Goals:
Aerobic capacity is increased
Ability to perform physical tasks related to self-care, home management, community, and work integration is increased.
The physical response to increased oxygen demand is improved
Strength, power, and endurance are increased
Symptoms associated with increased oxygen demand are decreased
Risk of recurrence of coronary artery disease is reduced
Behaviors that Foster healthy habits, wellness, and prevention are required.
Exercise Prescription
exercise prescription is based on frequency, intensity, time (duration), and type (mode) of the FITT equation.
The activity should be gradually progressive in a stepwise fashion of increasing energy cost (Kilocalories) with appropriate heart rate and blood pressure monitoring.
Contraindications for exercise training:
unstable angina
symptomatic and uncompensated heart failure and
Uncontrol arrhythmias
moderate to severe aortic stenosis
Uncontrolled diabetes
Resting blood pressure value in excess of 200/110 mmHg and
Uncontrol resting tachycardia
3rd-degree atrioventricular block
Thrombophlebitis.
Exercise intensity
Intensity may be prescribed by either heart rate or by a rating of perceived exertion (RPE).
The original rating of perceived exertion scale (the borg RPE scale), developed by borg, has been used extensively (Table 1).
It consists of numbers ranging from 6 to 20, which patients used to rate their perception of how hard they are working.
Commonly, the patients are asked to limit their exertion between fairly light and somewhat hard (11-13).
Borg also developed a category-ratio scale of 0 to 10 (Table 2).
A common aerobic exercise prescription based on heart rate is 70% to 85% of maximum heart rate.
The more deconditioned patient may be aerobically trained at 50% to 60% of the maximum heart rate.
The tool for self-monitoring for the patients is to be able to talk without becoming breathless while exercising. This is called the talk test that provides fair indications that the patient is appropriately exercising below his or her anaerobic threshold which usually occurs at approximately 55% to 70% of maximal oxygen uptake (Table 3).
Exercise frequency:
Exercise is commonly prescribed 3-5 times per week.
The patient should not experience increase fatigue as a result of exercise.
If fatigue does occur the frequency or intensity of the exercise should be decreased.
Patients, who chose to exercise daily must watch for signs and symptoms of fatigue and overexertion, recognizing that fatigue may not occur during the activity or later in the day or the next day.
Exercise duration (time):
The goal of 30-40 minutes of aerobic exercise with 5-10 minutes of warm-up and adequate cooldown is appropriate.
If this amount of activity is uncomfortable for the patient then whatever amount he or she can do comfortably, without Adverse symptoms is appropriate.
Mode of exercise (type):
The patient has the opportunity to experience a variety of equipment:
Treadmills,
Stair climbers,
Bicycles,
Rowers,
Cross-country sky stimulators,
Reclining bicycles,
Steppers,
Arm ergometers, and others.
Patient frequently asked which is the best equipment; the one that they enjoy and the one that they will use is by far the best for them.
What can you do if the patient becomes symptomatic with angina during a physical therapy intervention?
The first goal is to decrease Myocardial oxygen demand; immediately stop the activity.
The patient should sit or lie down on a bed or plinth.
The physical therapist should take the patient's Heart rate and blood pressure and calculate the Rate pressure product (RPP = HR x BP) to determine the Myocardial oxygen (MVO2) demand at which the patient becomes Ischemic, and termed the Ischemic threshold.
Give supplemental oxygen.
Take 12-lead ECG.
Administration of nitroglycerin (NTG) and other anti-ischemic medications.
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