Jonathon Stavres MS, ACSM-EP-C
According to the Centers for Disease Control and Prevention there are roughly 83 million adults who are diagnosed with cardiovascular disease (CVD). This relates to a cost of roughly $108.3 billion a year on medications, health care services, and loss time from work. After discharge from the hospital, CVD patients face a paradox. In order to maintain and improve their health, they must begin or continue a regular exercise routine. They may face physical limitations to exercise. Therefore, it is imperative for patients to understand how they can safely engage in an effective exercise program.
ACSM Guidelines for Exercise with CVD
The American College of Sports Medicine (ACSM) has adopted different guidelines /recommendations for the frequency, intensity, duration, and different modalities of exercise for people suffering from different CVD-related conditions.
Here are some recommendations for returning to exercise after a diagnosis of a coronary blockage (coronary artery disease, or CAD), a peripheral blockage (peripheral artery disease, or PAD), and a percutaneous transluminal coronary angioplasty (PTCA, or commonly referred to as a stent).
Attend Phase II cardiac rehab- The first and foremost recommendation for recently discharged CVD patients is to attend Phase II (commonly referred to as outpatient) cardiac rehabilitation. Most cardiac rehab units are staffed with nurses and exercise physiologists who can work with a variety of patients and conditions. In this environment, the patient is closely monitored for any adverse signs / symptoms. Insurance plans may dictate the number of sessions that a patient is able to attend. Upon discharge, regardless of how many cardiac rehab sessions are completed, you are in charge of your own exercise program.
Follow the four main principles of exercise– The FITT principle; how many days per week to exercise (frequency)?, at what intensity to exercise (intensity)?, how long to exercise each day (time)?, and what type of exercises to do (type)?
Frequency: ACSM recommends aerobic exercise on three or more days per week. While a patient should exercise at least 3 days per week, increasing frequency of moderate intensity exercise may improve benefits.
Intensity: One very easy tool to use is the Rating of Perceived Exertion (RPE) Borg scale. This is a scale ranging from 6-20. A six on the scale represents no feeling of overall exertion, while a twenty represents a feeling of maximal exertion; exerting yourself to a point that you could not surpass if you tried. Exercise at an intensity that is light to moderate, which correlates to RPE values of 11-16.
Time: Begin at an achievable duration, and progress towards 60 combined minutes of aerobic exercise. This can be performed in 10 minute bouts with rest periods between.
Type: Exercise should be light-impact cyclic-type activities. Popular machines are treadmills, ellipticals, NuSteps, and cycles. When just returning to exercise, patients should avoid actively using their arms in conjunction with the legs. Using both arms and legs will increase the strain on the cardiovascular system. Instead focus on leg exercises, and incorporate the arms as you progress.
These are very basic and general recommendations for returning to exercise for newly diagnosed CVD patients and patients recovering from a stent procedure.
Remember to consult with your physician and/or cardiologist after recovery, and if any symptoms or concerns arise.
*For examples of other variations/exercises look under Multimedia-VDF Exercise Tip
**Jonathon Stavres MS ACSM-EP-C is a guest contributing writer. He is a doctorate student in the Exercise Science/Exercise Physiology dept. at Kent State University
Pescatello, L. S., Arena, R., Riebe, D., & Thompson, P. D. (2014).ACSM’S guidelines for exercise testing and prescription. Baltimore, Maryland: Lippincot & Wilkins