Prior to the 1980s, the core of cardiac rehabilitation was based on exercise training, and the improvement of cardiovascular prognosis by exercise was confirmed by numerous basic and clinical studies. At that time, cardiac rehabilitation was limited to exercise rehabilitation, and further studies found that incorporating other cardiovascular risk factor treatments (i.e., secondary prevention) in combination with exercise rehabilitation could further improve patient prognosis. Thus, the early concept of cardiac rehabilitation has evolved into a modern cardiac rehabilitation that encompasses both rehabilitation (restoring and improving the patient’s functional capacity) and prevention (preventing recurrence of disease and death). Exercise is at the heart of cardiac rehabilitation. Numerous studies have confirmed that effective, regular, and appropriate intensity exercise can promote the restoration of fitness, improve cardiac function, improve quality of life, reduce rehospitalization rates, and reduce the rate of recurrent cardiovascular events and mortality in patients with cardiovascular disease. Mechanistically, exercise can improve vascular endothelial function, stabilize plaque, reduce cardiomyocyte apoptosis, and promote the establishment of collateral circulation. Different exercise intensities have different effects on improving patients’ physical performance, cardiac function and prognosis. Clinicians need to have the knowledge and skills on how to instruct patients to exercise effectively and safely. To instruct patients with cardiovascular disease to exercise, firstly, they need to master the risk assessment methods, secondly, they need to master the basic requirements of exercise prescription development, and at the same time, they need to simply master some exercise techniques. Routine exercise rehabilitation procedures Guided exercise therapy is given according to the patient’s assessment and risk stratification. Exercise prescription development is the key. The exercise rehabilitation program for each patient with coronary artery disease must be tailored to the patient’s actual condition, i.e., the principle of individualization. There is no exercise program that works for everyone, but universal guidelines should be followed. Exercise prescription refers to the individualized characteristics of the patient’s health, physical strength and cardiovascular function status, combined with study, work, living environment and exercise preferences, etc. Each exercise prescription includes: exercise form, exercise time, exercise intensity, exercise frequency and precautions in the exercise process. 1.Exercise form: mainly includes aerobic exercise and anaerobic exercise. Aerobic exercise includes: walking, jogging, swimming, cycling, etc. Anaerobic exercise includes: static training, weight-bearing and other exercises. The form of exercise in cardiac rehabilitation is mainly aerobic exercise, anaerobic exercise as a supplement. 2.Exercise time: the exercise time for cardiac patients is usually 10-60min, and the best exercise time is 30-60min. for patients who have just had a cardiovascular event, start from 10min/d and gradually increase the exercise time to finally reach 30-60min/d of exercise time. 3, exercise intensity: there are three methods of assessing exercise intensity: maximum oxygen consumption, maximum heart rate, and the symptom grading method. It is recommended that patients start exercising at 50% of maximum oxygen consumption or maximum heart rate, and gradually reach 60% of maximum oxygen uptake or 85% of maximum heart rate. The appropriate exercise intensity for patients is 11-13 according to the BORG exertional grading scale. Maximum oxygen consumption was measured by a cardiopulmonary exercise test, maximum heart rate = 220 – age (beats/mm). The patient’s exercise intensity was evaluated every 3-6 months to determine whether adjustments were needed. 4. Exercise frequency: at least 3 d per week, preferably 7 d per week. 5. Precautions during exercise: During exercise, patients should be monitored and given the necessary instructions. Temporarily stop exercise when the following conditions occur during or after exercise: ① feel chest pain, dyspnea, dizziness during exercise; ② blood pressure rise >200/100mmHg during exercise, systolic blood pressure rise more than 30mmHg or fall more than 10mmHg; ③ electrocardiogram monitor ST segment downward shift ≥0.1mV or rise ≥0.2mV during exercise; ④ serious arrhythmia during or after exercise . The classical exercise rehabilitation procedure consists of 3 steps: Step 1: Preparation activities, i.e. warm-up exercises, mostly low-level aerobic exercises, lasting 5-10 min. aiming to relax and stretch muscles, improve joint mobility and cardiovascular adaptations, prevent exercise-induced cardiac adverse events and prevent sports injuries. Step 2: Training phase, including aerobic exercise, impedance exercise, flexibility exercise, etc., total time 30-60min, of which, aerobic exercise is the basis, impedance exercise and flexibility exercise is complementary. 1, aerobic exercise: commonly used are walking, jogging, riding a white walker, swimming, climbing stairs, as well as walking on equipment, bicycle, rowing, etc., each exercise time for 20-40min. it is recommended that the initial start from 20min, according to the patient’s exercise ability to gradually increase the exercise time. The frequency of exercise is 3-5 times/week; the intensity of exercise is 50%-80% of the maximum exercise intensity. For patients with poor physical fitness, the exercise intensity level is set at 50%, and the intensity is gradually increased as physical fitness improves. For patients with good physical fitness, the exercise intensity should be set at 80%. Heart rate and maximum oxygen uptake are usually used to assess exercise intensity. At least 5 weeks after myocardial infarction or coronary artery bypass grafting (CABG) and should be followed by 4 consecutive weeks of medically supervised aerobic training: moderate to high intensity upper extremity strength training should not be performed within 3 months after CABG to avoid affecting sternal stability and sternal wound healing. 2. Flexibility exercises: The optimal function of skeletal muscles requires the patient’s joint activities to be maintained within the proper range. It is especially important to maintain flexibility and suppleness in the upper and lower trunk, neck and hips, and a lack of flexibility in these areas will increase the risk of chronic neck, shoulder and back pain. Poor flexibility is common in older adults, making them less able to perform activities of daily living. Flexibility training exercises are also important for older adults. Training principles should be carried out in a slow, controlled manner, gradually increasing the range of motion. Training method: each part of the stretching time 6-15 s, gradually increase to 30 s, if tolerated can be increased to 90 s, during the normal breathing, the intensity of the pulling sensation while not feeling pain, each action repeated 3-5 times, the total time of 10 min left, 3-5 times a week. The third step: relaxation exercise, which facilitates the slow return of blood from the exercise system to the heart, avoiding sudden increases in cardiac load induced by cardiac events. Relaxation exercises are an essential part of exercise training. Relaxation can be a continuation of slow-paced aerobic exercise or flexibility training, and can last 5-10 min depending on the severity of the patient’s condition, with the longer the duration of the relaxation exercise the more severe the condition. In addition to proper exercise prescription and medical guidance, safe exercise rehabilitation also requires medical monitoring such as ECG and blood pressure during exercise. For some low- and intermediate-risk patients, a heart rate monitor can be used as appropriate to monitor heart rate. At the same time, the patient’s performance during exercise should be closely observed so that the patient can be correctly judged and dealt with in a timely manner when discomfort occurs, and the patient should be taught to recognize possible danger signs. If the following symptoms occur during exercise, such as chest pain with pain radiating to the arm, ear, jaw, or back; dizziness; excessive exertion; shortness of breath; excessive sweating; nausea and vomiting; or irregular pulse, stop exercising immediately: if the above symptoms persist after stopping exercise, especially if the heart rate still increases 5-6 min after stopping exercise, further observation and treatment should be performed. If any unusual joint or muscle pain is felt, there may be a bone or muscle injury and the exercise should also be stopped immediately. In 2007, the American Heart Association (AHA) estimated the incidence of adverse cardiac events during rehabilitation exercise to be one adverse event per 60,000 – 80,000 supervised exercise hours, with the most common adverse event being arrhythmias, which occur at approximately the same rate in men and women: others include myocardial infarction, cardiac arrest, and death. and death_. Patients at high risk for adverse events include: myocardial infarction within 6 weeks, exercise-induced myocardial ischemia, left ventricular ejection fraction < 30%, history of persistent ventricular arrhythmias, history of persistent life-threatening supraventricular arrhythmias, history of sudden cardiac arrest that has not been stabilized with treatment, and recent implantation of an automatic cardioverter-defibrillator and/or frequency-responsive pacemaker. Therefore, when formulating exercise rehabilitation prescriptions, patients should be assessed for risk, with low-risk patients requiring no supervised exercise and both intermediate-risk and high-risk patients requiring supervised exercise. And when formulating exercise prescriptions, patients should be educated on general exercise knowledge to avoid over-exercising and identify discomfort symptoms. At the same time, in the exercise site, appropriate resuscitation instruments and drugs should be equipped, and rehabilitation physicians and nurses should receive cardiac emergency training.