EXERCISE POST-MI

“Exercise is extremely safe and serious complications are rare”

Contacts

British Association for Cardiac Rehabilitation c/o Action Heart 117 Wellington Road Dudley West Midlands DY1 lUB Tel: 01384 230333

Cardiac rehabilitation can contribute considerably to psychological wellbeing. Controlled trials have shown that exercise is an effective treatment for depression, while in post-infarct patients controlled trials have also shown that exercise rehabilitation can produce significant benefits such as increased confidence, wellbeing and happiness with decreases in anxiety and depression.

These benefits are relatively short-lived if exercise alone is used to treat the patient, but the addition of stress management and relaxation training as part of the rehabilitation programme significantly enhances the effects of the exercise programme.

9Improved survival

Patients treated with a multidisciplinary approach gain more improvement than those receiving exercise alone.

Where possible and appropriate, patients should be encouraged to join the local cardiac rehabilitation programme which nearly all hospitals now provide. In practice, few do at present and, even among participants, there is a considerable drop-out rate. However, making it very clear what the benefits of exercising are and giving strong encouragement to stick with the programme will help overcome patients’ natural fears and keep them positive about the gains exercise can bring.

Meta-analyses of the combined results of trials involving up to 4,500 patients show a 20 to 25% reduction in death rates in the exercise treated groups.

Dr Hugh Bethell is a general practitioner in Alton, Hampshire with a special interest in exercise and cardiac rehabilitation. He has contributed to several national guidelines on cardiac rehabilitation and runs a specialist clinic.

Coronary Prevention Group London School of Hygiene 2 Taviton Street London WC1H OBT Tel: 0171 927 2125

Primary Care Cardiovascular Society 36 Berrymede Road London W4 5JD Tel: 0181 994 8775

Resources

Edinburgh Healthcare Trust produce a week-by-week cardiac rehabilitation programme called the Heart Manual designed for patients but supervised by trained staff. The Manual includes activity logs, exercise advice, fitness plans, relaxation instructions (inc. audio tape) and dietary guidance along with comprehensive physiological information about their medical condition and recovery. For more information contact the Heart Manual Office on 0131 537 9127 or Heart.Manual@btinternet.com

1 How to calculate appropriate exercise intensity

A good rule of thumb for the exercise intensity needed to improve physical fitness is to aim for a heart rate between 70% and 85% of maximum. Maximum heart rate (MHR) declines progressively with time and is approximately 220 minus the age in years. 70% MHR is about 170 minus age and 85% MHR is about 195 minus age – ie. a 50 year old man should exercise to a heart rate between 120 and 145.

This rule applies to cardiac patients provided that they do not suffer significant symptoms on exercise and are not taking medication which lowers heart rate response to exercise such as betablockers, some calcium channel blockers and amiodarone. For patients with exercise-induced angina, appropriate training heart rates are just below the anginal threshold (as shown by exercise testing – though these can be increased by prophylactic glyceryl trinitrate).

Patients on rate-slowing drugs need to be exercise-tested to determine appropriate heart rate targets. The formula can be the same as for normal subjects namely between 70% and 85% the MHR found at maximum exercise, but MHR will be much lower. If maximum testing is not possible, training heart rates can be derived from the patient’s rate of perceived exertion during the test using the Borg score. Levels between “moderate” and “heavy” would be appropriate.

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