Cardiac Rehabilitation and Secondary Prevention

Question 1

Cardiac Rehab: Goals

Answer 1

> ↓ cardiac morbidity and relieve symptoms
Promote risk modification and secondary prevention
↓ anxiety and increase knowledge and self-confidence
↑ fitness and the ability to resume normal activities

Question 2

Cardiac Rehab: Phases

Answer 2

Phase I: in-hospital period (average 3-5 days)
Phase II: Immediate post-discharge/convalescent stage (2-6 weeks)
Phase III: Supervised outpatient programme (6-12 weeks)
Phase IV: Long-term maintenance programme in the community.

Question 3

Consequences of an increase in VO2max

Answer 3

Goals is that repeated submaximal ADLs constitute a smaller percentage of the increased max capacity and therefore impose relatively less physiological stress.

Question 4

Principles of exercise prescription

Answer 4

> Individuality: every individual adapts differently.
Progressive overload: place greater demands on the body than it’s used to.
Regression or reversibility: use it or lose it.
Specificity: adaptations are specific to (FIIT):
- Volume: which includes Frequency and Time or duration.
- Intensity of training.
- Type or mode of training.

Question 5

Intensity of exercise

Answer 5

> Heart Rate: 60-75% of HRmax. If the test was symptom-limited, intensity 10-20 bpm lower than HR when symptoms occurred.
Heart Rate Reserve approach (Karvonen method):
Max HR - Resting HR = HRR
Training interval 40-65% of HRR + RHR

> Perceived exertion: Borg scale 12-13 ≃ 40% VO2Max; Borg 15 ≃ 65& VO2Max

> Metabolic Equivalent Values (METs): 3.5 ml O2/kg BWx min

Question 6

Type of training

Answer 6

CHD pt who spend 250-300 kcal/session + 1000-1500 kcal/week in additional exercise will improve aerobic capacity by 15-30% over 4-6 months.

Question 7

Programme format

Answer 7

> Warm-up: 15’, Borg 10-11 (20 bpm below lower end of prescribed training HR)
Aerobic conditioning: continuous or circuit.
Resistance training: 1x10-15 reps using 8-10 exercises
Cool-down: 10’, mvmt of diminishing intensity and passive stretches. Pt observation for up to 30’ after exercise recommended.

Question 8

In-hospital period

Answer 8

Type/mode: interval rather than continuous. Walking and sitting/standing fx activities, including active, non-resisted general arm and leg exercises.

Frequency and Timing: bouts of 5-10’ with rest periods, 2-3/day. Overall duration from 5 to 20’, 1-2/day.

Intensity: RPE <11 or to individual tolerance or to these targets:

• RHR + 20-30 bpm post-MI.
• 40-50% HRR if an exercise capacity test was performed.

Question 9

Immediate post-discharge convalescense phase

Answer 9

Home-based period that lasts 2-6 weeks.

Question 10

Supervised outpatient exercise programme

Answer 10

Duration of phase: from 3-6 weeks post-event and lasts fro up to 6-12 weeks.