An exercise based CR program involves:
- assessing the patient’s baseline ability, limitations and cardiovascular risk
- developing an exercise prescription (see below)
- observing the patient’s response to that prescription and adjusting the prescription as necessary
- encouraging long-term participation in regular unsupervised exercise.
An appropriate exercise prescription, in parallel with a medication prescription, includes:
- type of activity (mode) and location (centre- or home-based)
- frequency (usually on a weekly basis)
- duration (how long for each session and for the program)
- intensity (dose)
Type of activity (mode)
Low impact aerobic exercises such as walking, cycling, rowing and machine stair climbing (that use large muscle groups) are all effective. The mode(s) of exercise chosen should be enjoyable for the individual and simple to carry out to maximise adherence.
During the supervised training phase, a treadmill or stationary cycling may be used as the primary training mode.
Frequency and duration
A typical exercise prescription initially includes three supervised centre-based sessions per week (or a minimum of one per week with instructions for two equivalent home sessions). Over time, patients transition to home-based (or group) exercise on most days. This is necessary to achieve a significant improvement in functional capacity.
Each session includes three phases:
- warm up (5–10 minutes)
- training phase (20–45 minutes of continuous or discontinuous aerobic activity)
- cool down (5–10 minutes).
Programs typically have patients attending at least one supervised session per week for 12 weeks before fully transitioning to home-based exercise patients after 12–36 supervised sessions.
Exercise intensity can be specified as a heart rate, a speed and grade of a treadmill/stationary cycle, or using the rating of perceived exertion (RPE or Borg scale), which most patients can learn and apply easily during unsupervised exercise.
The exercise intensity for healthy adults is usually a 12 to 13 (somewhat hard) on the RPE scale. This corresponds to 60–70% of functional capacity. Individuals with a low-baseline fitness level, which is often the case with cardiac patients, should begin at a lower percentage of capacity (e.g. equivalent to a rating of exertion of 10 on the Borg scale).
The incremental benefit of very high intensity exercise (>90% capacity) is small and is not recommended because it leads to lactate accumulation and fatigue, and increases the risk of physical injury and cardiovascular complications.
The exercise prescription is progressed according to patient tolerance, motivation and goals, symptoms, baseline fitness level and musculoskeletal limitations.