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Exercise with Cardiac Patients – Practical Recommendations for Sports Therapy in Cardiac Rehabilitation

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Introduction

Physical activities are a natural necessity and — just as targeted training — result in lower cardiovascular and overall mortality of cardiac patients, while also improving these patients’ prognosis, quality of life, and physical performance. They can therefore be considered an independent therapeutic method that is equal to therapy approaches based on medication, intervention, and surgery and can supplement them in a meaningful way.

Sports therapy and physical education measures help patients acquire individual resources and abilities and have the potential to contribute to a change in exercise-related lifestyle. According to current insights, a beneficial exercise and training program for cardiac patients should include endurance and strength training.

The following training recommendations for cardiac patients are intended to allow for therapeutically supported, dosed, controlled, and hence, successful management of training measures for people with cardiovascular diseases.

Aspects of Physical Education Activities

It should be clearly emphasised that sports therapy, and especially physical education activities, cannot simply consist of establishing training parameters during the patient’s rehabilitation phases 1 and 2. Rather, the core task of physical education is to motivate inactive and ill people to exercise in a regular and healthy way for the long term.

Consequently, physical educators, who must consult with physicians and base their programs on diagnostic results, are much more than simple “exercise managers” within the scope of their activities. They play an essential role as advisors and accompany their patients throughout a long-term recovery process. Accordingly, this process is not only determined by curative measures, but also by gradually developing a focus on (secondary) prevention and permanent well-being during the course of the patient’s treatment.

The didactic and methodological decisions with regard to physical exertion, selection of exercises, organisational forms etc. as well as communication and guidance therefore must, in addition to the physical condition of patients, take into account their psychological condition, mental resilience, social circumstances, personal motivation, attitudes, and intentions. After all, the demanding purpose of the treatment is to initiate behaviour change or, at least, to achieve behavioural modifications.

This can only be successful with the identification and consideration of as many behaviour-relevant factors and determinants as possible. A biography-based, multidisciplinary exercise history can provide valuable insights for this purpose. Such a patient history not only offers information about the living and working conditions of the patient (how can sport/exercise be integrated into the existing daily schedule?), but also clarifies the availability of exercise groups (how do I address situations in which no cardiac rehabilitation group is available in a radius of 20 km?) and sheds light on the opportunities and risks of the patient’s social environment (family, friends, coworkers).

It is helpful for sports therapy to keep the entire personality of a patient in mind in order to employ suitable impulses — including appropriate training management — to strengthen personal resources and abilities. Such an approach empowers patients to take responsibility for the long-term design of their healthy activities. The section below provides an overview of the therapy components endurance and strength training.

General Aerobic Endurance Training

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1) Training Resources

The following types of endurance sport can generally be recommended. The selection should always keep individual circumstances (motivation, primary illnesses, body weight, practical aspects etc.) as well as the cardiovascular training effect and controllability in mind
  • (Nordic) walking, running (jogging)
  • Bicycle ergometer training
  • Endurance training on cardio equipment (treadmill, stepper, cross trainer, rowing
  • machine etc.)
  • Bicycling
  • Swimming, aquajogging
  • Inline skating
  • Cross-country skiing
  • Rowing

2) Objectives

Improvement of patient prognosis
  • Decreased overall mortality
  • Decreased cardiovascular mortality
  • Improved life expectancy
  • Decreased rate of cardiac events and rehospitalization
  • Reduced cardiovascular risk factors
Improved quality of life /fewer symptoms
  • Stabilised or enhanced general and cardiopulmonary physical fitness
  • Fewer cardiopulmonary symptoms such as dyspnea, angina pectoris, and exercise intolerance
  • Improved psychological well-being
  • Enhanced psychological resilience
  • Stabilised or enhanced psycho-vegetative resilience
  • Improved social reintegration (“stake”)
  • Improved body perception and self-esteem

3) Indications

Training is recommended for the following patient conditions with consideration for the contraindications listed further below:
  • All stages of coronary heart disease, including
    • History of myocardial infarction (NSTEMI, STEMI)
    • History of unstable angina pectoris
    • History of interventional and surgical revascularization
  • Arterial hypertension/ hypertensive heart disease
  • Cardiomyopathies (note contraindications)
  • Stable chronic heart failure (NYHA classes I—III), including patients with history of decompensation
  • Congenital or acquired heart defects (asymptomatic or clinically stable phase)
  • Surgically repaired heart valve defects
  • History of heart transplant
  • Patients with increased cardiovascular risk
  • profile such as diabetes mellitus, lipo metabolic disorder, obesity, or metabolic syndrome

4) Risk Stratification

To avoid risk, patients with the following health conditions need to be closely monitored with particular care during training:
  • Acute myocardial infarction, intervention for cardiac surgical procedure in the past four weeks
  • Severely restricted left or right ventricular function
  • Symptomatic heart failure from NYHA class II
  • Complex ventricular arrhythmia in the past history
  • History of reanimation or fainting outside of acute events
  • Blood pressure decrease under physical exertion
  • Angina pectoris or heart failure under physical exertion < 5 MET
  • Past history of bradycardic (tachycardic) arrhythmia
  • Relevant post-cardiotomy syndrome

Strength Training

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The emphasis of strength training in rehabilitation is not on reaching maximum muscle power, but on economic and optimally prepared execution of movements in everyday situations and leisure activities.

1) Training Resources

  • Sequential training equipment
  • Pulley traction equipment
  • Dumbbells
  • Expanders or latex/Thera Band® resistance bands
  • Body’s own weight

2) Objectives

  • Compensating loss of strength and muscle/ bone substance due to age, disease, or periods of rest
  • Primary prevention of muscular and skeletal diseases
  • Maintenance and improvement of mobility
  • Improved symptoms/ quality of life
  • Improved physical performance
  • Preparation for everyday situations/ job
  • Reduced cardiovascular risk factors
  • Optimised innervation ability
  • Development of neuromuscular balances
  • Adaptations of the passive musculoskeletal system
  • Improved posture
  • Improved intermuscular and intramuscular coordination to prevent falls

3) How It Works

  • Improves muscle strength (maximum strength, endurance strength)
  • Inter-/ intramuscular coordination
  • Creatine phosphate level and activity of the corresponding enzymes
  • Increases muscle mass
  • Positive impact on cardiovascular risk factor profile – Improved body proportions
  • Improves glucose metabolism
  • Long-term positive impact on hemodynamics under exertion – Decreased cardiac afterload
  • Reduces cardiac pressure output
  • Reduces rate-pressure product and therefore, O2 requirement of the heart
  • Compensates strength deficits and muscular imbalances
  • Improves body perception

4) Indications

Strength training should be a standard treatment for all cardiac patients especially those with:

  • Atrophy as a result of postoperative immobility
  • Disease-related muscular atrophy
  • General physical weakness
  • Secondary orthopaedic diseases

Spiroergometry System For Accurate Tracking

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As a world renowned manufacturer of high quality ergometers, Lode offers a turn-key solution for cardiac rehabilitation – Lode Cardiac Rehab Manager (LCRM). The complete solution consists of their intuitive and user-friendly LCRM software, a very compact wearable ECG streamer and is completed with Lode rehab ergometers. To learn more about Lode’s LCRM solutions, visit our page now: https://bmec.asia/th/lode/

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