The document discusses the benefits of exercise for patients with cardiovascular diseases like coronary artery disease and heart failure. It outlines that regular physical activity can decrease mortality by 20-30% and improve blood pressure and quality of life. Exercise is shown to have greater benefits than procedures like PCI. Guidelines recommend 20-30 minutes per day of moderate intensity exercise for secondary prevention after a heart attack. The document also provides recommendations on exercise prescription, including frequency, duration, intensity and progression. It notes contraindications and risks but states risks are low in supervised programs.

1. Dr. RAVINDER
NARWAL
Dr. RAVINDER
NARWAL

2. Objectives :-Objectives :- Benefits of exercise
The benefits of exercise with 1000kcal per week in
secondary prevention decreases the all cause
mortality around 20-30%
 Physical activity improves systolic blood pressure,
angina symptoms and exercises tolerance in
patients without revascularization

For patients with revascularization physical activity
improves quality of lives and exercise tolerance, as
well as 29% of cardiac events and around 20% lower
re-admission rates
2

3. physical activity is protective
However, it is important to note that only current
physical activity is protective – sports participation
in youth does not provide protection in later life
unless activity is maintained.

4. Objectives :-Objectives :- Benefits of exercise
4

5. PA effect on Hypertension/Blood
Pressure
Studies show that there is an inverse relationship between
physical activity and the incidence of hypertension, with
inactive individuals having a 30-50% greater risk of high
blood pressure/hypertension than fit and active individuals.
The frequency of exercise has a significant effect: the acute
effect of PA causes a reduction in blood pressure lasting 4 to
10 hours; therefore, daily activity may achieve clinically
significant improvement,
Aerobic fitness training has the greatest benefit, but
dynamic resistance and isometric resistance at moderate
intensity training has a smaller benefit 5

6. The evidence for benefit of exercise in Coronary
Artery Disease (CAD) is compelling and it has been
conclusively established that exercise is indicated in
the primary and secondary prevention of CAD.
 Studies demonstrate that the benefits of exercise
are greaterthan the results of PCI (Percutaneous
Coronary Intervention) techniques.
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Exercise in Coronary Artery
Disease

7. In one study of 101 men with stable CAD, over a two year
period, regular exercise intervention outperformed PCI
on all measures:
"Event free survival" rates after 24 months were 78% in the
exercise group versus 62% in the PCI.
At two years, maximal oxygen consumption (VO2max) had
increased by 10% in the exercise group versus 7% in the PCI
group.
Inflammatory markers improved in the exercise group: high-
sensitive C-reactive protein levels and interleukin-6 levels
were significantly reduced after two years of exercise by 41
and 18%, respectively, whereas no relevant changes were
observed in the PCI group.
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Exercise in Coronary Artery
Disease

8. Guidelines on secondary prevention for
patients following a myocardial
infarct recommend:
Following MI, patients should be physically active for 20-30
minutes a day to the point of slight breathlessness.
People who are not active to this level should increase their
activity gradually aiming to increase their exercise capacity.
They should start at a level that is comfortable, and increase
the duration and intensity of activity as they gain fitness.
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PA in secondary prevention of
MI

9. The benefits of physical exercise in patients with
Chronic Heart Failure (CHF) have been identified in
many studies and in a large meta-analysis published
in 2006, the authors came to the following
conclusions:
Exercise training in stable patients with mild to
moderate CHF results in statistically significant
improvements in maximum heart rate, maximum
cardiac output, peak VO2, anaerobic threshold, 6
minute walk test and HRQL (quality of life
questionnaire)

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PA/ Exercise in Chronic Heart
Failure

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Exercise Prescription:-Testing

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Exercise Prescription:-Testing

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Exercise Prescription:-Testing

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Exercise Prescription:-Testing

14. he American College of Sports Medicine (ACSM)
published guidelines which were based on their
traditional exercise guidelines but adapted for the
physiological differences in patients with CAD
compared to healthy individuals.
 Patients with CAD should perform everyday
physical activity as well as supervised exercise
lessons.

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Exercise Prescription

15. Continuous exercise using large muscle groups (e.g.
walking, swimming, group aerobics) fosters cardiovascular
endurance. Upper extremity exercises (e.g. using an arm
ergometer) may be useful for people with musculoskeletal
problems in their lower extremities.
Resistance exercises should be provided in a circuit training
approach. 10-12 exercises using 10-12 repetitions with
sufficient resistance that can be performed comfortably.
Cross-training is possible as well.

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Exercise Prescription:-Mode

16. A minimum of three nonconsecutive days per week
With the increased frequency of exercise, the risk of
musculoskeletal injuries increase

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Exercise Prescription:-Frequency

17. 10 minute warm-up and cool-down phases,
including stretching and flexibility exercises.
20-40 minute continuous or interval cardiovascular
exercise. Interval training may be useful for people
with peripheral vascular disease and intermittent
claudication.

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Exercise Prescription:-Duration

18. Cardiovascular exercise in supervised programs
should be of moderate intensity. Intensity can be
determined using various methods;
1. 40-85% VO2 max
2.40-85% maximal heart rate reserve (HRmax - resting
heart rate) X 40-85% + resting heart rate
3.55-90% of HRmax
4.The Rating of Perceived Exertion (RPE) is
appropriate to monitor exercise intensity

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Exercise Prescription:-Intensity

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Exercise Prescription:-Intensity

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Exercise Prescription:-Intensity

21. Slow progression of exercise in

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Exercise Prescription:-Progression
Duration
Intensity

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Exercise Prescription:-Monitoring
Patient observation
Measure heart rate and rhythm
Measure blood pressure when clinically indicated (depending on
the patient-specific risks for exercise-related complications)
Patients who exercise without direct supervision should exercise
at a lower intensity

23. Patients should exercise at a sub-symptom threshold
to avoid provoking myocardial ischemia, significant
arrhythmias or symptoms of exercise intolerance.
Patients at higher risk should exercise at lower levels
of intensity
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Contraindications for Exercises

24. 1. Uncontrolled or poorly controlled asthma
2. Cancer or blood disorders when treatment or disease
cause leukocytes below 0.5 x10/L, haemoglobin below
60g/L or platelets below 20 x 10/L
3. COPD: Patients are required to be stable before training
and oxygen saturation levels should be above 88-90%.
4. Diabetes if blood glucose is >13 mmol/L or <5.5 mmol/L
5. Patients with diabetic peripheral or autonomic
neuropathy or foot ulcers should avoid weight bearing
exercise
6. Any diabetic with acute illness or infection
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Absolute contraindications to exercise

25. 1. Heart disease - acute myocardial infarction or unstable angina
until stable for at least 5 days, dyspnoea at rest, pericarditis,
myocarditis, endocarditis, symptomatic aortic stenosis,
cardiomyopathy, unstable or acute heart failure, uncontrolled
tachycardia
2. Hypertension - resting blood pressures of a systolic >180mmHg or
diastolic >100mmHg or higher should receive medication before
regular physical activity with particular restrictions on heavy
strength conditioning, which can create particularly high pressures
3. Osteoporosis - avoid activities with a high risk of falling
4. Fever - should be settled to avoid a risk of developing myocarditis
5. Unexplained dizzy spells
6. Acute pulmonary embolus or pulmonary infarction
7. Excessive or unexplained breathlessness on exertion
8. Any acute severe illness
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Absolute contraindications to exercise

26. Risk of Exercise for patients with coronary heart disease:
 Acute myocardial infarction
 Cardiac arrest and
 Sudden death.
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Risk of Exercises

27. Incidence in supervised cardiac
rehabilitation programs are:
1 myocardial infarction per 294,000 patient hours
1 cardiac arrest per 112, 000 patient hours
1 death per 784,000 patient hours.
Over 80% of persons who reported cardiac arrest
symptoms while exercising have been successfully
resuscitated with prompt defibrillation
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Risk of Exercises

28. Incidence in supervised cardiac
rehabilitation programs are:
1 myocardial infarction per 294,000 patient hours
1 cardiac arrest per 112, 000 patient hours
1 death per 784,000 patient hours.
Over 80% of persons who reported cardiac arrest
symptoms while exercising have been successfully
resuscitated with prompt defibrillation
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Risk of Exercises

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