When supervising phase II cardiac rehabilitation patients, we control the intensity using Watts on an exercise bike and Heart Rate HR. Some patients when completing their program are above their target HR calculated at their initial exercise test. Most of them are recovering from valve or artery replacement. In wich case should one prohibit going above the target HR?
You can be more careful with patients with poor lv function, underlying arrythmia. In general in a institution with good back up facilities, it is safe enough
you are welcome.One can be satisfied with a submaximal test too in intial days of post procedure and just look for any symtoms
Hi Alexandra,
I recently read a rewiepaper about high intensity interval training in the fiel of rehabilitation, Wahl et al. 2010. I attached the paper. It is written in german, but just have a look in table 1. there a studys cited working with cardiac patients and high intensity interval training.
Rognmo O, Hetland E, Helgerud J, et al. High intensity aerobic
interval exercise is superior to moderate intensity exercise for increasing
aerobic capacity in patients with coronary artery disease.
Eur J Cardiovasc Prev Rehabil, 11: 216–222, 2004.
Amundsen BH, Rognmo O, Hatlen-Rebhan G, et al. High-intensity
aerobic exercise improves diastolic function in coronary artery disease.
Scand Cardiovasc J, 42: 110–117, 2008.
Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular
effect of aerobic interval training versus moderate continuous training
in heart failure patients: a randomized study. Circulation, 115:
3086–3094, 2007.
Warburton DE, McKenzie DC, Haykowsky MJ, et al. Effectiveness of
high-intensity interval training for the rehabilitation of patients with
coronary artery disease. Am J Cardiol, 95: 1080–1084, 2005.
I hope this is helpful.
Kind regrads
Florian
Hi Alexandra!
It is difficult to determine the optimal training intensity. It depends on patients (former physical activity, LV function, risk of arrhythmia, what kind of operation, etc.).
The training pulse can be useful, if there is a preserved chronotopic reserve. However, most of patients take beta blocker or other heart lowering drugs. In this cases it is better to determine the training intensity according to work intensity (watts) or according to Borg scale.
The training pulse is only a rough calculation. In the same patients it can be lower (if he is a starter, has no experience with exercise) or higher. So do not worry about higher than predetermined training pulse if it is well tolerated (Borg 13-14).
But be careful with patients after aortic repair. I do have bad experiences. In these patients the training should be limited (mostly to avoid blood pressure elevation above 150/90 mmHg).
Best wishes:
Attila
Alexandra,
Even though this is an old question, maybe this ansewer could help someone on this.
Any patient undergoing a Cardiac Rehabilitation Program (CRP), must be completed a protocol. This means, No limited by clinical conditions, A stress testing realized and an object to get with this.
In a phase II of CRP, one must be caution on target limits HR for every exercise session. Obviously, when this phase is reached, the basal cardiovascular variables are in better status than those at beginning days.
So, this is a good moment to repeat another exercise stress test, establishing with this a new HR target.
So never, try to extralimite the HR target.
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