EXERCISE & CARDIAC REHABILITATION

ging and swimming, the traditional method used in Phase IV is circuit train- ing. The benefits of circuit training include: ● Enabling a greater amount of work to be undertaken than continuous training for the same period of time ● Readily enables individual progression within a group situation

The circuit should provide the opportuni- ty for all major muscle groups to be used. A cardiac rehabilitation circuit usually consists of alternating aerobic and active recovery stations. Aerobic stations improve cardiac functional capacity and endurance with the active recovery sta- tions enabling the client to improve the muscular endurance of muscles not specif- ically used at the aerobic stations.

Muscular endurance work in the circuit should be high repetitions with low resis- tance. The duration at each station will depend on the fitness level of the individ- ual but a guide would be around 30-60 seconds at each station. This whole cir- cuit component usually lasts between 20 to 30 minutes.

The intensity of this component is nor- mally 60-80% of maximum heart rate. Some medications alter the response of the heart during exercise and the rate of perceived exertion is used as an alterna- tive method of measuring exercise inten- sity. For these individuals a rating of 13- 14 on the Borg scale is prescribed.

Shuttle walking Shuttle walking enables greater flexibility for progression and individualisation as well as providing an alternative to prevent overcrowding at aerobic stations. It is particularly useful if clients are unable to perform one of the stations.

Individuals work for one minute at each station alternating between aerobic and active recovery stations. The change over between stations should be unhurried to enable adequate time for clients to make adjustments to equipment without feeling overly pressured.

Floor work within the circuit can lead to orthostatic hypotension when returning to standing, increase the preload on the heart with a corresponding increase in the risk of arrhythmias and prove difficult for

older individuals for a number of reasons. To prevent these difficulties, floor work should take place after the cool down.

Individual exercise prescriptions and pro- gressions are provided in a number of ways. Increasing the intensity of an activ- ity - for example increasing the resistance on an exercise bike or substituting a band with greater resistance for bicep curls - will require the individual to work harder. Additionally reducing the time an individ- ual spends at an active recovery station by introducing shuttle walking increases the myocardial workload. Eventually some clients will omit the active recovery sta- tions completely and alternate between periods of shuttle walking and aerobic stations.

Cool down As with the warm up, the cool-down is longer than in mainstream classes lasting for a minimum of 10 minutes. This enables a gradual reduction in exercise intensity and reduces the risk of arrhythmias, blood pooling and hypotension. Stretches should include all major muscle groups used during the exercise session.

Muscular strength endurance This section provides the opportunity for exercises that need to be completed as part of the independent, unsupervised exercise prescription addressing the spe- cific needs of the individual. Consequently, adequate guidance on cor- rect exercise techniques needs to be included. This time is particularly impor- tant for people with postural or orthopaedic limitations who can be given exercises to do at home.

Relaxation An important element of cardiac rehabili- tation is educating the clients in the need to manage stress, which includes relax- ation techniques. By including a relax- ation session at the end of a class, there is an opportunity to continue this aspect of their programme.

End of the class The period following exercise is when potential cardiac problems can occur and it is therefore recommended that clients remain in the centre/facility where their class took place for at least 15 minutes. Many participants use this time for social interaction and refreshments.

Exercise without supervision As far as possible, all clients should be encouraged to exercise at least 3 times per week for 30 - 60 minutes at 60-80% of maximum heart rate/RPE 12-16 (on Borg scale) (3,4,5&6). Since the focus of exer- cise at Phase IV is to improve the func- tional capacity of the cardio-vascular sys- tem, aerobic exercise activities are gener- ally recommended and include: - ● walking/jogging ● cycling ● swimming ● gardening ● bowling ● ballroom dancing ● golf ● home fitness equipment including sta- tionary cycles, rowing machines

Exercise classes from the group classes can also be included.

Most patients are likely to be on a combi- nation of medications but GTN (glyceryl trinitrate) sprays are commonly used dur- ing exercise rehabilitation classes in response feelings of angina. The patient should use the spray and rest for five min- utes after use. If the symptoms do not

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