Curriculum Vitae

RICHI HENDRIK WATTIMENA

EDUCATION / TRAINING
2012 - 2017 Physical Medicine and Rehabilitation Specialist,
Universitas Padjadjaran Bandung

WORK EXPERIENCE:
2017 – now Specialist at Siloam Hospitals Lippo Village

Clinical and Research

Interest:
PROFESSIONAL ORGANISATION : q Heart Failure
2017 – now PERDOSRI q Musculoskeletal
q Pain
q Neuro-rehabilitation
Exercise Program for Heart Failure

RICHI HENDRIK WAT TIMENA, MD

Disclosure
I have no conflict of interest pertinent to this presentation
 CARDIAC
REHABILITATION

Defined as a multidisciplinary program that includes exercise

training, cardiac risk factor modification, psychosocial assessment,
and outcomes assessment
Cardinal manifestations
of HF Are Exercise Associated with poor
intolerance, chronic QOL and adverse
fatigue, and inability to outcomes
perform activities
EXERCISE
 EXERCISE
Exercise is physical activity that is planned, structured,
repetitive and purposed

FIIT principle à Frequency, Intensity, Time and Type (doses)

Type example : aerobic training, resistance training, flexibility

training
 Greater
functional gains Training benefits have As such, 50-70%
The frequency and been demonstrated to VO2peak or 60-80%
have been
duration of exercise achieved with occur with intensities heart rate reserve
prescribed should be ranging from 40-85% (HRR) is the intensity
longer duration
tailored to their VO2peak usually recommended
training
functional ability. for rehabilitation
programmes
programmes
BENEFITS
The net functional result of such improvements is an
increase in exercise duration and physical work capacity,
as well as a reduction in mortality, morbidity and hospital
admissions
The Best practice guidelines for cardiac rehabilitation and secondary
prevention state that: ‘ All patients with heart failure should be enrolled in
an exercise program as a part of comprehensive rehabilitation, including
before and after transplantation'.

In practice, cardiac rehabilitation (of which exercise training is an integral

part) is typically offered to patients with stable NYHA class II or III heart
failure.
CONCLUSIONS

Exercise training is one of the non-pharmacological treatments for CHF

Exercise are safe and beneficial in patients with HF

As a result, most patients can expect to improve their exercise tolerance,

functional ability, understanding of heart failure, and quality of life
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Precaution: Exercise training is safe and effective for most patients with clinically stable
heart failure. However, individuals should be stratified according to risk for a cardiac-related
event during exercise training. Some patients may need intermittent or constant monitoring
rather than transitioning to completely unsupervised exercise.
absolute contraindications are:
• progressive worsening of exercise tolerance
or dyspnoea at rest or on exertion
over previous 3–5 days
• significant ischaemia at low exercise
intensities (<2 METS, or –50 W)
• uncontrolled diabetes
• acute systemic illness or fever
• recent embolism
• thrombophlebitis
• active pericarditis or myocarditis
• severe aortic stenosis
• regurgitant valvular heart disease requiring
surgery
• myocardial infarction within previous 3
weeks
• new onset atrial fibrillation
• resting heart rate >120 bpm.
Relative contraindications include: Complex ventricular arrhythmia at rest or
appearing with exertion
• ≥2 kg increase in body mass over previous 1–
3 days • Supine resting heart rate ≥100 bpm
• Concurrent continuous or intermittent • Pre-existing comorbidities
dobutamine therapy
• Moderate aortic stenosis
• Decrease in systolic blood pressure with
exercise • BP > 180/110 mmHg (evaluated on a case by
case basis).
• NYHA Class IV
•
The benefits of exercise training in patients
with CHF include improved VO2 max and
exercise tolerance.
Evidence suggests that most improvement is
due to the effects of training on peripheral
circulation and skeletal muscle rather than on
the heart itself.
Exercise training can: • partially reverse
activation of the neurohormonal system and
reduce levels of pro-inflammatory cytokines
• improve the ratio of type 1 and type 2
muscle fibres which reduces skeletal muscle
fatigability20 • improve skeletal muscle
metabolism• increase blood flow within the
active skeletal muscles • reduce dependence
on anaerobic metabolism.