cardiac reahb exerc

CARDIAC REHABILITATION
HOME EXERCISE ADVICE
Introduction
Exercise is a very important as part of your rehabilitation and your future health.
You will need to exercise at least three times per week, minimum, (ideally 5 - 7 times
per week) for you to get any real benefit from the exercise. You should try to build up
the amount of exercise you do steadily but gradually.
Some of the benefits of exercise for cardiac patients include:
♥ Improved working ability of the heart, both at rest and on exercise
♥ Heart becomes more efficient as a pump
♥ You may be able to do more work before you experience any exercise
symptoms, such as angina
♥ Exercise may help to reduce blood pressure both in the short term (during an
exercise session it may not increase as much), and in the long term (resting
blood pressure may be reduced)
♥ Exercise helps to widen the vessels our blood travels around the body in. If wider,
the flow of blood is made easier and so blood pressure is reduced
♥ Exercise may also help to prevent any further development of the fatty plaques
which block the blood vessels
♥ Exercise can help to improve the circulation of blood in the heart itself so that the
heart muscle gets the oxygen it needs to work efficiently.
Types of exercise
To gain the benefits mentioned above, and many others that exercise can bring
about, cardiac patients should carry out cardiovascular or aerobic exercises. These
include walking, cycling, jogging and dancing. Swimming is not recommended as the
main form of exercise for cardiac patients but can be included in the overall exercise
regime. Please ask for specific advice relating to your condition if you wish to include
swimming.
You need to build the above exercises into your everyday life in addition to things
such as doing the housework, gardening, DIY and other activities such as golf.
Exercise such as housework, DIY and golf, etc do not maintain your heart rate for a
constant period of time and, although they will help with flexibility and stamina, are
not as beneficial for your heart.
Cardiovascular/aerobic activities and exercise allow your heart rate to increase
steadily and stay elevated for a continuous period of time.
Monitoring Exercise Intensity
It is important for you to know if you are exercising at the right level for you.
There are two ways to ensure you are exercising safely and assess the intensity of
exercise. These are: 1. Your Heart Rate 2. The Borg Scale
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1. Heart Rate (HR)
It is important to monitor the heart rate during exercise so you know that your heart
is:
• working hard enough - otherwise there will be no benefit from the exercise
and
• not working too hard
THR
…………………..
One of the Cardiac Rehabilitation Nurses can give you your own
Training Heart Rate Range (THR). This is calculated based on
your age and medication. While exercising your heart rate
should reach between the two figures. If your heart rate (HR)
goes above the top figure when exercising, you need to slow down gradually and
work at an easier pace. You will be advised about this by one of the Cardiac
Rehabilitation Team.
How to take your heart rate – this is your pulse
a) The Wrist – turn your palm up. Using your index and middle finger (of the
other hand), slide your fingers over down the outside of your thumb, over the
bulge at its base and onto the wrist. Press gently, gradually increasing the
pressure if necessary and feel for a slight bumping against your fingertips.
This is your pulse.
b) The Neck – place your index finger and middle finger flat across your throat,
at the “Adam’s Apple”. Press the fingertips gently inwards and upwards
beside the windpipe. The thumping against your fingertips is your pulse.
To Count Your Pulse:
1. Find your pulse either at your wrist or neck
2. Look at watch/clock with a second hand on
3. Wait until it reaches the 12 or 6.
4. Start counting the thumps.
5. Count for a) 15 seconds and multiply x 4
b) 30 seconds and multiply x 2
Both of these will give you your heart rate which is always recorded over one minute.
2. The Borg Scale
This is a scale used so that you can estimate how much physical effort you use to
perform the exercise. As well as considering how hard or easily you are working, you
also need to consider the sensations your body is feeling while exercising, i.e.,
breathing a bit faster, actually feeling your muscles working, feeling warmer and
perhaps starting to sweat a bit. Any, or all, of these indicate that you are using
increasing physical effort.
If you have any other physical problems, eg, a bad knee or hip, you will be using
more effort in your exercise because of the problem you have. Your need to include
this effort when estimating where you are on the scale
Again one of the Cardiac Rehabilitation Nurses can help you understand what level
you should aim for. You should never work above 15 on the Borg scale (i.e. feel that
the exercise is physically hard).
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2. The Borg Scale
6 No exertion at all (sitting down)
7 Extremely light / easy Very little / no effort involved
(Can keep going ‘all day’)
8
9 Very light / easy Little effort involved
(Can keep going for a very long time)
10
11 Fairly light / easy Starting to put some effort into it
(Can keep going for quite a long time)
12
13 Somewhat hard Need to put effort into maintaining the speed
(Can still keep going for a good period of time)
14
15 Hard work Really pushing yourself to keep going
(Can only keep going for a short time)
16
17 Very hard work Pushing yourself very hard to keep going
(Can only keep going for a very short time)
18
19 Extremely hard work Pushing yourself extremely hard
20 Maximal exertion
Preparation for exercise
• Warm Up
Warming up before any exercise is essential and should be for a minimum of 15
minutes. This allows time for the heart and circulation to adjust so that when your
muscles need more oxygen to exercise, it is there. During the warm up your
muscles, tendons and ligaments become warmer and your heart rate (pulse) will
start to rise.
Warm up should start with gentle movement, particularly of the legs which is where
we all have the big muscles needing the most oxygen. This movement should
become a little more vigorous as the warm up progresses.
• Warm Up Exercises
15 minutes (aim for Borg scale 9-10)
You need to do a combination of exercises taken from the 3 groups suggested
below. Do one minute of each of your selection from groups 1 and 2. Add in the
stretches one at-a-time between the other exercises. The stretches should be held
for about 10 seconds each. Repeat the exercises one-after-the-other to build your
warm up time to the 15 minutes required.
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1. Pulse raising exercises
• Marching on the spot (gentle) - advance to knee lifts (more vigorous)
• Heel Digs - add in bicep curls with arms when further into warm up
• Side Taps - add in side raise with arms when further into warm up
• Backward Toe Taps - add in front raise with arms walking around.
2. Mobilising Exercises
The following exercises should be done with marching between each one:
• Shoulder rolls with marching – 3 sets (forwards and backwards)
• Side bends – 4 right and 4 left (wiggle toes)
• Heel toe taps (ankle)
3. Stretches
The following stretches should be done with pulse raising exercises (e.g. marching
on the spot) in between each one. (Most of these are illustrated at the back of this
handout.)
• Hamstrings (back of legs)
• Calf (lower leg)
• Quadriceps / Flamingo stretch (front of upper leg)
Upper Back and shoulders •
• Chest
If not enough time is allowed for the warm up (with a mixture of all the above
components) you may be at risk of developing problems during the more vigorous
exercise, eg, dizziness, breathlessness, angina and injury to joints and muscles.
Please Note: If your main exercise is to be a walk, then the first 15 minutes of the
walk (at a slower speed) can be the warm up period.
Aerobic or Cardiovascular Exercise/Circuit Training
This is the effective part of your exercise session
Aerobic or Cardiovascular exercise uses oxygen to help supply the energy that
working muscles need. This type of exercise helps to make the heart stronger and
you to feel fitter. It is different from some other forms of exercise, such as strength or
mobility exercises, which do not use oxygen as effectively.
Ideally you should exercise aerobically at least three times per week for 20 to30
minutes.
Start with 5 to10 minutes gradually increasing to 30 minutes. Types of aerobic activity
are walking, dancing and cycling or circuit training exercises. All of these use
repetition of large muscle group activity.
There is a selection of different circuit training exercises on pages 8 and 9. Each
can be performed for up to 2 minutes to add variety. The exercises offer a selection
of different levels of difficulty and should feel fairly hard but not uncomfortable or too
strenuous.
As someone who had had a heart problem in the past, it is very important that you
keep your heart rate (pulse) within the Training Heart-Rate Range when
exercising so check your heart rate about 5 minutes into the main exercise part of
your session. If you are unable to count your heart rate then you may wish to
consider buying a Heart Rate Monitor (choose a simple, inexpensive one).
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You should also maintain a Borg level of 11 –13, i.e., you are putting some effort into
the exercise but it is not becoming ‘hard work’.
With any exercise period, whether you are out for a walk or doing another form of
exercise, it is essential that you keep moving to make sure your heart rate remains
raised. If indoors, do not sit down between exercises or stop moving your
feet/toes.
The Final Stage
Cool Down
Cooling down exercise allows blood pressure to return to normal slowly and will
prevent dizziness occurring. Heat and waste products are removed from the
exercising muscle groups, which reduces the risk of stiffness and aching later on.
The cool down should last for at least 10 minutes.
It can include:-
1. Gentle exercises, ie, slow walking – this can be the last 10 minutes of your
walk
2. A selection of the pulse raising warm-up exercises done at very slow
speed
3. Gentle and slow mobilising exercises from the warm up
4. Stretches from the warm up – holding for 15 – 20 seconds
(examples in the back of this handout).
At the end of the cool down you should have recovered from the exercise. Your
heart rate and breathing rate should have returned to what it was before you started
to exercise.
What You May Experience While Exercising
NORMAL WHILST EXERCISING
- KEEP GOING STOP EXERCISING IF ANY OF THE FOLLOWING ARE PRESENT
Breathing – faster and deeper
Inappropriate levels of breathlessness
Feel your muscles working
Chest pain or your usual angina pain
Heart beating faster Pulse irregular (unless this is normal
for you)
Skin will become warm
Excessive sweating
Slightly sweaty
Dizziness
Feelings of unusual and excessive
tiredness
Unusual pain, not associated with
muscle soreness (can be any where
in your body)
Please note:
Do not exercise if you are feeling unwell.
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