When to start resistance exercise

There is some dispute as to when coronary heart disease patients should commence an RE programme. There is general consensus that patients should complete a period of aerobic exercise prior to initiating resistance training. The ACSM (2001) and SIGN (2002) recommend a period of four to six weeks' aerobic acclimatisation. This period allows for patients' haemodynamic responses to exercise to be assessed and for any complications to be ruled out before progression to RE. Additionally, the patient...

Obesity

Obesity is excess body fat for a given age or gender and can increase the risk of coronary heart disease two-fold (BHF, 2004). Body Mass Index (BMI) is an accepted method of estimating a person's relative weight. BMI is calculated by dividing weight in kilograms by the square of height in metres. The following are the differing ranges of BMI BMI 20-24.9kg m2 healthy, stable, weight range BMI 25-29.9 kg m2 overweight BMI 30-39.9 kg m2 obese BMI 40kg m2 and above severely obese In the last ten...

Resistance equipment

The type of exercise will depend on both the equipment and space available. Resistance bands and dumbbells are easily accessible and allow for a gradual progression in resistance or weight. Method of delivery can be either circuit-type group sessions or delivered by the exercise leader where the class performs the same exercise. Caution should be used for those with balance or grip problems who may drop weights. RE can be performed using exercise mats on the floor. All floor exercises should be...

Resistance Training

Muscle strength, endurance and aerobic function are required for a fully active lifestyle (Pollock, et al., 2000). Muscle strength is defined as the ability of a muscle or muscle group to produce maximal force at a given velocity of movement. Muscle endurance is the ability of a muscle or muscle group to perform repeated muscle actions against a sub-maximal resistance (ACSM, 2001). Resistance exercise (RE) incorporates all types of strength and weight training and will lead to improvements in...

Acute coronary syndromes

Acute coronary syndromes include unstable angina, non-ST-segment elevation MI (NSTE MI) and ST-segment elevation MI (STE MI) (Santiago and Tadros, 2002). It is acknowledged that with revised definition of myocardial infarction, diagnosed by cardiac troponin estimation, there will be a resultant increase in the reporting of myocardial infarction, with increased workloads for the services involved (Dalal, et al, 2004). In the Cochrane systematic review by Jolliffe, et al. (2004) the reviewers...

Congenital heart disease

The patient group includes children and young people. Exercise and physical activity levels are dependent on the differing types of congenital heart disease. There may be barriers to exercise in this group, such as current symptoms, lack of interest in exercise and health fears (Swan and Hillis, 2000). A review by Brugemann, et al. (2004) found that patients with congenital heart disease should be included in multidisciplinary CR. In addition, physical training was found to be safe. A...

Diabetes

FITT principles apply as for the post-MI group. Special attention is required for participants who are on insulin or oral hypoglycaemic agents (OHA). Awareness by the exercise leader and participant of the potential for both hypoglycaemia and hyperglycaemia within an exercise situation is essential. Any planned new physical activity should be discussed with the diabetic CR participant and the diabetes care team (Diabetes UK, 2003). After a cardiac event, metabolic stress may induce latent...

Hypertension

The frequency remains at 3-5 sessions per week, integrating activity into everyday life. The intensity should be reduced to 50 to 75 HRmax. SBP increases in proportion to the intensity of the activity. Moderate intensity activity should be prescribed to avoid large increases in SBP. When HR and SBP are elevated, the myocardium is working harder and requires more oxygen due to a large increase in RPP. Hypertensive patients have a higher resting BP and when coupled with the associated increase in...

Cardiac Rehabilitation Phase Iii Overload Frequency

Early studies into phase III cardiac rehabilitation (CR) programmes were based on exercise education sessions that ran three days per week for eight weeks or longer (Jolliffe, et al., 2004). Various studies have been carried out to determine the optimum frequency for cardiac rehabilitation programmes. There is still on-going debate around this topic, but recent literature has shown that two-three times per week, for a minimum of eight weeks, is sufficient to achieve physiological and...

Variability in estimated METs

Ainsworth, et al. (1993) have compiled an extensive compendium on the estimated MET values for a variety of physical activities. It is important to recognise that these values are estimates, which means that each individual patient could be working above or below this estimate. The variability of the estimate depends on the simplicity or complexity of the movements. For example, the variability of pedalling an exercise cycle ergometer will likely be less than that of stepping or walking. The...

References

American College of Sports Medicine (2000) Guidelines for Exercise Testing and Prescription, 6th edn. Lippincott, Williams and Wilkins, Baltimore, MD. Armstrong, G., Dunn, M., Bredin, Y., McCuskey,F., Brown, C. (2004) Patients' Views on Community Cardiac Rehabilitation. Proceedings of the British Association for Cardiac Rehabilitation Conference. Beswick, A.D., Rees, K., Griebsch, I., Taylor, F.C., Burke, M., West, R.R., et al. (2004) Provision, uptake and cost of cardiac rehabilitation...

B

Need a much more defined interval approach than will fitter participants (see rationale for interval training p. 135). Active recovery stations should last for no more than one minute. The time between consecutive stations should be kept to a minimum, and, as a guide, should only last long enough for participants to walk from one station to the next. Different ways of controlling the circuit time and movement are discussed later in this chapter. Figure 5.5. Concentric circles circuit. Figure...

Relapse prevention model

Relapse is a breakdown or setback in a person's attempt to change or modify target behaviour. The relapse prevention model was developed to treat addictive behaviours, such as alcoholism and smoking (Marlatt and Gordon, 1985). The model proposes that relapse may result from an individual's inability to cope with situations that pose a risk of return to the previous behaviour. For example, a former smoker finds himself or herself in a social situation with lots of smokers and is tempted to...

Best Practice Guidelines For Cardiac Rehabilitation And Secondary Prevention

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) (2004) Guidelines for Cardiac Rehabilitation and Secondary Prevention Programmes, 4th edn, Human Kinetics, Champaign, IL. American College of Sports Medicine (ACSM) (2000) ACSM's Guidelines for Exercise Testing and Prescription, 6th edn, Williams and Wilkins, Baltimore, MD. American College of Sports Medicine (ACSM) (2001) ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, 4th edn, Williams...

Heart rate response during intervaltype exercise

Heart Rate Based Interval Training

Interval circuit exercise is specifically beneficial to individuals with low functional capacity, left ventricular dysfunction or concomitant pulmonary or peripheral circulatory disease exercise limitations (Cachovan, et al., 1976 Maass, et al., 1983 Meyer, et al., 1990 Cooper, 2001). The use of interval circuit exercise is a typical feature in the UK for phase III and IV rehabilitation programmes. Interval training permits the patient to produce a greater amount of work in a training session...

Rationale for interval training

The premise of interval training is that an individual can produce a greater amount of work in a training session if the training bouts are spaced between periods of lower intensity work. Usually these active recovery (AR) periods are between 30 seconds and one minute in duration (see Chapter 4). Key Points on Active Recovery Exercises lower intensity cardiovascular activity, e.g. walking musculoskeletal endurance (MSE) work, e.g. exercises to improve local endurance of muscles NOT used in the...

Measurement of functional capacity

Exercise tolerance testing ETT , or field tests of functional capacity, can produce an estimated METs value to guide risk stratification and exercise prescription. True values can only be obtained through cardio-pulmonary exercise testing using gas analysis. Predicted VO2max or extrapolated MET values have a degree of error, as compared to true VO2max when measured using gas analysis. Factors Influencing Accuracy in Clinical Practice METs or Vo2max peak The use of a sub-maximal symptom limited...

Summary

The concept of a holistic approach to risk stratification is encouraged. This would include the use of traditional medical risk and a broader view of other CHD risk markers and assessment techniques. As there is no gold standard for risk stratification, exercise leaders are encouraged to use those reviewed along with their clinical experience. Risk Stratification and Health Screening for Exercise REFERENCES American Association of Cardiovascular and Pulmonary Rehabilitation AACVPR 1999...

The physiological rationale for using heart rate

In healthy individuals and cardiac patients, the common aim of using heart rate is to act as a marker of the physiological strain of the exercising skeletal muscles. Specific to the cardiac patient, the role of heart rate in conjunction with systolic blood pressure also acts as a key indicator of myocardial strain Froelicher and Myers, 2000 . As a marker of the body's general physiological strain during aerobic exercise, heart rate is usually described as a percentage of maximal heart rate...