What is coronary heart disease? It simply means that there is blockage of arteries that supply oxygen to the heart by a plaque (build by cholesterol and calcium deposit).
There is insufficient oxygen to the heart that can leads to ischemia of the heart cells especially during exercise in which requires the heart to work out more. This can cause heart attack.
Individuals with this problem however can still manage to do exercises safely with some precautions.
Individual with coronary heart disease generally will have compromised oxygen uptake and exercise tolerance. They will usually have other risk factors as well such as uncontrolled hypertension, elevated lipids profile, diabetes, smoking and obesity.
In order to make sure that exercise is beneficial to these individual, all the associated risk factors should be addressed as well. These includes blood pressure control, sugar level, lipid profile, quit smoking, and reducing weight.
Exercise program have been proven to reduce mortality caused by coronary heart disease. Also, the benefits of exercise have contributed the survival of patients following bypass surgery.
Before engaging in any forms of exercise, individuals who have coronary heart disease have to go through a compulsory and comprehensive medical check. This includes medical history, physical examination and graded exercise test.
If the medical check fails, then they should defer from exercise until the problems have been resolved. However, there are certain conditions that exercise can be performed under strict medical supervision.
Exercise prescription for individuals with coronary heart disease includes a supervised exercise session and also daily physical activities. Daily activities should be practiced before starting a formal exercise session.
The training program should be based on the cardiovascular and general medical status. In this case, an individual tailored program based on principles of exercise such as mode, frequency, duration, intensity and progression should be adhered to.
For cardiovascular endurance training, exercise using large muscle group, such as walking, jogging, cycling, swimming, rowing and group aerobics is advised. For those having problems with lower limb, arm ergometer can be utilized.
Resistance training is also beneficial for selected individual. It is usually performed using circuit trainings approach, up to 10 to 12 exercises, using 10 to 12 repetitions of resistances that can be performed accordingly to the individual. Cross training can be used as well to decrease musculoskeletal problems and increases their compliance.
Frequency should be at least 3 days a week on alternate days. Be precaution of exercising daily as it is increases risk of developing overuse injuries especially musculoskeletal injury.
Duration for them should be 20 to 40 minutes each session either continuously or through interval training. A warm up and cool down session should be included as well by performing stretching exercise. For individual who have peripheral vascular disease or intermittent claudication, they can perform it in separate session.
As for intensity, a moderate and comfortable ones should be commenced. VO2max of 40 to 85%, which correlates with 40 to 85% of maximal heart rate reserve or 55 to 90% of maximal heart rate is the guidance.
Rating of perceived exertion (RPE) may also be used to monitor training intensity and to keep it at moderate level. The intensity should be level below that could trigger ischemia, arrhythmias or symptoms of exercise intolerance as judged clinically or by exercise testing.
Intensity that is recommended varies according to the level of supervision available and also the patient’s risk. A lower intensities should be tailored to higher risk patients when they exercising without supervision or without continuous ECG monitoring.Any exercise program for them should start with an initial slow and gradual progression of the intensity and duration.