Cardiac Rehbailitation

In most cardiac rehabilitation centers, there is a doctor, nurse(s), exercise physiologists (EP) and dietitian(s) in order to safely promote exercise with the patients. Before any exercise program, patients should expect to take an exercise assessment to determine how well their body reacts to exercise. In almost all cases, cardiac rehabilitation will start with shorter bouts of exercise at a lower intensity.

There are two types of cardiac rehabilitation; in patient and out patient.

In patient cardiac rehabilitation is the first step towards exercise after an incident or procedure. After an assessment, patients are carefully monitored by exercise physiologists during exercise. In most cases, after a cardiac incident, the patient will be placed on medications that will cap the heart rate and blood pressure. It is important that the patient, and EP, knows how to determine intensity levels on other scales (such as rate of perceived exertion 1-10). Because exercise effects each individual differently, vitals, signs and symptons should be monitored every few minutes through out the exercise routine. Such vitals include, heart rate, blood pressure, rate of perceived exertion, EKG leads and/or VO2 max. Important signs and symptoms include a tight chest, tingling in extremities, dizziness, shortness of breath, etc. If a patient is experiencing any "unstable" symptoms, exercise ceases immediately.

Out patient cardiac rehabilitation begins once the patient "graduates" from in patient rehab. Patients are still closely monitored during exercise. The goal of out patient rehabilitation is to ensure that the patient(s) is able to safely exercise on their own. This time is used to educated the patient on how to make appropriate lifestyle changes and why it is important to do so. It is not uncommon for family and friends to become involved during this phase, in order to optimize the chances of the patient continuing with healthy lifestyle choices.

Although there are recommendations on exercise for these individuals, it is important to refer back to the assessment, signs and symptoms. Exercise prescriptions will be based on the individuals needs, therefor each prescription will be modified.

FITT FOR AEROBIC

Frequency: 2 - 4 sessions/day for the first 3 days of hospitalization

Intensity: Heart attack - Heart rate at rest + 20 beats per minute

Heart surgery - Heart rate at rest +30 beats per minute

LIMIT = NO MORE THAN 120 BEATS PER MINUTE

Time: Intermittent walking 3 - 5 minutes at a time, slowly progressing

to 10 - 15 minutes of continuous walking with no rest

Type: Walking, treadmill, cycling

FITT FOR FLEXIBILTY

Frequency: At least once per day, as often as tolerated

Intensity: Mild stretching

Time: At least 30 seconds per joint

Type: Passive or static (refer to "Why Stretching Works" blog)

FITT FOR AEROBIC

Frequency: At least 3 days/week, preferably 5 or more

Intensity: With exercise test - 40% to 80% of exercise capacity

Without exercise test - seated or standing use RPE 1-10

Time: 20 minutes - 60 minutes/session

Type: Egometer, stair climbers, elliptical, treadmill, etc.

FITT FOR RESISTANCE

Frequency: 2 -3 days/week - nonconsecutive

Intensity: 10 - 15 repetitions without significant fatigue

40% - 60% of 1 rep max OR RPE 5-8 out of 10

Time: 1 - 3 sets of 8 - 10 exercises for the major muscle groups

Type: Equipment that is safe and comfortable for patient use

FITT FOR FLEXIBILTY

Frequency: At least 2 - 3 days/week, preferably every day

Intensity: To slight discomfort

Time: 15 seconds per stretch, at least 4 times

Type: Static, dynamic or PNF (see "Why Stretching Works" blog)

*RPE: Rate of Percieved Exertion

ACSM's Guidelines for Exercise Testing & Prescription - 10th edition