling or 9ogging. 1egular medical follow up
and periodic graded e2ercise test are required every 5
to 6 months or annually
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Cardiac %est
&est; ()ercise cardiac test should $e per*ormed $e*ore prescription
,ardiac estin#: &estin# (GH ,& %-echo olter e)am ,oronary an#io#raphy
,ardiac e)ercise stress test
◎,ardiac e)ercise stress test is #enerally sa*e and adverse
outcomes are in*reuent
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Cardiac Exercise #tress %est
Modality 4 readmill >icycle Arm er#ometers
4 ipyridamole Adenosine
(nd point
4 @ormal (S B 857 a#e;#ender predicted & ma)
4 Symptom-limited ma)imum (S 4 Cow-level su$ma)imal (S
HR & '()
*)+ HR ma#
ea$ M- &
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Braddo# Box 3&-' "ontraindications to exercise stress testing
Asol!te
• 7cute myocardial infarction "within $ days)•:igh'risk unstable angina•;ncontrolled cardiac arrhythmias causing symptoms of hemodynamic compromise•-ymptomatic severe aortic stenosis•;ncontrolled symptomatic congestive heart failure• 7cute pulmonary embolus or pulmonary infarction•
7cute myocarditis or pericarditis• 7cute aortic dissection(elati$e •Left main coronary artery disease•Moderate stenotic valvular heart disease•*lectrolyte abnormalities 7•-evere arterial hypertension "# $%% mm:g systolic blood pressure and<or ((%mm:g diastolic blood pressure)•0achyarrhythmias or bradyarrhythmias•:ypertrophic cardiomyopathy and other forms of left ventricular outflow tractobstruction•Mental or physical impairment leading to inability to e2ercise adequately•:igh'degree atrioventricular block
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Contraindications to Exercise
Nnsta$le an#ina
&estin# S depression ? %mm
Nncontrolled arrhythmias
,ritical aortic stenosisNncompensated con#estive heart *ailure
&estin# S> ? %00mm# or > ?110mm#
/all in S> ? 10mm# with e)erciseSymptomatic orthostatic S> drop 10-%0 mm#
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Coorbidities !pacting the #afety of Exercise
ia$etes ypo#lycemia
Anticoa#ulation ro#ressive $ruise or +@& ? 5.0
"isual and ,o#nitive+mpairment
@eed close supervision
Dound and Sin +nte#rity Sacral pressure sores reuire pressurerelie*
&heumatolo#ic @eurolo#ic!rthopedic or >alancedisorders
Darrant close attention
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Cardiac Rehabilitation
1. +ntroduction o* ,ardiac &eha$ilitation%. isease-Speci*ic (**ects on hysiolo#ic &esponses
and /itness
3. Scienti*ic and hysiolo#ic &ationale *or ()ercise
herapy in atients with eart isease
2. Mor$idity Mortality and Sa*ety o* ,ardiac
&eha$ilitation
5. ()ercise rescription and ro#rammin#
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Braddo# Box 3&-& Adaptations noted )ith aeroic training
*!nctional
:igher peak work rate1educed disturbance of body function*nhanced rate of recovery after e2ercise
"ardio$asc!lar and p!l#onary /ncreased stroke volume and peak C=/ncreased respiratory muscle strength, ma2imal voluntary ventilation
1educed dyspnea+!sc!los,eletal
/ncreased fle2ibility/ncreased muscle, tendon, and cartilage strength/ncreased bone density/ncreased lean muscle mass
1educed body fat percentageBioche#ical /ncreased aerobic en>yme concentration
Endocrine 1educed stress hormone release
Psychologic /mproved depression and an2iety
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Exercise Pattern – Resistance Exercise
Moderate-intensity dynamic resistance e)ercise de*ined as507 –607 o* one repetition ma)imum O1&MP9 results inimproved muscle stren#th and endurance
A small reduction o* 3 and 2 mm # *or restin# systolic
$lood pressure and diastolic $lood pressure respectively
A commonly recommended resistance-trainin# pro#raminvolves per*ormin# one set o* ei#ht to 10 re#ionale)ercises per*ormed % to 3 days per wee
+sometric e)ercises are not recommended $ecause o* a potential si#ni*icant rise in systolic and diastolic $lood pressure
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Exercise Pattern – Resistance Exercise
ime to Start &esistance ()ercise 4 ,atheteriIation with or without ,+: 3 wees later
4 &ecover *rom an uncomplicated M+: 5 wees later
4 ,A>H sur#ery or valve sur#ery involvin# a
sternotomy: avoid upper-lim$ resistance trainin#
until sternal healin# has occurred9 #enerally 6 to 1%
wees a*ter sur#ery
&C#"’ % bl '( * # f + i E i P i i
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llness ntensity "o##ents
"oronary arterydisease
&/50-150 of %(( To affect #ortality fre!encyd!ration and intensity of trainingsho!ld s!# to yield a )ee,lyenergy expendit!re 4.5,cal46),-.a
Angina ore!i$alent
&/50-150 of %(( )ithnecessary ad7!st#ent to
,eep !pper %(( li#it to no#ore than eats elo)ische#ic threshold
"onsider a prophylacticnitroglycerin 5 #in efore
anticipated exertion if sy#pto#sli#it ro!tine A8Ls or aility toexercise.
+yocardialinfarction
&/50-150 of %(( Achie$e 5-2 ,cal of energyexpendit!re thro!gh physical
acti$ity each )ee,.a
PT"A )ith or)itho!t stent
&/50-150 of %(( Achie$e 5-2 ,cal of energyexpendit!re thro!gh physicalacti$ity each )ee,.a
&C#" ’ s %able '()* #uary of +ni,ue Exercise Prescription
!ssues aong Patients with Cardiovascular Disease
&C#"’ % bl '( * # f + i E i P i i
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llness ntensity "o##ents
"AB9 or$al$es!rgery
&/50-150 of%(( (estrict !pper-ody #o$e#ent!ntil stern!# is healed :'-2),;.
%eart fail!re &/50-<0 of%((
f needed initially g!ide exerciseintensity at '0 of %(( and
ad7!st d!ration to three o!tsof #in each progressing to3-& #in.
"ardiactransplant
(PE -& (estrict !pper-ody resistanceexercises !ntil stern!# is
healed :'-2 ),;.Pace#a,er
"8i$entric!lar ("T
0 elo)acti$ationthreshold
A$oid acti$ities that stretch thear#s. After 1 ), nonallisticacti$ities #ay e res!#ed andallistic acti$ities #ay e
res!#ed after 2 ),.
&C#" ’ s %able '()* #uary of +ni,ue Exercise Prescription
!ssues aong Patients with Cardiovascular Disease
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Coronary &rtery Disease
+ntensity: 20;507-857 o* &&
o a**ect mortality *reuency duration and
intensity o* trainin# should sum to yield a weely
ener#y e)penditure: 1500 cal; wee
otal ener#y e)penditure is more important than
duration or type o* activity
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Braddo Box '*)- Risk .actors for Coronary
&rtery Disease
+odifiale • !hysical inactivity• :ypertension• -moking• 3yslipidemia• =verweight or obesity• 3iabetes• Metabolic syndrome=on-#odifiale • /ncreasing age
• ?ender@ male # female• !rior history@ cardiac, peripheral vascular, or cerebrovascular
disease• amily history@ genetics• Cultural or socioeconomic
&C#"’ % bl '( ' # f Eff f C di i
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&C#" ’ s %able '()' #uary of Effects of Cardiorespiratory
Exercise %raining on #elected Cardiovascular Risk .actors
(is, *actor Effect
>#o,ing By itself? little or no effect
Exercise sho!ld e part of a co#prehensi$e s#o,ingcessation progra#
Lipidanor#alities
"holesterol Little or no effect
L8L cholesterol Little or no effect
%8L cholesterol +ild to #oderate increase
%ypertension (ed!ces incidence :especially a#ong )hite #en;
>ystolic (ed!ced? a$erage ' ## %g
8iastolic (ed!ced? a$erage 5 ## %g
@esity Exercise alone? #ild effect
Exercise sho!ld e part of a co#prehensi$e )eight-#anage#ent progra#
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&ngina
()ercise li*estyle $ehavior chan#es and medical compliance
20;507-857 o* &&
atients with evidence o* e)ercise-induced ischemia i.e.
an#ina (,H chan#es9 the upper & *or e)ercise trainin#should $e set 10 or more $eats $elow the & or &
Hoal *or patients with an#ina
4 o per*orm routine daily activities at a lower & thusreducin# the amount o* an#ina; *ati#ue they e)perience
4 o increase the amount o* wor home activity ore)ercise they can per*orm at a #iven &
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&ngina
atients need to reco#niIe and understand their
symptoms *irst
atients re#ularly e)perience an#ina at relatively
low worloads e.#. % M(s9 to tae onesu$lin#ual nitro#lycerin a$out 15 minutes $e*ore startin# their warm-up.
:()ercise in a pain-*ree manner and at sli#htly hi#herworloads
A lon#er warm-up Q10 min9 to minimiIe or avoidischemia
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"yocardial !nfarction
Start at the lower end o* their trainin# intensity207 –607 o* & reserve method9
hree nonconsecutive days o* cardiacreha$ilitation per wee with each e)ercise session
consistin# o* a 5- to 10-minute warm-up and cool-down period
ro#ressively increase e)ercise intensity andduration up to 857 o* & reserve method and %0to 60 minutes
(ncoura#ed to adopt an active li*e style includin#e)ercise and daily activities so that they e)pend?1500 cal each wee
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Revasculari/ation 0Coronary &rtery Bypass Graft
and Percutaneous Coronary !ntervention1
Si#ns o* ischemia durin# e)ercise are o*teneliminated a*ter revasculariIation
atients under#oin# ,+ 4 &ecommendations *or e)ercise pro#rammin# *or
patients a*ter ,+ are #enerally the same as *or other patients with ,A
4 >ecause patients under#oin# ,+ *reuently do not
e)perience myocardial dama#e or e)tensive sur#erythey can sometimes $e#in cardiac reha$ilitation returnto wor and resume ACs much sooner
4 ,ardiac reha$ilitation can $e#in within 28 hours a*ter,+
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Revasculari/ation 0Coronary &rtery Bypass Graft and
Percutaneous Coronary !ntervention1
atients under#oin# ,A>H sur#ery 4 >e#in reha$ilitation as early as % wees a*ter sur#ery
with the initial *ocus on aero$ic-type e)ercises
4 All upper-$ody e)ercise should $e limited to &!M and
li#ht repetitive activities until 2 to 8 wees a*ter sur#ery 4 /ollowin# the initial wound healin# patients should $e
a$le to e)ercise up to 857 o* & reserve method 3 to
2 days per wee *or %0 to 60 minutes
4 A*ter the sternum is healed at 6 to 1% wees patientscan then $e#in a resistance-trainin# pro#ram similar to
other patients with cardiovascular disease
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2alve Dysfunction3Repair3Replaceent
eart valve a$normalities: +ncrease the wor the heart due to reducin# e**ective
cardiac output
: Myocardial hypertrophy
: Mild diastolic dys*unction or a decrease in ventriculardistensi$ility
()ercise will not improve or chan#e the *unction o* thevalves $ut it will help to improve the e**iciency o* o)y#en
e)traction $y the seletal muscles and improve the worcapacity o* the individual
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2alve Dysfunction3Repair3Replaceent
he ma'ority o* valve a$normalities can $ecorrected with sur#ical procedures.
atients *ollow the same #uidelines as ,A>H patients *ollowin# sur#ery
atients on war*arin *or mechanical valves oratrial *i$rillation should avoid contact sports
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4eart .ailure
()ercise intolerance:
ea e)ercise capacityreduced 307 to 207 in patients with heart *ailure
Several mechanisms to e)plain the e)ercise
intolerance: 4 A reduction in pea cardiac output ~2079
4 ,hronotropic incompetence
4 &educed stroe volume
4 he a$ility to increase $lood *low to the more meta$olically active
seletal muscles durin# e)ercise is attenuated 4 A$normalities in the seletal muscle such as a reduction in
myosin heavy chain + iso*orms reduced activity o* the enIymesassociated aero$ic meta$olism and a reduction in *i$er siIe
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4eart .ailure
Moderate e)ercise is #enerally sa*e and results inimprovements in many aspects
()ercise trainin# increases e'ection *raction anddecreases C" end-diastolic volume
atients with decompensated heart *ailure should not $e involved in an e)ercise pro#ram
More opportunity *or rest then pro#ressivelyincrease to 30 minutes or more.
he upper end o* e)ercise intensity at 607 o* &reserve method $ased on patientRs condition
(,H monitorin# or not
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Cardiac %ransplant
,ardiac transplant recipients continue toe)perience e)ercise intolerance a*ter
transplantation
his e)ercise intolerance is $elieved to $e
primarily attri$uta$le to the a$sence o* e**erent
sympathetic innervation o* the myocardium
a**ectin# heart rate and contractility responses
residual seletal muscle a$normalities developed $e*ore transplantation $ecause o* heart *ailure and
decreased seletal muscle stren#th
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Cardiac %ransplant
A*ter transplantation many di**erences:
4 (levated restin# & o*ten ?K0 $pm9 4 (levated systolic and diastolic >s at rest ★
4 Attenuated increase in & durin# su$ma)imal wor
4 Cower pea & and pea stroe volume
4 Hreater increase in plasma norepinephrine durin#e)ercise 4 elayed slowin# o* & in recovery ☆
★ (levated systolic and diastolic >s at rest partly attri$uta$le to
increased plasma norepinephrine and the immunosuppressivemedications i.e. cyclosporine and prednisone9
☆ elayed & in recovery is thou#ht to $e attri$uta$le to increasedlevels o* plasma norepinephrine e)ertin# its positive chronotropice**ect in the a$sence o* va#al e**erent innervation
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Cardiac %ransplant
+n the *irst year a*ter sur#ery it is $est to simply disre#ard all&-$ased methods $ecause o* the a$normal & control in these
patients
,ardiac transplant patients under#o e)ercise trainin#: 4 ()ercise capacity increases $y a$out 157 to 207
4 &estin# & is unchan#ed or decreases sli#htly
4 ea & increases
4 Cittle chan#e in pea stroe volume or cardiac dimensions
4 uality o* li*e is *avora$ly altered
A pro#ressive resistance trainin# pro#ram started 6 to 1% weesa*ter transplant sur#ery and per*ormed twice per wee
/e0isa -able 123( Borg %cales for Rating erceived #ertion
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5-Grade scale 0-Grade Scale
6 No exertion at all 0 Nothing
7 Extremely light
0!5
"ery# $ery light %&'st
noticea(le)
* "ery light
0
"ery light
+ight
,
, +ight %ea.)
/ Somehat hard
/ 1oderate
5 2ard %hea$y)
6
5 2ea$y %strong)
7 "ery hard 6
7 "ery hea$y
* Extremely hard
,0 1aximal exertion *
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Paceakers$ !plantable Cardiac Defibrillators$
and &rrhythias
+n #eneral the e)ercise trainin# prescription is unaltered*or patients with these devices.
()ercise intensity in patients with an +, should $e set at
least 10 $eats $elow the pro#rammed *irin# threshold
Avoid activities that stretch the arms. A*ter 8 w
non$allistic activities may $e resumed and $allistic
activities may $e resumed a*ter 1% w.
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#uary
he inclusion o* e)ercise in the treatment o*these patients is $ene*icial $ecause o* its*avora$le e**ects on ris *actors symptoms*unctional capacity physiolo#y and ualityo* li*e.
All patients with cardiovascular disease
should $e encoura#ed to participate ine)ercise $ecause o* its real or liely positiveimpact on mortality and mor$idity.
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Than!s for our attention!
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