Cardiovascular disease is a major cause of morbidity and mortality. Cardiac rehabilitation through physical exercise is a precious treatment for patients with a wide range of heart diseases. (1)
Thus, the prescription must be governed by the individuality and severity of the patient's situation. Current guidelines support exercise prescription in patients after acute coronary syndrome, myocardial revascularization surgery, coronary stent placement, valve surgery, and stable chronic systolic heart failure (research that shows better clinical results. (1))
The objectives of cardiac rehabilitation can be differentiated for each person, which can be: Somatic, Psychosocial or Educational. Recommendations around the world mention the involvement of a multidisciplinary team in the rehabilitation process. (2)
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Patients should be examined by:
• Detailed clinical evaluation;
• Detailed physical examination;
• Risk stratification;
• Symptom-limited stress test.
The individualized Physical Activity prescription can be divided by exercises that represent any body movement that promote greater energy expenditure, than at rest. And so it’s recommended:
Level of physical activity by background: domestic and recreational activities to increase physical activity and social support to make positive changes.
Individualized physical activity according to: the patient's age, previous habits, comorbidities, preferences and goals.
A minimum of 30 min / session of aerobic activity: moderately vigorous exercise, at least three to four times a week; gradual progress in daily activities over time, educating about the need for the patient to be active.
The Individualized Physical Exercise Prescription is defined as a program of planned, structured and repetitive body movements, with the aim of maintaining or improving physical capacity.
Aerobic training should be assessed by Heart Rate (HR), HR% and HR% Reserve, blood pressure before, during and after exercise, to identify factors that may indicate the end of training.
• 1/2 week of 4 to 6 exercises;
• 15-30 min low intensity.
• increase the volume to 30 to 60 min, until the patient is able to manage his effort.
Aerobic Training (prevent valsalva maneuver):
• Evaluate the heart rate through an exercise test, usually assessed on the bicycle. After knowing the HR, work 10 heartbeats (BC) below the threshold.
This training should be dynamic, 1 to 2 min. rest between exercises
• <30% 1-Maximum repetition (MR);
• 12-25 repetitions
• 2-3 training sessions per week.
• 30-50% 1-RM;
• 12-13 repetitions;
• 2-3 workouts per week
• 60-80% 1-RM;
• 8-15 reps;
• 2-3 workouts per week.
Note: These indications are general. In addition to this, it’s recommended to search for spaces and qualified professionals to intervene in cardiac rehabilitation, after a detailed analysis of the patient and his clinical condition.
By Fábio Oliveira, Personal Trainer at Academia Bodylab
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1. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420-5.
2. Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur J Prev Cardiol. 2016;23(16):1715-33.