Exercise Prescription Techniques in Cardiac Rehabilitation Centers in Midwest States

Abstract

Introduction: Cardiac rehabilitation (CR) is a primary prescribed treatment for a variety of cardiovascular disease states, including: coronary artery disease, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), myocardial infarction (MI), and heart failure. For this reason, exercise prescription guidelines for cardiac patients have been established. However, it is unclear how these guidelines are being administered at cardiac rehabilitation centers. The purpose of this study is to assess current exercise prescription techniques at cardiac rehabilitation clinics across several Midwest states in the United States. Methods: Fifty-eight CR programs from Michigan, Indiana, Illinois, Minnesota, Wisconsin, and Ohio were administered a questionnaire assessing clinic characteristics, aerobic and resistance exercise prescription techniques. Results: Most reported patient types were PCI, CABG, and MI. Clinical exercise physiologists were the primary exercise prescription writers (81%). Only 32% of the clinics required a clinical certification. Baseline stress tests prior to CR were performed in 33% of programs. Rating of Perceived Exertion (RPE) was the most commonly used indicator of exercise intensity, followed by heart rate reserve (HRR), and METs. Resistance exercise was practiced in 89% of CR programs. The most common intensity indicator was trial and error, and RPE. Conclusion: Results demonstrate exercise prescription variability among CR programs. This emphasizes the complexity and expertise among clinical exercise physiologists. These results also highlight the importance that academic programs place on training students across all prescription techniques, and utilization of research-based prescription guidelines published by professional organizations.

The Influence of Exercise Workload Progression Across 36 Sessions of Cardiac Rehabilitation on Functional Capacity

“…The progression of exercise is typically not standardized from one CR center to another, so comparison between different healthcare systems should be done with caution [6,16]. Several vague recommendations for exercise progression have been published, and include a gradual increase in RPE from 1 to 5 units beyond 13 (6–20 scale) per session as tolerated [17]; a systematic increase in exercise duration, frequency, and intensity [14]; and an increase in exercise duration prior to an increase in intensity [18].…”

“…For these reasons, exercise programming in CR should be focused on improving exercise capacity. However, a recent survey study among CR facilities found that nearly 60% of clinics reported no defined goals for improving exercise capacity among patients [6].…”

“…A possible reason for lack of goal-setting is the large discrepancies in exercise prescription techniques in cardiac rehabilitation [6,7]. Despite a clear understanding that more robust improvements in functional capacity following CR are associated with better health outcomes for cardiac patients, it remains unclear how to most effectively improve functional capacity throughout CR.…”

Exercise Prescription Guidelines for Cardiovascular Disease Patients in the Absence of a Baseline Stress Test

“…This helps clinical exercise physiologists establish ischemic thresholds that should not be exceeded during exercise training in order to avoid eliciting ischemia. Despite this approach being the gold standard for exercise programming in CR [5,6], in a recent survey study among CR clinics in the United States it was reported that only 33% of clinics conduct baseline GXTs [7]. A similar survey of forty-five Dutch clinics identified that 36% of heart failure patients, and 30% of coronary artery disease patients did not perform a baseline GXT prior to beginning CR [8].…”

Six-minute walk test in cardiac rehabilitation

“…Однако в ру тинной практике перечисленные нагрузочные тесты выполняются не часто, в т. ч. перед включением больного в программу КР. Анализ реальной практики 56 реабилитационных клиник в 6 штатах США показал выполнение нагрузочного теста (ВЭМ или тредмиле) перед началом КР только у 34% больных [4]. Снижение частоты применения нагрузочных проб объясняли разными причинами: сокращением сроков госпитализации, совершенствованием методов диагностики, достижением полной реваскуляризации миокарда, противопоказаниями больного и даже личными предпочтениями врачей.…”