Life is Movement Aristotle 4th century BC

Authors: J Brügemann H GerdsPloeger

Publish Date: 2013/08/23

Volume: 21, Issue: 10, Pages: 427-428

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Abstract

During our clinical or outpatient contacts we often tell patients with coronary heart disease that physical activity will lessen the burden of their disease reduce their risk of mortality and enhance their quality of life However after delivering this oneliner we have no illusions that patients will start moving and stay active straight away Many practical barriers deter them and behavioural change such as adopting a physically active lifestyle is only achieved when various stages of change have been successfully completed 1What really helps is referring patients quickly to an outpatient or clinical cardiac rehabilitation CR program This does not always happen properly but with the help of allied professionals such as the nursing specialist the situation in the Netherlands is better now than 10 years ago The number of referrals has also increased due to the Netherlands Society of Cardiology/Netherlands Heart Foundation NVVC / NHS Cardiac Rehabilitation Guidelines of 2004 updated in 2011 2 as well as through the encouragement of the Healthcare InspectorateAt the patient’s intake the cardiac rehabilitation goals are clarified and established in consultation with the patient The intake includes an exercise test ergometry Then with the patient’s medical history and exercise test results in hand a multidisciplinary team decides on a CR program In Groningen we speak of ‘Short Fit’ ‘Long Fit’ and occasionally ‘Fit Plus’ programs Underlying the choice is the patient’s single multiple or complex heartrelated problems Often the backbone of the CR trajectory is exercise the component applied by the physiotherapist which gives this allied professional a crucial role in CR But in addition to physical therapy and movement agogics other allied professionals in social work psychology dietetics nursing case management logistics and evaluation as well as the cardiologist all contributeRecommendations for postoperative patients not only for regular endurance training and possibly strength training but also ‘functional exercises’ These exercises enable patients to be more independent for longer and/or able to resume work Examples here are lifting carrying bending over putting down pushing balancing climbing stairs and turning safely 6 in other words physical agility and flexibility The guidelines explicitly state ‘The patient knows learns how to cope with their symptoms’ meaning how to ‘respond to the demands of life’ With regard to the mobilisation phase in our opinion the guidelines correctly point out the opportunities for Clinical Cardiac Rehabilitation offered by a few centres in the Netherlands 7An option for fatigueled training where the familiar Borg scale Rating of Perceived Exertion RPE can give direction We recommend ‘rather tiring’ in Dutch ‘tamelijk vermoeiend’ level 12–13 on a scale of 6–20 For endurance exercise outside the home we regularly advise patients to follow the intensity of the Talk Test ‘You can talk but not sing while exercising’ 8 This gives patients something to hold on to in the postCR phase if for example they no longer exercise according to heart rate Again in our opinion the postCR phase is almost more important than actual CR After all prevention of relapse in patients after 6 weeks of exercise / new movement following a sedentary lifestyle is but one of the core objectives of CR This touches on the issue of nonadherence or noncompliance During the program the patient and the CR team must look for movement / exercises that fit easily in the patient’s day to day life 9 Examples are brisk walking cycling to and from work swimming or trying to connect the patient with what the Americans call a ‘Coronary Club’ and we in the Netherlands call a ‘Hart in Beweging’ HIB Heart in Motion club If patients have anginal symptoms that deter them from making an effort prophylactic shortacting nitrate use can be considered 10Acknowledgement of the importance of relaxation besides training movement / exercise In the relaxation part of the CR program the patient learns how to cope mentally and emotionally with body signals such as rapid breathing and heart beat shortness of breath and possibly chest discomfort In our opinion however daily aerobic activity gentle endurance exercises remains the cornerstone of the exercise program

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