Cardiac Rehabilitation Centre Pre-Admission Recommendations The following recommendations are for individuals who have been referred to the Cardiac Rehabilitation Centre (CRC) and have temporarily been place??on our program?? s waiting list. ***Note: Please consult your physician prior to implementing any of the following recommendations. Why should I exercise? The majority of individuals with a diagnosis of heart and /or blood vessel disease (artherosclerosis) are under challenging their cardivascular system. This actually results in a deterioration of your health and a higher risk of heart attack or illness.. Challenging the heart and other muscles of the body with aerobic exercise will cause them to adapt, becoming more efficient with their use of oxygen, nutrients & energy stores. Ultimately, aerobic training will improve your endurance capacity and provide you with more energy for your daily life routines. This is the result of a slowing or reversal of the process of plaque build up in the arteries, a decrease in the clumping of red blood cells and the improved ability of the arteries to stretched and contract. In addition, even low intensity regular aerobic exercise will improve the immune system, helping to fight disease. What is aerobic exercise? Aerobic exercise involves the rhythmic use of the large muscle groups of the body over a prolonger period of time. It is a low resistance (intensity) exercise with a high number of repetitions (duration). What are some examples of aerobic exercise? Walking, bicycling, step-ups, swimming, jogging, rowing, X-country skiing and skipping.
How to start? The aerobic exercise with the greatest of benefits and lowest risk for an initial exercise program is walking. a) Determine your current abilities: Step 1: Take a walk and time how long you can walk before you begin to experience the signs and symptoms of too high a workload for your heart ( see below). Step 2: Record your maximum time in a notebook ( see attached exercise record sheet) Step 3: Develop a plan to walk seven (7) days a week at a time of day that you can manage and which will be stress free and risk free. early in the day or after a nap when you are well rested when family members will not have significant demands on your time when it is light out not within 45 minutes to an hour of a meal begin slowly and increase your effort at a slow but regular pace Step 4: Write out a monthly plan in your exercise note book. Two (2) example plans have been illustrated on the sheet attached. ( in the examples the maximum time achieved in step 1 and recorded in step 2 are given the arbitrary number of 10 minutes but you could start at anywhere from 3 minutes to 30 minutes depending on your personal abilities and health) Step 5 : Begin your daily walking program: (1) Before each exercise session begin with a warm-up phase. Performing a warmup is recommended for the following reason: It gradually increases your metabolic rate ( the rate at which you burn energy) from rest to a level required for exercise. This minimizes the chance of an inability of your body to supply you with sufficient energy for exercise. It allows time for the heart to supply itself and the tissues of the body with vital oxygen. It increases the blood flow to working muscles, warming them up, and thus leaving them less prone to injury. It promotes a gradual increase in heart rate and blood pressure thus decreasing the chance of increasing blood pressure to dangerously high levels It allows you time to monitor your signs & symptoms as you progress into exercise mode. Every warm-up should last a minimum of 5 minutes and a maximum of 10 minutes.
Week 1 Week 2 Week 3 Week 4 Week 5 PLAN ONE Day 1 = Maximum time on the test walk i.e. 10 minutes in this example PLAN TWO Day 1 = Maximum time on the test walk i.e. 5 minutes in this example a.m. p.m. Day 1 10 Day 1 5 5 Day 2 10 Day 2 5 5 Day 3 10 Day 3 5 5 Day 4 10 Day 4 5 5 Day 5 10 Day 5 5 5 Day 6 12 Day 6 6 6 Day 7 12 Day 7 6 6 Day 1 12 Day 1 6 6 Day 2 12 Day 2 6 6 Day 3 12 Day 3 6 6 Day 4 14 Day 4 7 7 Day 5 14 Day 5 7 7 Day 6 14 Day 6 7 7 Day 7 14 Day 7 7 7 Day 1 16 Day 1 8 8 Day 2 16 Day 2 8 8 Day 3 16 Day 3 8 8 Day 4 16 Day 4 8 8 Day 5 18 Day 5 9 9 Day 6 18 Day 6 9 9 Day 7 18 Day 7 9 9 Day 1 18 Day 1 9 9 Day 2 20 Day 2 10 10 Day 3 20 Day 3 10 10 Day 4 20 Day 4 10 10 Day 5 20 Day 5 10 10 Day 6 25 Day 6 12 12 Day 7 25 Day 7 12 12 Day 1 25 Day 1 12 12 Day 2 25 Day 2 12 12 Day 3 25 Day 3 12 12 Day 4 22 Day 4 12 12 Day 5 25 Day 5 12 12 Day 6 30 Day 6 15 15 Day 7 30 Day 7 15 15
(2) A cool-down phase must also be performed at the end of an exercise session. A cool-down phase promotes a controlled decrease in blood pressure and heart rate, which ensures adequate supply of oxygen to the heart and other muscles during recovery, therefore minimizing the potential of developimg angina, of having a heart attack, or of your blood pressure to jump back to its peak levels in the first few hours following exercise. Warm-up: Type 1: walk slowly and then gradually increase your walking pace to moderate exercise levels (weeks 1 & 2 ). Type 2: begin with standing marching and side stepping on the spot for 2 to 3 minutes. Progress to arm punching and arm circles at shoulder height for 2 to 3 minutes Finish with marching on the spot with arm punching for 2 3 minutes ( This warm-up has additional benefits for the cardiovascular system and should be started at the beginning of week 3) Cool-down: Part 1: walk at a progressively slower pace for 5 10 minutes, gradually decreasing to an ambling or sauntering pace Part 2 : perform leg stretches in standing Progress to adding in arm stretches at week 3 and trunk stretches at week 6. (see attached exercise sheet) The GOAL: walking non-stop at moderate pace for a minimum of 30 minutes total per day The KEYS TO SUCCESS are: Consistency Record you planning in advance Documenting your results every day Watching for and responding to your signs & symptoms
SIGNS & SYMPTOMS of too heavy a workload on the heart: Angina ( chest heaviness, tightness, burning discomfort or pain OR an aching in the neck or jaw OR an aching, pain or numbness and tingling running down on or both of your arms OR an aching or pain between the shoulder blades) Shortness of breath ( greater than would be expected with your level of exertion - if you can say a long sentence in one breath you are usually not exercising too hard try There was once a fox who could not fit in the box ) Dizziness, light headedness or confusion Nausea An irregular heart beat or palpitations Significant fatigue ( greater than would be expected with your level of exertion) A change in skin colour ( if your face and neck drain of colour) Cold and clammy skin / excessive sweating Severe leg pain or cramps If you experience one or more of the symptoms: first decrease your speed and exertion level. If the symptoms persist, stop, sit and rest and, if you have been prescribed it, take your nitroglycerin spray (or pill). If in 3 to 5 minutes the symptom(s) continue, take your nitro a second time. If in another 3 to 5 minutes the symptoms have not gone away, take your nitro a third time and go immediately to the hospital.
Special Considerations: Individuals with Stable Angina If you experience angina at low exertion levels or can t progress your walking program without experiencing angina or shortness of breath, ask your doctor about taking your nitroglycerin spray before starting your warm-up & walk. This can open up blood vessels and promote better oxygen delivery to the heart and other tissues of the body (e.g. the legs). Individuals with Congestive Heart Failure (CHF): a. should avoid prolonged isometric muscle (contraction increasing the tension within the muscle without any change in muscle length, i.e. pushing against a wall). b. should check foot, ankle and calf swelling: if this increases contact your doctor and decrease the intensity of your walking program slightly until you are evaluated c. should ensure fluid intake is sufficient to match losses (e.g. due to sweating) but not exceed them Following a heart attack (Myocardial Infarction) The scarring down of the damaged heart tissue and the healing process takes 8 to 10 weeks. During the healing phase a program of progresssive daily walking and a gradual return to your regular daily activities at home is optimal. This is a period when keeing moving is critical to healing but equally important are a healthy diet, relaxation and a good night sleep. In consultation with your doctor, expect a return to driving at 5 to 6 weeks and a graduated return to work any where from 3 to 6 months following your heart attack. Following heart surgery The progress of healing of the heart tissue and your chest wall takes 8 to 10 weeks. Although you may continue to feel sore and tender to the touch for up to 6 months, it is rare that damage will occur to the surgical sites with exercise and activity after the 8 to 10 week recovery period unless an infection occurs. You may begin a progressive daily walking program immediately upon discharge from the hospital and gentle stretching within 4 to 6 weeks. Individuals with you are encouraged to take a buddy with you on your walk for the first days or anytime you increase your wokload. Diabetes Continue to take a blood sugar reading every morning and record it in your daily note book. Add a blood sugar reading following your daily walk at least 3 times a week. If adding exercise to your day causes any changes in your blood sugars modify your food intake to accommodate to changes. To avoid blood sugars that are too low after exercise (hypoglycemia) always take candy or fruit slices with you on your walk to take if or when you need it.