EXERCISE & CARDIAC REHABILITATION Rating Exertion

(RPE) 6 7

8 9

10

11 Light 12 13

14 15

16 17

18 19

Moderate Somewhat hard Hard (heavy) Very hard Extremely hard 20 Maximal exertion Table 3: Rating of perceived exertion - Borg scale

Phase IV continues to use both heart rate monitoring and perceived exertion scales although the use of heart rate monitors is not usually encouraged.

It is crucial that all exercise prescriptions should be specific to the needs of the individual, enable progression and be reviewed regularly. Since many partici- pants in Phase IV are older adults, a num- ber of exercise guidelines used in cardiac rehabilitation are also found in older adult exercise classes.

● Age ● Gender ● Ethnicity ● Exercise history ● Risk stratification ● Medication ● Limitations to exercise ● Other medical conditions ● Residential location ● Location and time of Phase IV class

Table 2: Factors to be considered when planning individual exercise prescriptions

Exercise intensity At Phase III, clients are introduced to the exercise class format, are prescribed the intensity of their exercise programme and informed of the methods they need to use to monitor the intensity of their exercise. Methods include heart rate monitoring by either heart rate monitors or pulse taking and using the rate of perceived exertion scales (Borg scale).

14 SportEX

MET values An alternative method of prescribing exer- cise intensity is the use of metabolic val- ues. Tables detailing the energy cost - the MET values - for numerous activities have been developed (2,3&5). These enable the instructor to prescribe activities that are commensurate with the fitness level of the individual and to avoid activities that would place excessive demands on the client.

Exercise components In all components, an emphasis should be placed on correct and safe exercise tech- nique to enable clients to utilise the exer- cises that may form part of their individ- ual home-based exercise prescription.

Warm up The duration of the warm up should be at least 15 minutes to enable a gradual increase in cardiac workload and prevent the onset of arrhythmias and ischaemia. Initially the warm up should comprise of gradual pulse and body temperature rais- ing by using large muscle groups in low impact actions - for example walking type actions, side stepping. These actions should increase in size and range and gen- erally include some coordination work to increase the intensity of the activity. To prevent excessive oxygen demands on the heart for no significant increase in work- load, sustained actions with the hands above the head should be avoided.

Avoiding overuse of particular movements or excessive repetitions can prevent local muscular fatigue.

The intensity of the warm up should enable the pulse to increase to within 20 beats per minute (bpm) of the individual’s training heart rate and/or 12 on the Borg scale. It should be noted that using the heart rate as an indication of exercise intensity is not appropriate when an indi- vidual is on medication that affects the heart rate response to exercise (see med- ication table). For other clients the train- ing heart rate is 60-80% of an individual’s maximum heart rate. Maximum heart rate is calculated by taking the age of the client and subtracting this figure from 220. For example for a client aged 50 the maximum heart rate is 220 - 50 = 170.

As in all warm ups, stretches should include all major muscle groups. When stretching it is important the instructor provides a number of alternatives to meet any difficulties clients may experience and that an appropriate pulse rate is main- tained. For example if balance is a prob- lem then encourage patients to perform the stretch while seated or to support themselves using a wall.

Music is not generally used during the warm-up enabling social interaction and giving guidance for exercise and general instructions.

Conditioning activity Although there are a number of different activities appropriate for improving car- diovascular fitness including walking, jog-

Hardly anything Fine

A little out of breath Feeling good Can just keep going Totally exhausting Description

No exertion at all Nothing Very, very weak

Very light Just noticeable Very slight

Note: Some scales run from 1- 10, 1-15 and as in this case 6- 20. The reason for the scale running from 6-20 is that it was originally established for use on middle-aged men in order to predict exercise heart rate. If the RPE value is multi- plied by 10 this would rough- ly predict the heart rate at that intensity. Eg. an RPE of 6, equating to sitting still (no exertion at all) represents a heart rate of 60, an average heart rate of a middle-aged man at rest.