14 Jun Cardiac rehabilitation for exercise professionals part 1
Exercise Services; Indications and Contraindications; Case Study
Hi, I’m Steve Selig, founder of fit.test, and in this video I’m going to talk about cardiac rehabilitation for exercise professionals. In part one of this series, I’ll talk about the exercise services that are effective within a cardiac rehab plan, and the indications and contraindications for cardiac rehabilitation services. Then I’ll finish up with a case study.
The cardiac rehabilitation guidelines for health professionals were revised and published by the National Heart Foundation of Australia in 2019. I have provided the link to these here and at the bottom of this post. There is good evidence that by increasing participation in exercise, we can reduce hospital admissions and improve quality of life and of course, function.
I want to start by highlighting the strong recommendation that we as exercise professionals need to be giving cardiac rehab participants a tailored which means an individualised plan. Essentially, a progressive and supervised exercise training program.
It is very important to assess your client at the beginning
In order to do that, it is very important that you assess your client at the start of your service. This means that you should conduct a symptom-limited exercise test be performed either on a bicycle ergometer or on a treadmill. My app, fit test, is designed to do just that. A particular strength of fit.test is that it can be used to conduct either a submaximal or maximal intensity test. The former is very useful if your client develops exercise-induced symptoms.
Most of the time, I conduct submaximal cycle ergometer or treadmill tests up to either fatigue or the threshold of symptoms, whichever comes first. And from this, I can use fit.test to design an individualised exercise plan. Easy!
I suggest that you replace the word “adherence” with “participation” in exercise and a healthy lifestyle which involves your client taking an active interest in their own health care and becomes self-fulfilling and self-generating when it works at its best.
Cardiac rehabilitation for these patient groups
Cardiac rehabilitation services can be safely and effectively applied for all of these patient groups:
- Ischaemic heart disease (IHD) / coronary artery disease (CAD) / stable angina
- Stable chronic heart failure (CHF)
- Controlled hypertension
- Heart valve disease
- Peripheral arterial disease
- Most arrhythmias / most conduction defects: but some defects need special care for exercise
- Implantable devices: permanent pacemakers (PPM), automated implantable cardioverter defibrillators (AICD), implantable recorders
- Adult congenital heart disease / cardiac transplant
- Survivors of cancer: cardiomyopathies coming from medical treatments for cancer
- Other rarer forms of heart disease: arterial dissections / aneurysms / connective tissue disorders / myocardial scarring
So now I go to my case study of a 54 year-old female with a history of severe ischaemic heart disease (IHD) who also has significant peripheral arterial disease. Many of her central and peripheral arteries have been stented and she is also on aggressive conventional therapy.
At first, we conducted a 6 minute walk test because she was just so limited even for a very slow walk on a treadmill. She achieved just 175 meters in total over the six minutes, which is a very small distance and that even required a 30 sec rest halfway through. She trained with us for a few months, attending for exercise physiology sessions 2-3 times per week and made some courageous and meaningful changes to her lifestyle. All of this has resulted in her being able to walk at 6 kph for 15 minutes after just a few months.
She had been scheduled for a right calf stent based on previous angiography and symptoms. She attended for the stent and had a repeat angiogram just prior to stenting. This showed that she no longer needed the stent because she’d actually sprouted some new arteries which were also responsible for her improvement in symptoms and greatly improved treadmill performance. So she went home with no stent needed!
That’s all I really wanted to say and I hope you continue to enjoy fit.test and my YouTube channel.
You can contact me at [email protected] and have a great day.