1. Exercise for a Healthy Heart
Background education
Our purpose…
Exercise is a key component to a healthy lifestyle
 To aid you on a smoother, more effective road to regaining as active of a lifestyle as possible
We are here to help YOU establish a safe and effective exercise program (here in the gym classes and at home throughout the week) – at present and long-term
Ensure you are progressing, not only with your exercise program but ALL components of heart healthy living – work with other program disciplines to ensure you are achieving what you want

2. Cardiac Rehab Overview
Education Classes
Nursing Assessment
Exercise Test (Stress Test)
Exercise Therapist Assessment
Exercise Classes
Overview of the program
Finish up the education classes
Meet with the nurse
Have an exercise (stress) test here at the program
Meet with the exercise therapist
Start into the exercise classes

3. Exercise Test (Stress test)
Functional Assessment
Increases in speed and elevation over time
Blood pressure, heart rate, rhythm rate and symptoms monitored throughout test
A Functional assessment where you work as hard as you can while being carefully monitored
Usually occurs on a treadmill, with increases in elevation and speed every 3 minutes according to specific protocol
Blood pressure, heart rate, rhythm rate, symptoms are monitored by being connected to a 12 lead and BP cuff for duration of exercise test
Exercise therapist use this information to determine individual safe training heart rate range

4. One-on-One Assessment
Exercise Therapist Assessment
30 minutes session
Review exercise test
Discuss exercise plan and prescription
Exercise history and goals
Medical history – muscle or joint concerns
Exercise log/gym session overview
How to monitor intensity
Review of exercise test by going through Cardiac Rehab Exercise Guidelines sheet
Discuss Fitness level (stress test) and appropriate activities
Discuss exercise history and goals
Medical history (musculoskeletal injuries, concerns or barriers to exercise)
Review of exercise log: keeping track of resting HR, BP, time, distance, speed and HR on pieces of exercise equipment
Talk about how to monitor intensity with exercise using HR range or RPE scale

5. Exercise Classes 2 x per week 60 minutes per class 4 months
Monitoring blood pressure, heart rate and blood sugars (if diabetic)
Nurse and exercise therapists
discuss attendance, missed classes and program length
opportunity to monitor blood pressure, heart rate, blood sugars, symptoms and exercise progression throughout the four month program
chance for appropriate resources to be accessed while exercising, utilizing the interdisciplinary team members
group exercise session with individualized programs

6. Why Physical Activity?
Working to improve both physical fitness & physiological function
Heart pumps blood and oxygen
to the body with less effort
Improves symptom management
Improves circulation
Positive mental health and quality of life
Less mental stress, depression and anxiety
Feeling BETTER!!
Physical Fitness = capacity of the heart, blood vessels, lungs and muscles to function at optimum
Body’s ability to function efficiently and effectively day to day (work, leisure, ADL)
Physiological Function = the heart delivers a certain amount of blood around the body per minute
With improved physical fitness, the heart pumps blood and oxygen to the body with less effort which improves symptom management and improves vessel function as well as circulation therefore decreasing blood pressure
Improved psychological well being through reduced stress, anxiety and depression

7. Why Physical Activity? Positive effect on risk factors Blood pressure
Cholesterol
Blood sugars
Weight management
Stress, anxiety & depression
Smoking cessation
Blood Pressure: A stronger heart can pump more blood with less effort therefore decreasing the force on your arteries, lowering blood pressure.
Cholesterol: exercise stimulates enzymes to move LDL cholesterol from blood to the liver
Blood Sugars: exercise helps to improve insulin sensitivity and glucose tolerance
Weight Management: exercise helps to decrease fat mass and increase muscle mass for an overall weight management
Stress, anxiety, depression: exercise reduces levels of the body’s stress hormones (adrenaline and cortisol) and stimulates the production of endorphins (natural painkillers and mood elevators). Exercise also helps one gain confidence, have a better body image, as well as building networks and friendships
Smoking Cessation: decreases appetite, eases nicotine withdrawal symptoms and distracts thoughts of smoking

8. Physical Activity
Any body movement that increases energy expenditure above resting levels
Can be activities of daily living, occupation, leisure and active transportation
Most days of the week, preferably daily
Minimum: 150 minutes/week of physical activity (1000 kcal/week)
>50% of people over age 35 are inactive
<5% of people actually meet the daily recommended amounts of physical activity
150 minutes/week is the minimum amount of recommended activity to be accumulated per week just to meet metabolic needs

9. Exercise Planned Structured Repetitive
Improves and maintains overall physical fitness
Working to improve and maintain overall physical fitness by exercising at a desired intensity for a specified amount of time
(Includes cardiorespiratory fitness, muscular strength and endurance, body composition, flexibility, balance, agility, reaction time and power)

10. Aerobic Exercise Continuous, rhythmic exercise using
large muscle groups
3-5 days of the week
30 – 60 minutes per session of moderate intensity
Eg. Walking, running,
biking, stair climbing,
swimming
Canadian guidelines: 3-5 days/week, minutes of moderate intensity exercise

11. Aerobic Exercise Moderate intensity exercise measured by:
Target Heart Rate Range
Rating of Perceived Exertion
(RPE scale)
3. Metabolic Equivalents
(MET level)
Measured 3 ways, each will be discussed on following slides

12. Target Heart Rate Range
Based on your initial stress test
Most desirable intensity to exercise at
Safe intensity
Monitoring Heart Rate
Pulse Check
Heart Rate Monitor
In order to improve fitness level and ensure exercise is in a safe range, a “target heart rate range” is prescribed
goal of the exercise is to increase heart rate to within prescribed heart rate range in order to help improve fitness level & achieve goals, decrease risk of cardiovascular events, decrease risk of injury and increase compliance
As fitness level increases, heart rate per given workload decreases therefore you have to increase intensity to get “back into” target heart rate range
**If medications have been changed, this could affect target heart rate (specifically beta blockers)
Monitoring Heart Rate
Pulse Check
Each time your heart contracts and pumps blood out, a pulse can be felt in your arteries
Wrist – safest and easiest place to take your pulse
Place 2 fingers on the inside, thumb side of your wrists over the radial artery
Exert gentle pressure to feel the pulse
When you check your pulse while exercising, you may need to stop however it is important to keep you feet moving, shifting your weight from foot to foot
Heart Rate Monitor
Will be discussed on following slide

13. Heart Rate Monitor Device that measures heart rate
Wear it during exercise and general activities
Water proof
Purchased at any fitness store
Chest Strap Transmitter
Contains 2 elements – chest strap transmitter & wrist (watch) receiver
when electrodes come in contact with the skin they monitor electrical voltages in the heart
when a heart beat is detected a radio signal is transmitted to the receiver and is used to determine heart rate
Can be purchase at any fitness stores, place that sells fitness goods or here at the program
(Cardiac Rehab sells a Polar Heart Rate Monitor for $88.00 – cash, cheque or visa)
Wrist Receiver - Watch

14. Rating of Perceived Exertion
RPE Scale
Rating of Perceived Exertion
Perceived exertion is how hard you feel like your body is working based on the physical sensations you feel during physical activity and exercise (increased heart rate, breathing, sweating, and muscle (leg) fatigue).
By monitoring how your body feels, it is easier to adjust your intensity of your exercise and activity
aim for a rating between 3-5 on the 10-point scale = moderate to hard/strong intensity “rating”
the feeling of exertion should reflect how heavy and strenuous the exercise feels to you, combining all sensations and feeling of physical stress, effort and fatigue. It is a TOTAL feeling of exertion, not just shortness of breath or leg pain.
Use the scale to choose a number that best describes your level of exertion
“Talk Test” – can you walk and talk – carry on a conversation?

15. Metabolic Equivalent Metabolic equivalent = MET Amount of oxygen used
by the body during physical activity
The harder your body is working during an activity – the higher the MET required
Metabolic Equivalent = physiological measure to express energy cost of physical activities
Goal = to improve your MET level
Compendium of Physical Activities is a reference guide that assigns intensity units (METS) to physical activities

16. Resistance Training To increase or maintain strength
2-3 days of the week
12-15 repetitions at a moderate weight
Eg. Weight Machines,
free weights, rubber tubing,
resistance bands
Canadian Guidelines recommend 2-3 days of the week for at least repetitions at a moderate weight in order to achieve muscular strength and endurance

17. Flexibility (stretching)
To improve range of motion
3-5 days per week
20-60 seconds per stretch
All major muscle groups
Eg. Stretching, Yoga,
Tai Chi
Canadian Guidelines recommend 3-5 days of the week, holding each stretch at least seconds

18. Exercise Safety Warm Up Allows the body to get ready for exercise
5 – 10 minutes, easy pace
Eg. walk slowly gradually
increasing speed, bike no
resistance, walking on a spot,
stepping side-to-side
Warm up
Prepares the body for physical work by increasing circulation to the heart and muscles
Helps to increase muscle temperature allowing for stronger muscle contractions, greater flexibility and decreases muscle injury

19. Exercise Safety Cool Down Allows the body to recover
from your exercise
5-10 minutes, easy pace
After your exercise, continue
your activity at a lower level
walking on a spot,
stepping side-to-side
Cool Down
Helps to return blood to your heart and decrease heart rate to resting rate
Prevents muscle cramps, dizziness, hyperventilation and fainting

20. Exercise Safety Nitro spray Symptoms Blood Sugar Medications
Inform staff of hospital or ER visits
Replace fluids – Drink water!
Coffee, food, alcohol, smoking
Nitro Spray: If it’s been prescribed, you should carry it on you at all times…exercise is not any different!
Symptoms: If any symptoms occur whatsoever with exercise, tell us so we can help you out and find a conclusion
Blood Sugar: Monitor blood sugar before and after exercise in order to be in a safe range during and after exercise
Medications: Take them as prescribed. Do not change up the time of your medication because of exercise, if you change your routine, you’ll forget to take them!
Hospital Visits: The more we know, the more we can try to help out
Replace fluids: Fluid lost through sweating while exercising needs to be replaced. Before, during or after exercise (at least 2 of those 3 times) you should be replacing fluid by drinking water (1 cup for every 20 minutes of exercise)
Coffee, food, alcohol, smoking: all of those things can affect heart rate and blood pressure before exercise

21. Gym Reminders Heart Rate Monitoring Footwear Water Towel Clothing
Glucometer and snack (diabetes)
Attendance
Gym Cancellations
Reminders of what to bring/do for the exercise classes:
Heart Rate Monitoring: bring heart rate monitor to class, or know of some way to monitor heart rate for the class
Footwear: make sure to wear proper footwear (soft, rubber soles, closed toe and heel)
Water: proper hydration with exercise, bring a bottle with you as there is no water cooler or fountain
Towel: if you sweat excessively, you may want to have a small towel with you during exercise
Clothing: wear loose, comfortable clothing that you can move around in easily
Glucometer and snack: bring glucometer to class in order to check blood sugars, healthy snack in case needed
Attendance: If a medical issues arises, we can place you on a medical hold however there are no make up classes for missed classes or vacations. If you are returning to work, please discuss with exercise therapist
Gym Cancellations: if you know ahead of time that you are going to miss a class, please let us know

22. Tips for getting started
Small changes make BIG differences
Start by increasing physical activity
Slowly introduce exercise
Find an activity you enjoy! Variety is important!
Find an exercise partner/family member
Set exercise goals/action plan
It’s NEVER too late to start!

23. There are 1440 minutes in every day…Schedule 30 of them for exercise!!

24. Thank you
This presentation has been developed by the Cardiac Rehabilitation staff at the Regional Cardiac Care Centre of St. Mary’s General Hospital, Kitchener, Ontario.