1. Exercise Prescription Cardiac Rehabilitation

2. WHY EXERCISE? ªHypertension ªDyslipidemia ªSmoking ªObesity ªDiabetes ªStress

3. CONTRAINDICATIONS TO EXERCISE ªUnstable angina ªsystolic/diastolic hypertension ªorthostatic drop > 20mm Hg with symptoms ªcritical aortic stenosis ªacute systemic illness or fever ªuncompensated CHF ªactive pericarditis, myocarditis ªrecent embolism ªUncontrolled atrial or ventricular arrhythmias ªuncontrolled sinus tachycardia > 120 bpm ª3rd degree AV block ªresting ST displacement > 2 mm ªuncontrolled diabetes (BG > 15) ªsevere orthopedic problems ªother acute metabolic problems

4. Exerciseis Medicine Exercise is Medicine “the art of exercise prescription is successful integration of exercise science with behavioural techniques that result in long-term program compliance and the attainment of the individual’s goal”

5. Exercise Prescription Exercise is prescribed taking into account 4 different factors: ªF- frequency -how often ªI- intensity - using RPE scale or heart rate ªT- type - aerobic exercise ªT- time - number of minutes per session

6. RPE scale Rate of Perceived Exertion ª6 ª7 very,very light ª8 ª9 very light ª10 ª11 fairly light ª12 ª13 somewhat hard ª14 ª15 hard ª16 ª17very hard ª18 ª19 very,very, hard

7. Exercise Prescription Post Discharge ª Frequency - every day, once or twice ª Intensity - easy, comfortable pace ª Type - walking ª Time - start at 5 minutes and increase by 5 minutes per week if tolerated

8. Exercise Prescription Recovery Program F - every day I - 10-30 beats above resting heart rate or RPE between 11 and 13 T - walking, cycling, arm ergometer T - increasing by 5 minutes per week to 30 to 40 minutes of exercise

9. Exercise Prescription Maintenance F - 5 to 6 times per week I - moderate intensity, 11-13 on the RPE scale, talk test – best values obtained from a stress test: 60%-80% of heart rate reserve (Karvonen’s Equation) T - walking, jogging, cycling, swimming, paddling, rowing, cross country skiing, snowshoeing,skating T - 30 -60 minutes

10. Resistance Training Light weight training for muscle endurance is appropriate for cardiac patients: ª3 months post event ªstart with light weights and increase gradually ªdoes not replace an aerobic workout ªincreases muscle tone and maintains mass to maintain muscular power