Early out-of-hospital cardiac rehabilitation instructions Due to the tremendous advances in coronary revascularization and pharmacologic therapy, the length of hospitalization for acute infarction and coronary artery bypass grafting has been significantly reduced, and the corresponding duration of cardiac rehabilitation during hospitalization has also been reduced, resulting in fewer opportunities to instruct patients on risk factor reduction and appropriate exercise training. Therefore, the second phase of cardiac rehabilitation, the early out-of-hospital phase, is particularly important. Modern definition of cardiac rehabilitation: Cardiac rehabilitation is a comprehensive long-term program that includes medical evaluation, exercise prescription, cardiac risk factors, education, counseling, and behavioral interventions. Here is a brief introduction. (1) Pre-discharge preparation (1) Assessment, education and counseling: The physician in charge explains the patient’s condition, current treatment and future treatment plan, assesses the presence of psychological barriers, educates the patient and caregivers to recognize the symptoms of acute myocardial infarction and respond correctly and early, and corrects risk factors. (2) Discharge planning: Evaluate when the patient is fit for discharge, assess the patient’s ability to care for himself after discharge, and make a post-hospital exercise plan taking into account the patient’s post-operative recovery status and response to cardiac rehabilitation exercises, explain and instruct the patient and caregiver on the steps of discharge exercise, and specify the next follow-up visit. (3) Recommend patients to participate in out-of-hospital early cardiac rehabilitation program. Early cardiac rehabilitation exercises after discharge from hospital (3-6 months) Patients should maintain the healthy lifestyle and exercise habits they have developed after discharge from hospital. If patients have specific health problems, they should continue to exercise in the cardiac rehabilitation center and remain supervised if necessary. The following aspects should be noted when exercising. （Class A: Apparently healthy, no clinical evidence of increased cardiovascular risk with exercise Class B: Stable cardiovascular disease, low risk of cardiovascular complications with exercise Class C: Moderate or high risk of cardiovascular complications (severe infarction or cardiac arrest, NYHA class III or IV, exercise tolerance < 6 metabolic equivalents, clear ischemia on endurance test) Class D: Unstable disease is contraindicated (II) Exercise prescription 1. Aerobic exercise and anaerobic exercise. Aerobic exercise requires a duration of > 15 minutes, including walking, jogging, running in place, aerobic body-building exercises, swimming, cycling, etc. Anaerobic exercise includes static training, weight lifting or sprinting, also known as isometric exercise. After a cardiovascular event, patients may not have recovered or have a short time to recover, so they should not engage in strenuous and competitive exercises, so the type of exercise should be comprehensive, mainly aerobic exercise, supplemented by anaerobic exercise. The simplest and most widely used in cardiac rehabilitation is walking and jogging, and for patients with obesity or joint disease, in situ bicycle exercise is also an excellent choice. 2, exercise intensity: the practical method is estimated by heart rate, most patients’ metabolic equivalent and heart rate is linear relationship, so it can be used to express the intensity of exercise: (l) for most patients in a variety of conditions, 70%-85% of the maximum heart rate can be stable corresponding to 60%-80% of the maximum metabolic equivalent. (2) Exercise target heart rate: target heart rate, is the effective and safe exercise heart rate when improving the function of the cardiovascular circulatory system through aerobic exercise. Target heart rate = 170 or 180 – age (years), of which more than 60 years or frail middle-aged and elderly people use 170 – age (years); or according to the formula, Karvonen formula: maximum heart rate reserve = resting heart rate + (maximum heart rate – resting heart rate) X exercise intensity % maximum heart rate (HRmax) = 220 – age (years) maximum heart rate – resting heart rate = reserve heart rate Cardiac rehabilitation exercise intensities are classified according to the percentage of maximum heart rate achieved: low intensity < 60% of maximum heart rate, moderate intensity = 60%-75% of maximum heart rate, high intensity = 75%-90% of maximum heart rate. Limited benefit from high-intensity exercise (over 90%) is not recommended. For example, the target heart rate (THR) for a 60-year-old cardiac patient with a moderate-intensity exercise program = 80 + (160-80) X 60% = 128. 3. Exercise duration: Usually 15-60 minutes, but for most cardiac patients, the optimal exercise duration is 20-40 minutes, which usually includes 10-15 minutes of warm-up and 5-IO minutes of tune-up exercise, with the real exercise duration being 20-30 minutes. The real exercise time is 20-30 minutes, because at least 15 minutes of aerobic exercise is required to improve the cardiorespiratory reserve (and the exercise intensity is required to reach the target heart rate). 4, exercise frequency: according to the exercise effect and accumulation effect, 3-4 times a week is the most appropriate frequency of exercise, walking can be done every day. It is recommended to start with 3 times per week for at least 3-6 months, after which the frequency can be increased to 4-5 times per week if the patient has no traumatic complications and is interested in increasing the frequency. Encourage aerobic exercise of appropriate intensity (e.g. brisk walking) for 30-60 min per day, as much as possible, preferably every day, and increase physical activity in daily life. 5, exercise precautions: exercise should be temporarily stopped if the following conditions occur: (l) exercise chest pain, dyspnea, dizziness or induced angina; (2) exercise heart rate of more than 130 beats/min; or fluctuations in the range of more than 30 beats/min; (3) exercise blood pressure rise > 200mmHg, systolic blood pressure rise > 3OmmHg or fall of more than 10mmHg; (4) exercise (4) ECG monitoring ST segment downward shift) 0.1mv or elevation) 0.2mv during exercise; (5) Severe arrhythmia during or after exercise.