The exercise prescription for patients with coronary heart disease should be formulated according to the patient’s health, physical strength and cardiovascular function status, combined with individualized characteristics such as study, work, living environment and exercise preferences. The content of each exercise prescription follows the FITT principle, including exercise frequency, intensity, form and time.
1.Exercise frequency
Aerobic exercise 3~5d per week, preferably 7d per week, resistance exercise, flexibility exercise 2~3d per week, at least 1d interval.
2.Intensity of exercise
In a certain range with the increase in exercise intensity, the cardiovascular health or physical fitness benefits obtained from exercise also increased. Cardiovascular health or physical benefits of the maximum exercise intensity threshold to be obtained through the exercise load test.
Commonly used methods for determining exercise intensity include the heart rate reserve method, anaerobic threshold method, percent peak oxygen uptake, percent oxygen uptake reserve, target heart rate method, peak heart rate method, and self-perceived exertional rating method. Among them, the first four methods require electrocardiographic load test or cardiopulmonary exercise load test to obtain relevant parameters.
The combined application of the above methods is recommended, especially in combination with the self-perceived exertion grading method.
(1) Heart rate reserve method
This method is not affected by drugs (β-blockers, etc.) and is more commonly used in clinical practice. Target heart rate = (maximum heart rate – resting heart rate) × exercise intensity + resting heart rate. For example, if a patient exercises at a maximum heart rate of 160 beats/min and a resting heart rate of 70 beats/min, and the exercise intensity chosen is 60%, the target heart rate = (160-70) × 60% + 70 = 124 beats/min.
(2) Anaerobic threshold method
The anaerobic threshold level is equivalent to about 60% of the maximum oxygen uptake, this level of exercise is the best exercise intensity for patients with coronary heart disease, this parameter needs to be obtained by cardiopulmonary exercise test or blood lactate threshold, certain equipment and skilled technicians are required.
(3) Target heart rate method
This method is simple and convenient, but less accurate.
(4) Peak heart rate method
Target heart rate = age-projected maximum heart rate × exercise intensity, where the age-projected maximum heart rate = 220 – age, and the exercise intensity is moderate to high intensity, with an intensity range of 50% to 85%. When more accurate data cannot be obtained directly from exercise tests, this formula can be used to calculate exercise intensity.
(5) Self-perceived exertion grading method
The Borg scale is mostly used, and patients are usually recommended to exercise in the range of 11 to 16 points of intensity. This method is suitable for patients who are not in a position to receive an exercise load test, or who are being treated with beta-blockers, or who have dual-chamber pacemakers and frequency-response pacemakers placed. For patients with myocardial ischemia during exercise, the exercise target heart rate should be set to 10 beats/min less than the heart rate that induces myocardial ischemia.
3.Exercise form
It mainly includes aerobic exercise and resistance exercise. Aerobic exercise includes walking, jogging, swimming and cycling, etc.; resistance exercise includes static training and weight-bearing, etc. Although the form of exercise in cardiac rehabilitation is mainly aerobic exercise, resistance exercise is an essential component.
4.Exercise time
The optimal exercise time for cardiac patients is 30-60min/d. For patients who have just had a cardiovascular event, start with 10min/d and gradually increase the exercise time to eventually reach 30-60min/d.