Exercise Prescription for Individuals with Cardiovascular Disease and Modifiable Risk Factors

73 Pages·2014·3.02 MB·English

5th Asian Preventive Cardiology & Cardiac Rehabilitation Conference
cum 9th Certificate Course in Cardiac Rehabilitation
Workshop 2: Exercises
Exercise Prescription for Individuals
with Cardiovascular Disease and
Modifiable Risk Factors
Clement Kin Ming CHAN
FHKCOP (Cardiopulmonary Physiotherapy), MSc Geriatric Rehabilitation,

PgD Health Services Management, BSc Physiotherapy, RPT
[email protected]

6 November 2014, 1145 – 1230,
HK Convention & Exhibition Centre
Exercise Prescription for the
General Public in Preventing CVD

Physical Activity and Physical Activity and
Public Health Update Public Health for
Recommendation for Older Adults
Adults

from from
the American College of Sports Medicine and the American College of Sports Medicine and
the American Heart Association the American Heart Association

Circulation. 2007;116:1-13 Circulation 2007; 116:1094-1105
Exercise Prescription
for individuals with
Modifiable CVS Risk Factors
(HT / DM / Obesity / Hyperlipidaemia)
Exercise Prescription for individuals with Modifiable CVS Risk Factors
HT
What is the role of physical activity in the management of ?
(NHLBI, 2013)
•
At least 44 randomized controlled trials including 2674 participants
have studied the effect of exercise training on resting blood pressure(1).

•
Average:  SBP 3.4  DBP 2.4 mmHg

•
Normotensive subjects:  SBP 2.6  DBP 1.8 mmHg
•
Hypertensive subjects:  SBP 7.4  DBP 5.8 mmHg

Source:
(1) Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc.

2001;33(6 suppl): S484–S492.
(2) NHLBI Systematic Evidence Review From the Lifestyle Work Group (2013). Lifestyle interventions to reduce CVS Risk.
4
Exercise Prescription for individuals with Modifiable CVS Risk Factors
HT
What is the role of physical activity in the management of ?
(JNC7, 2003)
Source:
NHLBI (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
http://www.nhlbi.nih.gov/guidelines/hypertension/
5
Exercise Prescription for individuals with Modifiable CVS Risk Factors
Hypertension
Aerobic Exercise
 preferably all days of the week
 accumulated to 150 mins/week
 at moderate intensity (RPE* 12-16)
 at 40-60% VO2R / HRR
 activities using large muscle group
(continuous and rhythmic)
 brisk walking, swimming
 continuous or accumulated
30 to 60 mins/day or 150’/week with
bouts each lasting >10mins
*RPE: Rate of perceived exertion (on a 6-20 scale: no exertion at all is 6 and maximal exertion is 20)
Source:
American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription 8th Edition. Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins.
6
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA (2004); American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc.
36(3):533-53. Review.
Rate of Perceived Exertion (RPE)
15-grade Borg’s Scale 10-grade Modified Borg’s Scale
6 0 nothing
7 very, very light 0.5 very, very weak
8 1 very weak
9 very light 2 weak (light)
10 3 moderate
11 fairly light 4 somewhat strong
12 5 strong (heavy)

g
n
13 somewhat hard 6
i
n
i
a
r
T 14 7 very strong

e
s
ic 15 hard Anaerobic Threshold 8
r
e
x
E 16 9
17 very hard 10 very, very strong
18 (almost maximum)
Maximal Exertion
19 very, very hard  Maximum
20
Med Sci Sports Exerc. 1982;14-377-381
Calculations of Target Exercise HR
(HR Reserve Method)

Resting Heart Rate = 60
Maximum Heart Rate = 140
HR reserve = HR max/peak – HR rest = 80

Target Exercise Heart Rate
= HRresting + [(HRmax – HRresting) x Intensity* (%)]

* Intensity = 50%  THR exercise = 100
Intensity = 75%  THR exercise = 120
Exercise Prescription for individuals with Modifiable CVS Risk Factors
Hypertension
Resistance Training
 2 – 3 days per week
(at least 48 hours between each session)

 60-80% 1-RM

 8 to 10 multi-joint exercise
(Avoid Valsalva Maneuver)
 4 sec for @ repetition, 8 to 12 reps/set
 perform 2 to 3 sets
 2-3 mins of rest between sets
Source:
American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription 8th Edition. Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins.
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA (2004); American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc.
36(3):533-53. Review.
9
Loading of RT
Load-Repetition Relationship
Adapted from Dingwall H, Ferrier K, Semple J. Exercise prescription in cardiac rehabilitation. In:
Thow M, ed. Exercise Leadership in Cardiac Rehabilitation. West Sussex, England: Whurr
Publishers Ltd; 2006:97–131.