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The New Health and Human Services Cardiac Rehab Guidelines:
What this means to the Exercise Profession

© Eric P. Durak MSc

Aerobic conditioning
Specific guidelines for aerobic conditioning vary from individual to individual. Moderate exercise on machines is recommended for patients who have problems with gait, or who need constant supervision and data collection (direct from machines). Aquatic-based programs are beneficial for persons who need the buoyancy of water for conditions such as arthritis or joint pain, but it is estimated that in neck-high water, the heart is approximately 25% more efficient, due in part to improved venous return, and the lessened effects of gravity. Walking programs are most often recommended, but outcomes measurement is difficult, unless time, perceived intensity, or calories can be measured. Modified aerobic dance classes (low impact, chair aerobics, swing dance, etc.) are also beneficial to improve capacity and function in a social atmosphere. They may also improve compliance, as participants wish to exercise with friends and acquaintances who also attend classes4,6.

Strength training
The past decade has seen a change of thought as to the application of strength training to cardiac patients. From McKelvie's review in 1990,3 the amount of information about both the safety and efficacy of strength programming grown substantially. Perhaps the most important challenge is the actual prescription and progression of strength training programs for the individual. Although each patient differs in their needs, the table below highlights a typical strength program and progression for cardiac patients in three different stages.

TABLE I: Strength Program

StageExerciseSets/RepsProgressionComments
Phase IIMovement
(basic)
2 sets
10-15 reps
increase sets to
3-4 as patient
improves range
of motion.
Supervised -
1-on-1
ECG during
exercise
Light
dumb bells
1-2 sets
10-15 reps
increase by 1-2
lbs. each week
Elastic/rubber
tubing
1-2 sets
5-10 reps
work on improving
range of motion and
technique each session
Phase II/IIILight
dumb bells
2-3 sets
8-10 reps
increase 2- lbs.
each week on the
upper body, 5-10
lbs. on lower body
Supervised -
1-on-1
Strength
machines

Stretching

1-2 sets
10 reps
improve range of
motion and major
muscle group strength
improve post surgical
area and major muscle
groups
Phase IIIStrength
machines
2-4 sets
10-8-6 reps
Move from basic
exercises to a more
progressive format
Unsupervised
exercise, or
train with
a partner
Free weights2-4 sets
10-8-6, or
multiple
sets of 10
Work on perfecting
exercise form, strength,
and range of motion

Long term Programming
Success over months (and perhaps years) requires a well thought out plan. Outcomes can only be achieved if a progression is known, and followed as closely as possible. Below highlights a one year progression for a combination program in cardiac rehab for a phase IV patient who is post-op for over a year, and sedentary for the entire time.

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About The Author
Eric Durak received his Master of Science degree from the University of Michigan in 1986. His research experience is in the application of exercise for special population groups, such as diabetes, high risk pregnancy, cancer, and metabolic disorders. He has published scientific articles in journals such as: The American Journal of Obstetrics and Gynecology, Diabetes Care, The......more
 
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