Guidelines for Cardiac Rehabilitation

Young-Soo Jin

doi:10.5124/jkma.2005.48.9.808

J Korean Med Assoc > Volume 48(9); 2005 > Article

Jin: Guidelines for Cardiac Rehabilitation

Special Issue

Exercise Prescription according to Diseases

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2005; 48(9): 808-821.

Published online: September 30, 2005

DOI: http://dx.doi.org/10.5124/jkma.2005.48.9.808

Guidelines for Cardiac Rehabilitation

Young-Soo Jin, M.D.

Sports & Health Medicine Center, Ulsan University College of Medicine, Asan Medical Center, Korea. ysjin@amc.seoul.kr

Abstract

Changes in cardiac rehabilitation in the 1990s involved the development of different patterns of the delivery of rehabilitative care. Patients were offered with a choice of individual versus group and center-based versus home-based physical activity programs. The recent application of risk-stratification procedures for coronary patients has brought major changes in the delivery of cardiac rehabilitation exercise training. Patients considered at low risk are able to undertake less supervised rehabilitation in a safe manner. Contemporary cardiac rehabilitation programs provide several important core components, including baseline patient assessment, nutrition counseling, risk factor management, psychosocial management, and activity counseling. However, appropriately prescribed exercise therapy remains the cornerstone of these programs. Cardiac rehabilitation programs have been categorized as phase I (inpatient), phase II(up to 12 weeks of ECG monitoring), phase II(no ECG monitoring under clinical supervision), and phase IV(no ECG monitoring, professional supervision). Cardiac patients who have specific needs to consider when formulating the exercise prescription include those with a history of myocardial infarction and angina, congestive heart failure, mitral valve stenosis and cardiac transplantation. Finally, the goals of rehabilitative care should include improvement of the functional capacity to achieve functional independence with an emphasis on quality of life.

Cardiac rehabilitation; Exercise; MI; Angina; Congestive heart failure

References

1. Levin SA, Lown B. The 'chair treatment' of acute coronary thrombosis. Trans Assoc Am Physicians 1951;64:316-326.

2. Chapman CB, Fraser RS. Studies on the effect of exercise on cardiovascular response to exercise on cardiovascular function. III. Cardiovascular response to exercise in pateint with healded myocardial infarction. Circulation 1954;9:347-351.

3. American College of Sports Medicine. Guidelines for Graded Exercise Testing and Exercise Prescription 1975;Philadelphia: Lea & Febiger.

4. American Heart Association. The Exercise Standards Book 1979;Dallas: American Heart Association.

5. AACVPR. Guidelines for cardiac rehabilitation and secondary prevention programs 1999;Human Kintics.

6. ACSM. ACSM's guidelines for exercise testing and prescription 2005;7th ed. LWW. 174-204.

7. DeBusk RF, Haskell WL, Miller NH, Berra K, Taylor CB, Lew H, et al. Medically directed at-home rehabilitation after uncomplicated acute myocardial infarction: a new model for patient care. Am J Cardiol 1985;55:251-257.

8. Fletcher BJ, Dunbar SB, Felner JM, Jensen BE, Almon L, Fletcher GF, et al. Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease. Am J Cardiol 1994;73:170-174.

9. Hedback B, Perk J, Engvall J. Pedictive factors for return to work after coronary artery bypass grafting: the role of cardiac rehabilitation. Int J Rehabil Med 1990;22:15-20.

10. Raineri A, Assennato P, Candela B, Messina L. Short and long term results of early rehabilitation after myocardial infarction: physical fitness, hemodynamic assessments and psychological aspects. Cardiology 1982;69:231-241.

11. Tran ZV, Weltman A. Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight: A meta-analysis. JAMA 1985;254:919-924.

12. ACSM. ACSM's guidelines for exercise testing and prescription 2005;7th ed. LWW. 188.

13. Van Camp SP, Peterson RA. Cardiovascular complication of outpatient cardiac rehabilitation pregrams. JAMA 1986;256:1160-1163.

14. Hossack KF, Hartwig R. Cardiac arrest associated with supervised cardiac rehabilitation. J Cardiac Rehabil 1982;2:402-408.

15. Jugdutt BI, Michorowski BL, Kappagoda CT. Exercise training after anterior Q wave myocardial infarction: importance of regional left ventricular function and topography. J Am Coll Cardiol 1988;12:362-372.

16. Rowe MH, Jelinek MV, Liddell N, Hugens M. Effect of rapid mobilization on ejection fractions and ventricular volume after acute myocardial infarction. Am J Cardiol 1989;63:1037-1041.

17. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs 2003;4th ed. Champaign, IL: Human Kinetics.

18. ACSM. ACSM's guidelines for exercise testing and prescription 2005;7th ed. LWW. 22-27.

19. ACSM. ACSM's guidelines for exercise testing and prescription 2005;7th ed. LWW. 178-180.

20. Pollack ML, Franklin BA, Balady GJ. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety and prescription. Circulation 2000;101:828-833.

21. Hickson RC, Rosenkoetter MA, Brown MM. Strength training effects on aerobic power and short term endurance. Med Sci Sports Exerc 1980;12:336-339.

22. McCartney N, McKelvie R, Haslam D, Jones N. Usefulness of weightlifting training in improving strength and maximal power output in coronary artery disease. Am J Cardiology 1991;67:939-945.

23. Franklin B, Bonzheim K, Gordon S, Timmis G. Resistence training in cardiac rehabilitation. J Cardiopulmonary Rehabil 1991;11:99-107.

24. Verril D, Ribisl P. Resistive exercise training in cardiac rehabilitation. An update. Sports Med 2001;5:347-383.

25. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs 2003;4th ed. Champaign, IL: Human Kinetics.

26. ACSM. ACSM's guidelines for exercise testing and prescription 2005;7th ed. LWW. 190.

27. Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low-fat diet. Effects on Progression of coronary artery disease. Circulation 1992;86:1-11.

28. Gitkin A, Ganulette M, Friedman D. In: Durstine JL, Moore GE, editor. Angina and silent is chemia. American College of Sports Medicine's Exercise Management for Persons with Chronic Disease and Disabilities 2003;2nd ed. Champaign, IL: Human Kinetics. 64-69.

29. Hoberg E, Schuler G, Kunze B, et al. Silent myocardial ischemia as a potential link between lack of premonitoring symptoms and increased risk of cardiac arrest during physical stress. Am J Cardiol 1990;65:583-589.

30. Lee AP, Ice RG, Blessey RL, et al. Long term effects of physical training on coronary patients with impaired ventricular function. Circulation 1979;60:1519-1526.

31. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 1988;78:506-515.

32. Coats AJS, Adamopoulos S, Meyer TE, et al. Effects of exercise training in chronic heart failure. Lancet 1990;263:3029-3042.

33. Coats AJS, Adamopoulos S, Radaelli A, et al. Controlled trial of physical training in chronic heart failure: exercise performance, hemodynamics, ventilation and autonomic function. Circulation 1992;85:2119-2131.

34. Myers JN, Brubaker PH. In: Durstin JL, Moore GE, editor. Chronic heart failure. American College of Sports Medicine's Exercise Management for Persons with Chronic Disease and Disabilities 2003;2nd ed. Champaign IL: Human Kinetics. 64-69.

35. Meyer K, Samek L, Schwaibold M, Westbrook S, Hajric R, Lehmann M, et al. Physical responses to different modes of interval exercise in patients with chronic heart failure-application to exercise training. Er Heart J 1996;17:1040-1047.

36. McKay CR, Kawanishi DT, Kotlewski A, et al. Improvement in exercise capacity and exercise hemodynamics 3 month after double-ballon, catheter ballon valvuoplasty treatment of patients with symptomatic mitral stenosis. Circulation 1988;77:1013-1021.

37. Kasalicky J, Hurych J, Widmsky J, Dejdar R, Metys R, Stanek V. Left heart hemodynamics at rest during exercise hemodynamics in patients with mitral stenosis. Br Heart J 1968;30:188-195.

38. Stefandes C, Stratos C, Pitsavos C, et al. Retrograde nontranseptal ballon mitral valvuloplasty: immediate results and long-term follow-up. Circulation 1992;85:1760-1767.

39. Douard H, Chevalier L, Labbe L, Choussat A, Brouster JP. Physical training improves exercise capacity in patients with mitral stenosis after ballonvalvuloplasty. Er Heart J 1997;18(3):464-469.

40. Lim HY, Jin YS, Lee CW, Park SW, Kim JJ, Song JK, et al. Kinetics of recovery oxygen consumption after maximal graded exercise in patients with mitral stenosis: Effects of percutaneous ballon mitral valvuoplasty and exercise training In press.

41. Squires RW. Cardiac rehabilitation issues for heart transplantation patients. J Cardiopulm Rehabil 1990;10:159-168.

42. Keteyian S, Ehrman M, Fedel F, Rhoads K. Heart rate perceived exertion relationship during exercise in orthotopic heart transplantation patients. J Cardiopulm Rehabil 1990;10:287-293.

43. Kappagoda CT, Haennel RG, Serrano-fiz S, Davies DH, English TA. The hemodynamic responses to upright exercise after orthotopic cardiac transplant. Arch Phy Med Rehabil 1993;74:484-489.

Figure 1

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

^* < .01 vs control, ^†P < .05 and ^‡P < .01 vs previous last data in same group. ^δP < .05 and ^∥P < .01 vs non-tatining group. T1/2 Vo2= half-recovery time of peak oxygen consumption