Evaluating Exercise Progression in an Australian Cardiac Rehabilitation Program: Should Cardiac Intervention, Age, or Physical Capacity Be Considered?

Abstract

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

National survey of Australian cardiac rehabilitation programmes: does current exercise programming adhere to evidence-based guidelines and best practice?

“…In the Australian context, where our study found a low uptake of exercise capacity assessments, 6MWT may be a useful alternate method of assessing the functional response to CR, where mean pre–post improvement has been reported to exceed 20% in a single-centre study of 2524 CR participants 24. However, observational data from Australia suggest that exercise capacity assessments are needed in practice to accurately classify initial exercise capacity and subsequently tailor exercise prescription in CR 25…”

“… 24 However, observational data from Australia suggest that exercise capacity assessments are needed in practice to accurately classify initial exercise capacity and subsequently tailor exercise prescription in CR. 25 …”

“…24 However, observational data from Australia suggest that exercise capacity assessments are needed in practice to accurately classify initial exercise capacity and subsequently tailor exercise prescription in CR. 25 The specific assessment of resting ECG is recommended in major North American and European guidelines, 23 26 despite the inconclusive prognostic benefit in high-risk cohorts. 27 In the present study, 42% of services failed to assess resting ECG/HR.…”

Modification of the Forms of Self-Determined Regulation and Quality of Life after a Cardiac Rehabilitation Programme: Tennis-Based vs. Bicycle Ergometer-Based

“…In other words, patients from this tennis group did not carry out physical activity because they had suffered a stroke and because there was an (external) medical prescription that indicated that exercise was essential for their recovery or to prevent the appearance of more strokes. In this regard, the CRPs carried out with guided physical exercise are effective in favouring changes towards healthy and long-lasting habits in stroke patients [5]. The fact that the tennis group presents better results than the cycle ergometer group may be due to the interest that doing an activity such as tennis outside the hospital, playing with other patients, playing for points and so forth can generate.…”

“…Cardiac rehabilitation (CR) is a programme supervised by professionals that helps people recover from heart attacks and their associated surgery [1]. It has been shown to be an effective tool for improving body composition [2,3], functional capacity and physical fitness [4][5][6], heart rate variability (HRV) [7,8] and health-related quality of life (HRQoL) [9,10]. However, and despite the unquestionable benefits provided by CRPs, a study performed in 28 European countries concluded that less than half of the cardiovascular patients benefited from a CRP [11], and, in fact, the benefits were generally transitory as patients dropped out of the programmes [12].…”