EXERCISE TRAINING

FOR THE CORONARY

PATIENT
Dr.Aminuddin Arifin,SpRM
GOALS OF CORONARY
REHABILITATION

 THE ULTIMATE GOAL OF CORONARY

REHABILITATIVE SERVICES IS TO
HELP PATIENTS WITH CORONARY
HEART DISEASE (CHD) RESUME
ACTIVE AND PRODUCTIVE LIVES FOR
AS LONG AS POSIBLE,WITHIN THE
LIMITATIONS IMPOSED BY THEIR
DISEASE PROCESS.
OBJECTIVES FOR
ACCOMPLISHING THIS
INCLUDE

1. Attainment of optimal
physiologic,psychosocial,vocational and
recreational status.
2. Prevention of progression or reversal of the
underlying atherosclerotic process.
3. Reduction of risk of reinfarction and sudden
death and alleviation of angina pectoris.
POTENTIAL BENEFITS OF
EXERCISE TRAINING FOR
CORONARY PATIENT
1.Counteracts the deleterious effects of physical
inactivity
2.Improves functional capacity
3.Improves cardiovascular efficiency
4.Improves coronary blood flow
5.Reduces atherogenic risk factors for CHD
6.Reduces recurrent CHD events
7.Improves psychological well-being and quality of
life
CATEGORIES OF CORONARY
PATIENTS WHO ARE POTENTIAL
CANDIDATES FOR REHABILITATIVE
EXERCISE TRAINING

1.Patients after Myocardial Infarction

2.Patients after CABG
3.Patients after PTCA
4.Patients with Angina Pectoris
5.Patients with Left Ventricular Dysfunction and
Congestive Heart Failure
6.Patients after Heart Transplantation
7.Patients with Implanted Pacemakers
 GUIDELINES FOR RISK STRATIFICATION
FOR PATIENTS IN CORONARY
REHABILITATIVE EXERCISE PROGRAME

 LOW
- Uncomplicated clinical course in hospital
- No evidence of myocardial ischemia
- Functional capacity >/= 6 METs
- Normal left ventricular function (EF>/=50%)
- Absence of significant ventricular ectopy
 INTERMEDIATE
- ST segment depression >/= 2mm flat or
downsloping
- Reversible thallium defects
- Moderate to good left ventricular
function (ejection fraction 35 – 49 %)
- Changing patterns of or new
development of angina pectoris
 HIGH
- Prior myocardial infarction or infarct
involving >/=35% of the left ventricle
- EF < 35% at rest
- Fall in exercise systolic blood pressure or
failure of systolic blood pressure to rise
>/= 10 mmHg on exercise test
- Persistent or recurrent ischemic pain 24
hours or more after hospital admission
- Functional capacity < 5 METs with
hypotensive blood pressure response or 1-
mm ST segment depression
- Congestive heart failure syndrome in
hospital
- >/= 2mm ST segment depression at peak
heart rate </= 135 beats/min
- High-grade ventricular ectopy
 CONTRAINDICATION FOR EXERCISE
FOR CORONARY PATIENTS
 Absolute contraindication :
- Unstable angina pectoris
- Recent acute myocardial infarction and unstable condition
- Uncontrolled hypertension with resting systolic blood pressure of >200 mmHg or
diastolic blood pressure of >110 mmHg
- Inappropriate asymptomatic postural or exertional blood pressure response
- Serious atrial or ventricular arrhythmias
- Second- or third-degree heart block
- Recent embolism (systemic or pulmonary)
- Acute or chronic thrombophlebitis
- Dissecting aneurysm
- Fever of >100°F
- Exercise sternal movement after CABG (contraindication for upper-extremity and
trunk ROM exercise)
- Uncompensated heart failure
- Active pericarditis or myocarditis
- Severe aortic stenosis (>50mmHg gradient) and idiopathic hypertrophic subaortic
stenosis
- Acute systemic illness
 Relative contraindication :
- Resting diastolic blood pressure of >100mmHg or resting systolic blood
pressure of >180mmHg
- Inappropriate increase in blood pressure during exercise
- Hypotension
- Moderate aortic stenosis (25-50mmHg gradient)
- Compensated heart failure
- Significant emotional stress or psychological disorder
- Pericarditis associated withv CABG
- Resting ST segment depression of >2mm
- Poorly controlled diabetes mellitus
- Neuromuscular, musculoskeletal, or arthritic disorders that would prevent
activity
- Excessive incisional drainage after CABG
- Sinus tachycardia (>120 beats/min) at rest
- New ECG change after CABG or acute myocardial infarction that are
diagnostic or suggestive of new infarction
- Ventricular aneurism
- Symptomatic anemia (hematocrit of < 30%)
 FASE I PROGRAM REHABILITASI
JANTUNG (Donna schramm,Anjali jain)
STAGE MET AKTIVITAS

1 1.5 Pompa pergelangan kaki, latihan nafas dalam, dan batuk ; P-

AAROM semua extremitas, makan minum sendiri.

2 1.5 Sda, duduk ditepi tempat tidur, duduk di kursi

3 1.5 AROM, latihan peregangan, berdiri, duduk di kursi,

jalan pelan-pelan

4 1.5- 2 Berjalan diawasi sejauh 25 m, berpakaian mandiri

5 1.5- 3 Berjalan bebas di ruang rawat, berjalan 30 – 100 m,

naik sepeda statis selama 3 menit tanpa tahanan,
senam ringan.

6 1.5- 3 Berjalan 150 m 2 set, sepeda statis 5 menit, belajar

menghitung nadi
 FASE II REHABILITASI
JANTUNG
STAGE WAKTU AKTIVITAS

1 3-4 Mgg 2 x 8 mnt sepeda statis 35% MET dari treadmil

2 x 8 mnt ergometer lengan 30% MET dari treadmil
diawasi 12 mnt treadmil 50% MET dari treadmil

2 4 Mgg 2 x 8 mnt sepeda statis 45% MET dari treadmil

2 x 8 mnt ergometer 35% MET dari treadmil
12 mnt treadmil 60% MET dari treadmil

3 4-5 Mgg Sda, ditambah treadmil 70% MET dari treadmil

4 5 Mgg 12 mnt sepeda statis 45% MET dari treadmil

2 x 8 mnt ergometer lengan 45% MET dari treadmil
12 mnt treadmil 75% MET dari treadmil

5 5-6 Mgg 15 mnt sepeda statis 45% MET dari treadmil

6 6 Mgg 2 x 8 mnt ergometer lengan 45% MET dari treadmil
15 mnt treadmil 75% MET dari treadmil
Tak
diawasi
7 6-7 Mgg 15 mnt sepeda statis 3.7 MET
2 x 8 mnt ergometer lengan 4.5 MET
14 mnt treadmil 3.9 MET
3 – 5 mnt mesin dayung tahanan rendah

8 7 Mgg 15 mnt sepeda statis 4.9 MET

2 x 8 mnt ergometer lengan 5.5 MET
20 mnt treadmil 3.9 MET

9 9 Mgg 15 mnt sepeda statis 4.9 MET

2 x 8 mnt ergometer lengan 6.4 MET
22 mnt treadmil 6 MET

10 11 Mgg 15 mnt sepeda statis 6.1 MET

2 x 8 mnt ergometer lengan 6.4 MET
25 mnt treadmil 6 MET

11 12 Mgg 15 mnt sepeda statis 6.1 MET

25 mnt ergometer lengan 6 MET
12 12 Mgg 15 mnt sepeda statis 6.1 MET
25 mnt ergometer lengan 6 MET
27.5 mnt treadmil 6 MET

13 13 Mgg 15 mnt sepeda statis 6.1 MET

25 mnt ergometer lengan 6 MET
30 mnt treadmil 6 MET
 PROGRAM REHABILITASI JANTUNG

FASE LOKASI LAMANYA AKTIVITAS

I Rawat 7 – 14 Perawatan diri sendiri, berjalan

inap jarak dekat; target 1.5 km dlm
hari 30mnt (3MET)
II Rawat 8 – 12 Pemeliharaan jantung progresif
jalan 1 jam 3 x per minggu; target 3
minggu km dlm 30 mnt (6 MET)
III Komunitas Seumur Pemeliharaan jantung 1 jam 3 x
seminggu
hidup
TERIMA KASIH