Endurance Exercise Intensity Determination in the Rehabilitation of Coronary Artery Disease Patients

Abstract

In the care of coronary artery disease (CAD) patients, the benefits of exercise therapy are generally established. Even though the selected endurance exercise intensity might affect medical safety, therapy adherence and effectiveness in the rehabilitation of CAD patients in how to determine endurance exercise intensity properly remains difficult. The aim of this review is to describe the available methods for endurance exercise intensity determination in the rehabilitation of CAD patients, accompanied with their (dis)advantages, validity and reproducibility. In general, endurance exercise intensity can objectively be determined in CAD patients by calculating a fraction of maximal exercise tolerance and/or determining ventilatory threshold after execution of a cardiopulmonary exercise test with ergospirometry. This can be translated to a corresponding training heart rate (HR) or workload. In the absence of ergospirometry equipment, target exercise HR can be calculated directly by different ways (fraction of maximal HR and/or Karvonen formula), and/or anaerobic threshold can be determined. However, the use of HR for determining exercise intensity during training sessions seems complicated, because many factors/conditions affect the HR. In this regard, proper standardization of the exercise sessions, as well as exercise testing, might be required to improve the accuracy of exercise intensity determination. Alternatively, subjective methods for the determination of endurance exercise intensity in CAD patients, such as the Borg ratings of perceived exertion and the talk test, have been developed. However, these methods lack proper validity and reliability to determine endurance exercise intensity in CAD patients. In conclusion, a practical and systematic approach for the determination of endurance exercise intensity in CAD patients is presented in this article.

Exercise training programs in Dutch cardiac rehabilitation centres

“…An important requirement for ECR programs to be safe and effective is an exact determination of exercise intensity using parameters derived from a symptom-limited exercise test [8]. From a safety perspective, exercise intensity should not be too high as it has been postulated that strenuous exercise increases platelet activation [9,10].…”

How to determine the initial treadmill speed for the aerobic training of chronic hemiparetics?

“…The trainings are done at intensities that range from 40 to 85% of the HRR 2,14,16,17 as determined by the formula proposed by Karvonen et al 18 The HRR is an important physiological variable to quantify the maximum effort during training, and is also an important indicator used to prescribe training intensities of aerobic exercise programs -in addition, it presents a good correlation with the tests done on stationary bicycles. 19,20 The importance of and the training parameters for hemiparetics are well established, however there is no clear description as to the speed to be used to begin treadmill training in a clinical physiotherapeutic practice.…”

Determination of Ventilatory Threshold using Heart Rate Variability in Patients with Heart Failure

“…In the absence of gas exchange analyzers, VO 2 at VT can be determined by invasive lactate blood samples [17,18]. In their review, Hansen et al [22] underlined that VT 1 and Anaerobic Threshold (AT) are used interchangeably in the literature. They nevertheless reported a wide range (from 58 to 75 % of VO 2 peak) in AT determination and so a significant difference in heart rate value according to the method used [22].…”

“…In their review, Hansen et al [22] underlined that VT 1 and Anaerobic Threshold (AT) are used interchangeably in the literature. They nevertheless reported a wide range (from 58 to 75 % of VO 2 peak) in AT determination and so a significant difference in heart rate value according to the method used [22]. Zanettini et al [23] also reported that Self-regulation of exercise intensity based on BORG score was associated to higher heart rate values than VT 1 workload.…”