Safe And Effective Exercise Intensity

Exercise intensity is felt to be the most important of the four main components of the overload principle of training (McArdle, et al., 2001). The other three components of the overload or dose-response FITT principle are frequency, duration (time) and mode (type) of activity. Hence, the abbreviation FITT is used to describe the 'overload' or 'dose-response' principle. With regard to exercise intensity in cardiac patients, the key factors are those that influence:

• The safety of the intensity, to avoid the risk of a clinical cardiovascular event (e.g. ischaemia or arrhythmia) if it were too high, and

• The effectiveness of the programme, determining the intensity threshold or training zone that allows the appropriate physiological adaptations to occur. This would also correspond to the appropriate intensity that allows patients to sustain the required duration of activity for achieving the desired physiological and clinical benefits. If the intensity is too high, patients will not be able to achieve the appropriate duration, and if too low, the full potential of health and clinical benefits from exercise and fitness will not be attained.

There is also the important psychological aspect of determining the correct individualised intensity. Such influences relate to age, gender, mood, self-efficacy and self-esteem (Oldridge and Stoedefalke, 1984; Carlson, et al., 2001; Day, 2003; Yates, et al., 2003). In practical terms this relates to the patients' sense of control or mastery over their exercise, anxieties from the fear of over-exertion causing an event, and attaining enjoyment from the exercise. If the exercise leader fails to achieve these underpinning psychological factors, focusing only on physiological intensity, the required longer-term changes of behaviour for maintaining physical activity at appropriate levels are less likely.

It is important that CR programme teams ensure that patients are confident in working at their physiologically prescribed exercise intensity. This may require the need to build up the patients gradually to their desired intensity over the rehabilitation programme. In order to develop patient self-efficacy for controlling exercise intensity, they should be encouraged to become less reliant on the clinical measures of intensity, such as ECG, heart rate (HR) and METs and to focus, instead, on controlling intensity from their perceptions of exertion that correlate with these clinical measures. A key role of the early phases of CR includes not only enhancing physiological changes but also facilitating patients' learning, identifying and experiencing the correct intensity for attaining and sustaining such changes over the longer term (Song, 2003).

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