EXERCISE & CARDIAC REHABILITATION

disappear this process should be repeated twice more. If after three treatments the angina symptoms have not disappeared call an ambulance or if the classes are hospital-based get proper medical help as this could be an indication of acute myocardial infarction.

It should be noted that while both rate of perceived exertion and heart rates should be used for monitoring exercise intensity, in patients on medications which alter heart rates, rating of perceived exertion is a better indicator of intensity. Finally although cardiac events resulting from exercise programmes occur rarely it is essential that anyone taking a cardiac rehabilitation class is qualified in basic life support (CPR).

Final exercise considerations To prevent blood pooling and maintain venous return when exercising the legs/toes should kept moving particularly when standing during active recovery and muscular strength endurance work. Make sure to include prone and supine exercises after the cool down rather than during the circuit to reduce preload on the heart and the risk of arrhythmias. Cold weather, and particularly cold winds, can cause the onset of angina so avoid exercising outside during these times and in order to prevent excessive oxygen demands on the heart for no significant increase in workload, sus- tained actions with the hands above the head should be avoided.

Any primary care teams wishing to run a

phase IV programme should contact Martin Feaver who is one of two BACR Phase IV graduate network coordinators and will be able to arrange this. Telephone

07775

626788 or e-mail posimfitness@btinter- net.com

References 1. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 3rd Edition. Europe: Human Kinetics 1999 2. American College of Sports Medicine. Guidelines for Exercise Testing and Prescription. 5th Edition. London: Williams & Wilkins 1995 3. American College of Sports Medicine. Exercise management for persons with chronic disease and disabilities. Europe: Human Kinetics 1997 4. American Council on Exercise. Exercise for the Older Adult. ACE’s Guide for Fitness Professionals. Europe: Human Kinetics 1998 5. British Association for Cardiac Rehabilitation. Phase IV Exercise Instructor Training Manual 1998 6. BACR Guidelines for Cardiac Rehabilitation. Coats JS, McGee HM, Stokes HC, Thompson DR. Blackwell Science, London 1995 7. The British Medical Association New Guide to Medicines and Drugs. Dorling Kindersley, London 1998 8. Heart Disease and Rehabilitation 3rd Edition. Pollock ML and Schmidt DH (Eds). Europe: Human Kinetics 1995

NOTE: The circuit of exercise stations out- lined on pages 16-17 is available as a set of 12 A4 sheets, accompanied by a chart which outlines all the major cardiac med- ications and precautions that should be taken with exercise. The A4 pages are available laminated or on CD-ROM for (£13.50), or in PDF format (£11.50). Subscribers receive a 25% discount. For an additional £4, each sheet can be cus- tomised with an individual clinic/group/ organisation name. See p11 to order.

Useful contacts BACR - 01384 230222 BHF - 020 7935 0185 British Cardiac Society - 020 7383 3887 and www.cardiac.org.uk The Family Heart Association - 01865 370292 Overeaters Anonymous - 01426 984678

Useful internet sites WHO - www.who.ist DOH - www.doh.gov.uk American Heart Association - www.americanheart.org Imperial College of Science Technology and Medicine - www.med.ic.ac.uk NSMI - www.nsmi.org.uk

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