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strona 2 · sekcja: Assessment

An aerobic exercise assessment should be conducted to assess the patient’s aerobic exercise capacity.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 2 · sekcja: Assessment

The gold-standard assessment for aerobic exercise capacity is a cardiopulmonary exercise test (CPET) conducted on either a treadmill or cycle ergometer with gas analysis.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 4 · sekcja: Table 2 — Functional Exercise Capacity/Field Tests

Six-Minute Walk Test (6MWT): Low-resource test that involves walking as far as possible in 6 minutes, along a 20–30m flat track.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 5 · sekcja: Table 2 — Muscle Strength

1RM assessments: Defined as the maximum weight that can be lifted for one-repetition, through the full available range of motion and with an acceptable level of technical proficiency.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 6 · sekcja: Table 2 — Physical Activity

Pedometers, accelerometers, inclinometers, physical activity and sedentary behaviour questionnaires, and activity diaries.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Summary of Recommendations

Aerobic exercise capacity, muscle strength and physical activity assessments should be conducted at enrolment and at discharge.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 4 · sekcja: Table 2 — Graded Exercise Test

Test may be ceased once the patient reaches 85% of their age predicted HRmax (65% for those with beta-blockade therapy who are well rate controlled during exercise), or if clinically indicated; e.g., chest pains, dyspnoea, light-headedness, or fatigue.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 4 · sekcja: Table 2 — Incremental Shuttle Walk Test

Incremental walking test between two cones 10 m apart timed to an audio signal. The patient walks as long as possible or until unable to keep up with the signals.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 4 · sekcja: Table 2 — Six-Minute Walk Test

Walk as far as possible in 6 minutes along a 20–30 m flat track. Calculate average speed in km/h as (6MWT distance x 10) / 1000.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 5 · sekcja: Table 2 — 1RM assessment

Use full available range of motion and acceptable technical proficiency; terminate when the patient cannot perform one acceptable repetition on two consecutive attempts.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 5 · sekcja: Table 2 — Estimated 1RM

Estimate 1RM with a validated equation from a multiple-repetition test, for example a 3–6-repetition maximum test; lower-repetition tests of six or fewer have higher reliability.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 5 · sekcja: Table 2 — Low-resource strength assessment

Use either a specified repetition count completed as quickly as possible, such as five sit-to-stands, or the maximum repetitions in a specified time, such as 30 seconds.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 2 · sekcja: Introduction

A patient-centred approach is important, and communication with patients should be non-judgemental and respectful.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Prescribing and Progressing Resistance Exercise

Individualisation refers to tailoring the resistance exercise prescription specifically to a patient’s physical capacity, experience, preference and cardiac history.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Prescribing and Progressing Resistance Exercise

Clinicians are encouraged to initially provide a demonstration and then communicate with and coach the patient throughout the exercise delivery to facilitate skill acquisition and body awareness.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Prescribing and Progressing Physical Activity

For more specific physical activity advice, exercise specialists such as physiotherapists and exercise physiologists should be consulted.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Aerobic Exercise

3 or more days per week. Moderate-to-high intensity (e.g., 55%–90% HRmax, RPE 12–16) based on assessment of aerobic capacity. Session duration >30 min of total aerobic exercise.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Aerobic Exercise: Time

For patients who are severely deconditioned or have symptoms at low workloads, it is recommended to start with bouts of light-moderate continuous exercise of 5–10 min in duration with breaks as required, to allow full recovery and repeat 2–3 times.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Aerobic Exercise: Type

A variety of aerobic modes of exercise are recommended that use large muscle groups such as walking, jogging, cycling, swimming, rowing, stair climbing.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Aerobic Exercise: Volume

A minimum of 150 minutes of moderate-high intensity aerobic exercise, with an ideal target of >210 min per week for increased cardiometabolic benefit.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 7 · sekcja: Moderate-Intensity Continuous Training Versus High-Intensity Interval Training

The most commonly used HIIT model is a warm-up, followed by 4x4-min intervals at 75%–90% peak heart rate (HRpeak) with an active recovery phase of 3-min between bouts at approximately 60% HRpeak, followed by a cool-down.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Aerobic Exercise: Progression

Start slowly and progress gradually, increasing duration to meet 30 min before increasing intensity. Increases in intensity and duration of 5%–10% every 1–2 weeks are typically well-tolerated within cardiac patients.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Resistance Exercise

2–3 sessions per week. Recommend 48 hours between sessions, where possible, to maximise muscular recovery. Moderate-to-high intensity (e.g., 50%–80% 1RM or 5–7 RPE). Session duration: >20 min. Duration of muscle contraction >4 second per repetition (>1 s concentric phase, >3 s eccentric phase). Rest between sets: 60 s.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Resistance Exercise: Type

Whole body, single- or multi-joint exercises, performed bilaterally where possible. May include a range of modalities including bodyweight, free-weights, machine weights and elastic resistance bands.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Resistance Exercise: Volume

Total session volume per major muscle group = 15–36 repetitions, arranged as 1–3 sets of 8–15 repetitions.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Resistance Exercise: Progression

Progress repetitions before sets or intensity, up to a maximum of 15. Once 15 reps can be completed with ease, then intensity should be progressed to 4–6 on RPE scale at a new target of 8–10 reps.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Prescribing and Progressing Resistance Exercise

Clinicians should embed clear, concise instructions for each exercise and simple, consistent feedback at the conclusion of each set.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 10 · sekcja: Prescribing and Progressing Resistance Exercise

The recommendation for preliminary sessions is to commence at lower ranges of the recommended intensity so that patients can primarily focus on technique without being hampered by muscular fatigue.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Prescribing and Progressing Resistance Exercise

Patients should be advised that breath-holding (Valsalva manoeuvre) should be avoided during resistance exercise; muscle tension is a normal sensation; and muscle soreness is common in the first few days but reduces with subsequent exposures.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Physical Activity

MVPA should be completed on most days per week. A variety of MVPA is recommended including domestic, occupational, transportation and leisure activities.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Physical Activity: Progression

If appropriate, individuals may start with as little as 2–5 minutes of activity, 3–4 times a day. Progress towards 30 min of moderate intensity physical activity or 7,500 steps on most days.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 10 · sekcja: Physical Activity

Individuals should complete 150–300 minutes of moderate intensity aerobic physical activity; or 75–150 minutes of vigorous intensity aerobic physical activity or a combination of both per week.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Prescribing and Progressing Physical Activity

An individual’s goals, motivation and confidence to increase physical activity in everyday life should be reviewed as part of a comprehensive assessment, with each patient receiving an individually tailored physical activity program based on these findings.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 8 · sekcja: Table 3 — Physical Activity: Volume

Aim for at least 150 minutes of MVPA per week or at least 7,500 steps per day. Weekly activity does not need to be accumulated in 10-minute bouts; break up long sedentary periods with activity of any intensity, including light intensity.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 10 · sekcja: Physical Activity

Muscle strengthening should be completed on at least two days per week and varied functional balance and strength activities should be completed three days per week.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 3 · sekcja: Table 1 — contraindications note

Relative contraindications are a guide only and should be combined with clinical judgement at every session. If in doubt, medical advice should be sought before commencing an exercise or physical activity assessment or session.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

Prior to each supervised exercise session, it is recommended to assess the patient’s contraindications to exercise, measuring pre-exercise heart rate and blood pressure, to ensure that they are within an acceptable range at rest.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

During exercise it is recommended to monitor the patient’s heart rate and RPE (or Borg Scale for Dyspnoea in patients with heart failure).

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

A warm-up and cool-down should be included in all exercise sessions and physical activity for 5–10 minutes.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

Keep your move in the tube is a paradigm shift that promotes upper limb activity and exercise using short lever arms by performing activities close to the body.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

During unsupervised exercise and physical activity, individuals should monitor their intensity and symptoms (i.e., chest pain, dizziness, nausea, feeling unwell, excessive sweatiness). If patients experience any warning signs of a cardiac event, then they should be encouraged to call an ambulance immediately.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Resistance Exercise — Assessment

Clinicians should consider all relevant contraindications before resistance exercise testing, including the sternal stability of post-sternotomy patients before commencing upper-body resistance training.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

As patients progress and cardiac disease is stable with no symptoms, pre-exercise heart-rate and blood-pressure measurements are not necessary and may be counterproductive to confidence around unsupervised activity.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

Centre-based exercise sessions should have basic safety standards and procedures, including a defibrillator and resuscitative and first-aid equipment on site.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Prescribing and Progressing Physical Activity

Medical review is generally unnecessary before light-to-moderate physical activity unless contraindications are known. Vigorous or high-intensity physical activity requires full clinical assessment and medical review.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

For community activity advise comfortable clothing and footwear, adequate fluid intake, and avoiding activity after heavy meals, during illness and in extreme temperatures.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Safety and Monitoring

Continuous ECG monitoring is not essential in supervised exercise; it can be beneficial in circumstances such as atrial fibrillation or a history of significant ventricular arrhythmias when signs or symptoms require further investigation.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Aerobic Exercise: Progression

Start slowly and progress gradually, increasing duration to meet 30 min before increasing intensity. Increases in intensity and duration of 5%–10% every 1–2 weeks are typically well-tolerated within cardiac patients.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Resistance Exercise: Progression

Progress at least one of volume, intensity, type or frequency; progress volume and intensity before other variables. Progress repetitions before sets or intensity up to 15. When 15 repetitions are easy, increase intensity to RPE 4–6 with a new target of 8–10 repetitions, then progress toward the highest tolerable intensity and three sets per major muscle group.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 9 · sekcja: Table 3 — Physical Activity: Progression

Start slowly and progress gradually, increasing duration before intensity. If appropriate, start with 2–5 minutes 3–4 times daily and progress toward 30 minutes of moderate-intensity physical activity or 7,500 steps on most days.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Summary of Recommendations

Aerobic exercise capacity, muscle strength and physical activity assessments should be conducted at enrolment and at discharge to allow for a more detailed analysis of a patient’s response.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Wearable Activity Trackers

The use of wearable activity trackers can be successfully incorporated within clinical settings after reviewing some device and individual factors.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Wearable Activity Trackers

Clinicians can maximise the effectiveness of wearable activity trackers through encouraging, educating, monitoring, and providing effective feedback loops.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Using Telehealth to Assess and Prescribe Exercise and Physical Activity

Ideally, it is recommended that exercise and physical activity assessments are done in-person to ensure a safe and standardised assessment. However, when this is not possible, telehealth exercise assessments are recommended to allow individually tailored exercise and physical activity prescription.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Using Telehealth to Assess and Prescribe Exercise and Physical Activity

Before assessing exercise and physical activity using telehealth, safety needs to be considered, including verifying the patient’s location in case you need to call an ambulance or checking whether they have an action plan and medications nearby if required.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Using Telehealth to Assess and Prescribe Exercise and Physical Activity

Selection of a suitable exercise test is dependent on the space and equipment available, ensuring that the test can be repeated at the end of the program using the same methods.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Using Telehealth to Assess and Prescribe Exercise and Physical Activity

Before remote assessment determine available monitoring equipment, conduct a virtual tour to check the exercise space, take a standard subjective history and then perform a virtual exercise test.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 11 · sekcja: Wearable Activity Trackers

Consider device availability, usability, available metrics, interface clarity and device management.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d

strona 12 · sekcja: Wearable Activity Trackers

Consider device reliability, validity and data security and determine whether the patient is motivated and has matching digital literacy; encourage, educate, monitor and provide feedback.

SHA-256: 01fc7700f0066bfa130314fb429a03b578ae28017c0f9234428db90d92ff784d