Planning an exercise program for the sedentary patient: what a cardiologist needs to know - American College of Cardiology (2023)

Wisdom: past and present

The importance of lifestyle factors and health behaviors in maintaining good health has been known for centuries. In 1772, British physician Dr. William Heberden gives an example of how exercise was beneficial for cardiovascular disease without knowing the nature of the disease: “I knew someone who started sawing wood for half an hour every day and was almost cured. . "¹

We further recognize that promoting health-promoting behaviors reduces cardiovascular risk.²Given the many challenges of modern society that limit the adoption of such behaviors, organized efforts are needed at the individual and infrastructural levels to reduce the cardiovascular risk of these non-pharmacological agents. The American Heart Association has identified seven optimal health metrics as part of its strategic goals for 2020 and beyond: no smoking, normal body mass index (BMI), physical activity, healthy diet, normal cholesterol level, normal blood pressure, and a normal fasting glucose.³In the landmark INTERHEART study (Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries), which covered 52 countries, nine risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, alcohol use , physical activity, and psychosocial factors) accounted for >90% of the risk of acute myocardial infarction in men and 94% of the risk in women.⁴These identified cardiometabolic metrics are highly correlated and generally modifiable. However, while getting patients to change their lifestyle behaviors is particularly difficult, this intervention is perhaps the most effective and underutilized prescription. Observational studies suggest that four out of five heart attacks can be prevented by low-risk health-related behaviors.⁵

exercise is important

Physical activity is one of the most important lifestyle risk factors that deserves attention. Lack of regular exercise and excessive physical inactivity are clearly associated with cardiovascular risk and mortality in men and women.^6-10Reduced levels of physical fitness, as measured by exercise tests, were correlated with an increased risk of mortality.¹¹Even a modest incremental increase in physical activity and exercise results in a measurable reduction in mortality.^12,13The effect of exercise on health appears to be dose-dependent. Increased physical activity also has a beneficial effect on several cardiometabolic indices, including weight, blood pressure, glycemic parameters, blood lipids, inflammation, and psychosocial factors.¹⁴In addition to the health benefits, the tax advantages are obvious. In the United States, in the year 2000, the national cost associated with physical inactivity exceeded US$ 76 billion; An estimated $5.6 billion in savings would be achieved if 10% of adults started a regular walking program.¹⁵2010 focused on health promotion with two unique national initiatives. The United States Congress established the National Council on Prevention, Health Promotion, and Public Health, chaired by the Surgeon General and tasked with developing a national prevention strategy. First Lady Michelle Obama took aim at the childhood obesity epidemicLet's go!Bell. In addition, the US Department of Health and Human Services' Health Promotion and Disease Prevention Initiative,healthy people 2020, made physical activity a public health priority. the goals ofhealthy people 2020This includes providing adults with 30 minutes of moderate physical activity most days of the week and ensuring that healthcare professionals assess patients' physical activity and opportunities to progress toward compliance with physical activity guidelines.^sixteenThe doctor's encouragement is essential to encourage changes in lifestyle.^17,18

the practical recipe

Positioning patients to successfully initiate and increase their physical activity and exercise begins by helping them identify their reasons for wanting to be active. Reinforce and affirm motivations while emphasizing the benefits of exercise. It is recommended to provide information and advice for a safe and enjoyable training session, including the following recommendations:

1. Considerations about the "E"

Energy:Exercise should be scheduled at a time of day when the patient feels rested and has the most energy. Adequate hydration and nutrition are important to fuel physical activity, but it is recommended that one wait at least 1 hour after eating before beginning an exercise session. This is especially important for diabetic patients and should include some tips on controlling and monitoring blood sugar levels before and after exercise.

Surroundings:If the patient plans to exercise outdoors, it is recommended to avoid extreme temperatures (>85°F or <32°F). Patients should dress appropriately for the weather and wear comfortable, supportive (preferably athletic) shoes. An indoor exercise contingency plan can help maintain consistency of physical activity during inclement weather.

Effort:The saying “no pain, no gain” should be avoided; Instead, encourage a pace that allows patients to comfortably continue a conversation.

2. Exercise regulation components: type, frequency, intensity, duration

Type:Aerobic exercise such as walking (outdoor or on a treadmill) and cycling (upright or recumbent bike with minimal resistance) are recommended for beginners. The session should begin with a "warm up" phase of slow walking or cycling with little or no resistance and end with a "cool down" phase of similar intensity. Below is an example of a walk schedule. At the end of the exercise, encourage the patient to exercise the major muscle groups involved during the exercise (eg, this can minimize injury and fatigue and increase flexibility). In addition to movement recommendations, the sedentary patient should be advised to increase general activity. , including sitting less, taking stairs, and parking some distance from your destination.¹⁹

Frequency:Encouraging daily exercise can help maintain consistency in beginners. Start with the amount of time that the patient believes is manageable (or that you believe is safe based on the individual's cardiovascular history); This can only take 5 minutes. Suggesting that a person exercise for short periods several times a day is also an option to consider (eg, 5 minutes each, 3 times a day). Since the patient can exercise continuously for 30 minutes, it makes sense to set the frequency to 5 days a week.

Table 1: Exercise program for beginners

Intensity:Using a subjective measure of exertion as the person begins to become more active and exercise is helpful for the beginner. The exercise should feel "rather easy" and the person should be able to carry on a conversation without feeling short of breath. One such useful measure of intensity is the Borg Perceived Exertion Scale (RPE).²⁰Effort level is a number that can be used to estimate your heart rate when multiplied by 10. The intensity of the exercise or exertion should feel "fairly light" during the warm-up and cool-down and increase to "a little hard." ” during the more vigorous aspect of the session, as the patient's fitness level improves.

If a "target heart rate" is needed to control intensity, it is reasonable to suggest 20-30 beats per minute above resting heart rate as a training range for sedentary patients who begin to increase their activity (assuming that this rate range heart rate is safe and acceptable for the individual). As the patient's physical condition improves, a stronger intensity level can be individually determined and prescribed based on individual Exercise Tolerance Test (ETT) results, but this is not the focus of this article.

Duration:It is reasonable for the sedentary person to start slowly and maintain the exercise session for as long as they feel is manageable or as their physician deems safe and appropriate. This may take 3-5 minutes at first, but the most important thing is that the person enjoys the activity and feels comfortable. Success breeds success and this will (hopefully!) motivate you to keep going and progress. As mentioned above, several short bouts of exercise throughout the day are a useful approach to increasing exercise time and avoiding fatigue or overexertion in the sedentary individual. Physical activity guidelines for Americans²¹Include the following recommendation: 150 minutes of moderate aerobic exercise per week (30 minutes/day x 5 days) or 75 minutes of vigorous activity per week. For sedentary patients, this recommendation may seem a bit overwhelming and it is recommended that participants receive a more modest starting regimen.

3. Stay active

A number of resources and strategies to keep your patients motivated are worth discussing. Structured secondary prevention programs, such as cardiac rehabilitation programs, provide an excellent resource for you and your patients to get started and stay current with lifestyle changes, exercise, education and adjustment factors, risk, and social support. Additionally, participation in a cardiac rehabilitation program after a cardiac event has been shown to reduce mortality.^22,23The American Association for Cardiovascular and Pulmonary Rehabilitation maintains a directory of programs on its website (www.aacvpr.org). Fitness trackers and fitness apps are additional options you can recommend to your patients to practice their fitness activities. There are also interactive video games that can diversify patients' movement habits. Hiring a training partner adds an element of support and makes the activity enjoyable. Finally, suggest that when clients reach their physical activity and exercise goals, they reward this achievement with something appropriate that they enjoy. Prescribing exercises and moving your patients while sitting is necessary, necessary and effective.

references

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