What exercise, when and how much should a patient do after discharge from acute MI?
General Guideline for CHD Prescription Activity
Frequency Intensity
Duration
Phase I
Phase II
Healthy Adults Sitting, ADLs<4MET Supervised All endurance All endurance standing, S training, (CR) activities & activities, walking and Walking Walking, light weight Aerobic ROM cycling, resistance training and exercise exercises swimming training competitive sport 2-4 x daily Daily 3-4 x weekly 3-4 x weekly 3-5 x weekly MI & GABG MI & CABG 60-75% MHR 70-90% MHR 70-90% MHR RHR+10RHR (50-60% (60-85% 20bpm or 2-3 +20BPM VO2max) VO2max) METs <4METS initially, (40(50-60% increasing to 50%VO2max) VO2max) 70-90% MHR RPE 11-13 RPE 11-13 60RPE 12-16 (85%VO2max RPE 13-15 ) RPE 13-15 5-20min 5-30min 30-60min 30-60min 30-60min
Countess Of Chester 2010 ACSM
Phase III
Phase IV
HRmax = 220 – Age HRR= ([HRmax – HR rest] x Intensity) + HRmax RPE
Post OR â&#x20AC;˘ Either in CCU & Cardiac Ward Mobilization & Education
However, • Few studies have reported the effects of physical activities on physical functioning: • Shu-Lin, et al. Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan. Heart Lung 2002; 31:133-140 • Hirschhorn, et al. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery-a randomised controlled trial. Heart Lung Circ 2008; 17:129-138 • Hirschhorn, et al. Stationary cycling is as effective as walking in phase I cardiac rehabilitation: a randomised controlled trial. Heart Lung Circ 2010; 19: S5 • Matsunaga, et al. Adaptation to low-intensity exercise on a cycle ergometer by patients with acute myocardial infarction undergoing phase I cardiac rehabilitation. Circ J. 2004; 10:938-945.
4. MUTWALLI, H., FALLOWS, S., ARNOUS, A., & ZAMZAMI, M. (2012). Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program. Saudi Medical Journal, 33, 179-186. 5. MUTWALLI, H., FALLOWS, S., SYKES, K., MORRIS, M., ABUKHUDAIR, W., ASHMEG, A., ARNOUS, A., & ZAMZAMI, M. (2008). EFFECTIVENESS OF EARLY CARDIAC REHABILITATION ON POST- OPERATIVE CORONARY ARTERY BYPASS PATIENTS. Journal of the Saudi Heart Association, 20, 60-65. During hospital stay, all these studies found that CR group recorded better outcomes compared to UC group
Immediately After Hospital Discharge â&#x20AC;˘ CR often start 2 to 8 weeks after hospital discharge â&#x20AC;˘ Post-cardiac events patients have been reported to have high level of anxiety and depression with low physical activity following hospital discharge. Zamzami & Mutwalli (2008)
Low level of Quality of Life
MUTWALLI, et al. (2008). EFFECTIVENESS OF EARLY CARDIAC REHABILITATION ON POST-OPERATIVE CORONARY ARTERY BYPASS PATIENTS. Journal of the Saudi Heart Association, 20, 60-65. 2 weeks after hospital discharge >150% PF
MUTWALLI, et al. (2012). Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program. Saudi Medical Journal, 33, 179-186. 2 months after hospital discharge >200% PF
â&#x20AC;˘ 209 AMI patients (EF>45%); a month after discharge 4 weeks Ex programme (4 days/week) â&#x20AC;˘ 3 ex programmes: AG (52), RG (54) and A&R (53) 1. AG: 10-minute warm-up, 40-minutes of cycling (75%HRmax)and 10-minute cool-down.
2. RG:
10-minute warm-up, 4 sets of 10 Resis Ex & 10 to 12rep (60% max voluntary contraction)and 10-minute cool-down.
3. A&R: 2 sessions AEx AND 2 sessions REx
• 38 AMI patients (EF>40%); > a month after discharge 8 weeks Ex programme (3 days/week) • 10-minute warm-up, 35-minutes of aerobic Ex (6575%HRmax) and 10-minute cool-down. 10 min Rowing OR Cross Body
10 min cycling
10 min walking
Gym Plan
â&#x20AC;˘ 50 AMI patients (EF>40%); < 3 months after discharge 12 weeks Ex programme (3 days/week) â&#x20AC;˘ 10-minute warm-up, 30 to 40-minutes of aerobic Ex (70- 85% HRmax)and 10-minute cool-down. Aerobic Ex included walking, bicycling, jogging, rowing & light weights Circuit Plan
Gym Plan
Circuit Plan
Group Exercise Plan
In Conclusion • Before exercise programme, echo and ETT are recommended for AMI patients… • Health care providers should work together… • What could we do for Saudis AMI patients?
â&#x20AC;˘ 230 MI patients Hospital-based started 4 to 6 weeks after discharge 8 to 10 weeks Ex programme Home-based stared 1st week booklet & phone calls â&#x20AC;˘ Home-based was as effective as hospital-based for MI patients and did not show significantly affect on clinical outcomes.