1

Guideline .. 2539

revise
guideline references
guideline
cardiac rehabilitation

guideline
cardiac rehabilitation



cardiac rehabilitation

( )

1.

-
-
-
2.

3. 1 ( )

11

4. 2 ( )

16

- 3 ( )

19

5. Resistance training

20

6.

23

7. Heart Failure

25

.. 2552

..2553

(Cardiac Rehabilitation Guideline)
1.



(coronary heart disease)

(physiological conditions)
(psychological conditions) (social conditions)
(vocational conditions)






2.
(Director) /

(Staffs)
-
-
-
-
-
-
-

3.
-
-
-
-

4.

5.




6.
-
- (defibrillator)
-

- (ECG telemetry)
-
(stationary bicycle or arm ergometry)
(treadmill)

7.
1. Stable angina
2. Post myocardial infarction
3. Controlled congestive heart failure
4. Post percutaneous coronary intervention (PCI)
5. Post cardiac surgery including heart transplantation
6. Patient with high risk for coronary artery disease
7. Patient with peripheral vascular disease
8. Others
8.
1
2 8-12

3
4 3

9.
1. Unstable angina
2.
3.

4.
5. Recent pulmonary embolism severe pulmonary arterial
hypertension
6. (thrombophlebitis)
7. > 200 .
> 100 .
8. > 20 .

9. ST displacement > 3 .
10.
11.
12. Third degree A-V block
13.
14.
15.
16. Hypertrophic obstructive cardiomyopathy
10.
1.
2.
3.
4.
5. Supraventricular tachycardia
6. ST displacement > 3 . (horizontal down
sloping)
7. Ventricular tachycardia
8. Left bundle branch block

9.
10.
11.
12.
13.

second third degree A-V block

R on T PVCs
Multifocal PVCs (30% of the complexes)

( 220
110 .)
14. 10 /
11. (Risk stratification)
(Monitoring)

(left ventricular ejection
fraction) (arrhythmias)
(risk stratification) (
1 )

1.

2.
3.

3.1

3.2

3.3

10

Degree of Supervision


1. (home program)
(low risk)


2.
(supervised cardiac exercise program)

2.1


(Borgs rate of perceived exertion)

2.2

2.2.1

2.2.2
defibrillator

11

12.
1 (Phase 1)
(Inpatient Phase)
1

1.
2.
3.

4.






(METs)

12

1.
2.
3.

(mode) calisthenic exercise

(intensity)
(post-myocardial infarction)

20

30
(duration)
5-10 20-30
(frequency)
2
1
5 METs

( 3)

13

ICU
CCU

<2 METs - 15

-

- -
1-3 -
5
-Breathing

ICU
CCU

<2 METs - 15-30

2-3 /
-

- -


-
1-5 5

<2 METs - - 15
- -
-
1-6 5-10

-

-

<3 METs - - 24
-

-
-
1-7 5-10

<4 METs - - -
1-7 5-10

- 2-3

- 90

14

<5 METs -
()
-

- 150 -

-

1 -

-
1-8 5-10

METs -
- 150

- 1
-
1-6 5-10

-
-

exertional intolerance cardiac insufficiency

15

1.

2. - 13

3.

- 120 /- -
- 20 -
30 /
- 10
/

4.

-
200/100 .-
20 ..

5.EKG ( - Supraventricular tachycardia- ST

displacement (3 mm.)-Ventricular
tachycardia-Left bundle branch
)
block- 2-3 degree AV-block-PVC

- ST segment

-PVC
3 R on T PVC-Multifocal
PVC (30%)

16

2 (Phase 2)
(Outpatient Phase)
2
8-12

1.

2.
3.

4.

5.

2 (monitoring)


1
(ECG telemetry)

17

8-12
3 3

(Mode)


4-6 postMI, post-PCI 8 post cardiac surgery
resistance training dumbbell

(intensity)
Exercise Stress Test

20-30
70 /
70+30 = 100

Karvonen
Method
(
) x 0.4 0.85 +
= 220 ()

(moderate intensity) 0.4 0.6
O

18

Borg (Rating of Perceived Exertion Scale)
( 2) 11-13
O

Exercise Stress Test

Karvonen Method
( exercise stress test ) x 0.4 0.85 +

[VO2max]
40-85% VO2max
(moderate intensity) 40-60%
Borg (Rating of Perceived Exertion Scale)
11-13
O

(Duration)
60
stretching, warmup, aerobic / resistance training,
cool down stretching
aerobic exercise 20-30
(Frequency)
3-5

19

(Progression)
intensity


(intensity)
3 (Phase 3)
3 2
3
2

3

3
3
1. 2 6
2. 2
5 METs
3.
(self
monitor)
O

3
1. 3 3-6
3
2. 8 METs
intensity

20

3.
4.

Resistance training
Resistance training
1.
2. Exercise stress test ischemic response
3.
- congestive heart failure
- valvular heart disease
- ( > 160 .
> 100 . )
-
- Aerobic capacity 5 METs
- (LVEF < 0.35)
Resistance training
1. myocardial infarction CABG 6
PCI 4
2. resistance training

resistance training
3. resistance training 2

(
2 ) 3 resistance training
resistance training 2
O

21

4. resistance training
aerobic (/ RPE Scale)
5.
resistance training
6. resistance training
aerobic training
7.
8.
biceps

9. dumbbell
10. 1
11.
resistance training
Resistance training
(Mode) dumbbell
(Intensity)
1. 2 1 (
)
2. 3 2
1 repetition maximum ( 1 )
90% repetition maximum
2-3
30-50% 1 repetition maximum
3. RPE Scale<13 aerobic
exercise

22

(Duration)
- 12-15 2 2-3
(Progression)
- 12-15
2 3
12-15 1

13.




1. warm up calisthenic exercise
10
10
2.

( Borg scale) 5
- 2
10
- 3
15
- 4 15

23

- 15
20
3. cool down
cool down 5-10

1.
2. 300 ..
3.
4.
5. () 100 /
200/100 .
6.
7.
8.

- 1-2
-

-
-
-

24

- ()

-
-
-


-

-

20-30

- 30 3-5

1.
2. 50
3.
,
4.
5. (
)

1. (warm up)
10

25

2.
3. (cool down)
10

1.
2.
3.
4.
5.
6.

-
-
-
-
-
-
14.
supervised exercise


(interval training)

..

26

neurohormone

1 24
1.8 1-3
dobutamine continuous intermittent

New York Heart Association Functional Class IV
Complex ventricular arrhythmia
100
(Pre-existing co-morbidities)
O

(compensated heart failure)
3
30

110
(less than moderate
fatigue)
Cardiac index of 21 min -1.m -2 (for invasively monitored patients)
Central venous pressure of < 12 mmHg (for invasively monitored
patients)
O

27

(RPE 14)
40
S3 pulmonary rales
pulmonary rales
second component second sound (P2)
Poor pulse pressure (
< 10 .)
10 .

supraventricular ventricular ectopy

10-60 3-7

5

28

(VO2 peak) submaximal exercise capacity
6 minute walk test
ventilatory threshold

1. American Association of Cardiovascular and Pulmonary Rehabilitation.

Guidelines for cardiac rehabilitation and secondary prevention programs
4thedition. Champaign, IL: Human Kinetics ; 2004
2. Goble AJ. Worcester MUC. Best Practice guide lines for cardiac
rehabilitation and Secondary prevention, 1stedition. Melbourne.
Department of Human Services 1999:52-6
3. Guidelines for cardiac rehabilitation and secondary prevention programs,
Human Kinetics Publisher 3rd edition , 1999 ,39-52
4. Pashkow FJ, Dafoe WA: Clinical cardiac rehabilitation-A Cardiologists
guide 2nd edition :Baltimore; Williams@Wilkins: 1999:458-66
5. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha
BD, et al. Exercise and Heart Failure: A statement from American

29

6.
7.
8.

9.

10.

Heart Association Committee on exercise, rehabilitation, and prevention.

Circulation 2003;107:1210-1225
Pollock ML, Ward A, Foster C. Exercise Prescription for rehabilitation
of the cardiac patient In: Pollock ML, Schmidt DH. Editors. Heart Disease
and Rehabilitation. Boston: Houghton Mifflin 1979: 415-20
Rees K, Taylor RS, Singh S, Coats AJS, Ebrahim S. Exercise based
rehabilitation for heart failure(Review). The Cochrane Database of
Systematic Review 2004, Issue 3
Whellan DJ, OConnor CM, Lee KL, Keteyian HJ, Cooper LS, Ellis SJ,
et al. HF-ACTION Trial Investigators. Heart failure and a controlled trial
investigating outcomes of exercise training (HF-ACTION): design and
rationale. Am Heart J 2007;153:201-11
Working group on Cardiac Rehabilitation & Exercise Physiology and
Working Group on Heart Failure of the European Society of Cardiology.
Recommendations for exercise training in chronic heart failure patients.
European Heart Journal 2001;22:125-135

, , .
1. , 2546: 141-148

30

1
1.

- ( left ventricular ejection fraction

> 0.5)
-
ST
(ST displacement)
-
-

- 6 METs

3

- ( left
ventricular ejection fraction 0.31 0.49)
- 5-6 METs

3
-
-
ST 1-2 . (1-2 mm.ST depression)

31

- (left ventricular ejection

fraction < 0.3)
-

- 15 .

-
-
(complex ventricular arrhythmias)
-
ST 2 . (2 mm. ST depression)

32

Borg
(Borgs rating of perceived exertion) RPE
6. NOTHING AT ALL
7. VERY VERYLIGHT
9. VERY LIGHT
11. LIGHT
12.
13. SOME WHATHARD
15. HARD
16.
17. VERY HARD
18.
19. VERY VERY HARD
20.

()