What is a low-intensity exercise? Has a relatively simple distinction between methods. Low-intensity exercise - the body feel comfortable, not tired, breathing smoothly. Moderate-intensity exercise - breathing a little cramped, but can persist for some time. High-intensity exercise - out of breath, sore muscles fatigue.
Exercise and Cardiac Rehabilitation Siobhan Doyle Clinical Lead Physiotherapist • Benefits of exercise • Recent studies • Components of exercise class • Health and Safety recommendations • Physical inactivity is estimated to cause 22% of ischaemic heart disease • The risk of developing cardiovascular disease is 1.5 times greater in people who do not follow minimum physical activity recommendations Physical activity: • improves glucose metabolism • reduces body fat • lowers blood pressure • improves musculoskeletal strength • controls body weight • reduces symptoms of depression • A Cochrane review in 2004 concluded that exercise only cardiac rehabilitation reduced all cause mortality by 27% and cardiac mortality by 31% • The Canadian Co-ordinating Office for Health Technology Assessment reported reductions of all cause mortality of 24% and cardiac mortality of 23%. • A study by Witt et al in 2004 found that not only was participation in cardiac rehab associated with decreased mortality after MI but also with lower risk of recurrent MI Assessment before exercise training • Clinical risk stratification is suitable for low to moderate risk patients undergoing low to moderate intensity exercise • Exercise testing and echocardiography are recommended for high risk patients and/or high intensity exercise • Functional exercice capacity should be evaluated before and on completion of exercise testing. Exercise content • warm-up • conditioning phase • cool down • relaxation Warm-up • Graduated low intensity exercise • Short dynamic stretches Aim: • increase myocardial blood supply • Increase soft tissue flexibility • Mobilise joints Conditioning phase • Frequency: supervised exercise should be twice weekly for a minimum of 8 weeks. In addition patients should be given a home exercise programme • Intensity: low to moderate intensity exercise is most suitable to meet the needs of a broad range of patient groups. Individual patients should be prescribed target heart rate ranges and/or Borg RPE based on assessment and risk stratification • Time: Optimum training effect is achieved with 20-30 minutes of continuous aerobic activity. – Progression of conditioning phase depends on initial functional exercise capacity, age and health status. – More deconditioned patients may benefit more from interval type training • Type: Aerobic type activities have been found to be most beneficial. - Exercises should include simple repetitive movements of large muscle groups Monitoring • Exercise intensity should be monitored and modified using the Borg RPE scale and/or heart rate monitoring -Limitations exist when each of these methods is used individually. Cool down • Exercise should be followed by a cool down period which includes low intensity exercise and short stretches. • Patients should be supervised for up to 15 minutes following exercise Resistance training Cardiac patients may require resistance training to facilitate a return to physically demanding activities This is only appropriate for low-moderate risk patients and should not be introduced until 4- 6 weeks of supervised aerobic exercise have been completed Phase 4 • PHASE 4 is a community based activity which follows immediately after the completion of the phase 3 programme. The key aim is long term compliance to exercise and thus the programme must be enjoyable and convenient. Phase 4 • Regular supervised training sessions are provided and exercise prescription is individualised for additional unsupervised physical activity. • In the case of deterioration of functional capacity a referral can be made back to the primary care team. Health and safety for phase 3 and 4 • Fever and acute systemic illness • Unresolved/unstable angina • Resting blood pressure systolic >180 mmHg, diastolic > 100mmHg • Significant unexplained drop in BP • Tachycardia > 100bpm • New or recurrent symptoms of breathlessness, palpitations or dizziness • Swelling of ankles or significant lethargy Health and safety • Prior to exercise patients should be inducted in to the safe use of all equipment • All staff should be trained in basic life support and updated regularly • Appropriate resuscitation equipment including a defibrillator, should be available at every supervised exercise session. At least 1 staff member should be trained to advanced life support. Health and safety • Protocols for the management of medical emergencies must be available • Rapid access to emergency services must be available e.g. crash team or ambulance • Equipment must be maintained • Venue must be suitable – adequate space, temperature, ventilation and humidity • Drinking water must be available Health and safety Staffing levels • Phase 3 - Current guidelines recommend two trained staff should be present at all times during exercise training with a staff ratio of not more than 5:1 • Phase 4 – In the absence of guidelines for staffing levels for phase 4, recommendations for phase 3 should be followed. • There is a perception that exercise training for cardiac patients is dangerous but if these safety issues are implemented, available data suggests that cardiac rehabilitation programmes result in very few complications. The incidence of death is one per 1.3 million exercise hours.
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