VITRUVIAN EXERCISE PHYSIOLOGY
News & Information
CARDIOVASCULAR REHABILITATION AND PREVENTION
What is Cardiovascular disease?
Cardiovascular disease (CVD) refers to all diseases of the heart and circulatory system including coronary artery disease, stroke, heart failure, cardiomyopathy and atrial fibrillation. These conditions result in over 160,000 deaths in the UK annually. CVD is the leading cause of death globally. Advances in diagnostic techniques, surgical interventions and the fact we live longer means the overall burden of CVD in terms of health resources has increased.
Cardiovascular rehabilitation reduces both cardiovascular mortality and acute hospitalisation while also improving functional capacity and quality of life. It helps with supporting an early return to work, and developing self-management skills, which can be delivered in a variety of formals.
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The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) outlines clinical guidelines and recommendations for the prescription of exercise and cardiac rehabilitation for those who have experienced a heart attack, heart failure, angioplasty or heart surgery.
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The BACPR suggests 7 components to ensure programmes are effective in achieving health outcomes for patients.
Risk Factors
Non-modifiable factors
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Age
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Gender
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Family History
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Ethnic Origin
Modifiable factors
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Smoking
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Hyperlipidaemia (high cholesterol)
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Hypertension (high blood pressure)
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Physical inactivity
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Obesity
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Type 2 diabetes
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Excess alcohol
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Psychosocial factors
Diagnosis & Management
Diagnosis for Cardiovascular disease may require different tests. These include:
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Blood tests - to check for the release of specific proteins that are linked to inflammation of the arteries
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ECG – a test that records the electrical activity of the heart
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Echocardiogram- a heart ultrasound that uses sounds waves to create images of the heart to see its structure and function
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Exercise stress tests- assess how your heart responds to physical activity by monitoring variables such as heart rate and blood pressure, while you exercise on a treadmill or stationary bike
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MRI heart scans- scan of the heart to assess its structure and function
Heart disease treatment depends on the cause and the type of heart damage. Treatment may include lifestyle changes such as increasing exercise, eating a diet low in salt and saturated (unhealthy) fats, medications, or heart surgery. Medication controls symptoms and prevents complications. The type of medicine used depends on the type of heart disease. Below are some common heart disease medications, their possible side effects, and considerations for exercise:
Medication
Who it's prescribed for
Considerations for exercise
Potential side effects
Beta blockers
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Arrhythmias
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Hypertension​
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Tachycardia
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Heart failure
Reduces heart rate by 20-30 BPM to allow more time for ventricular filling. Therefore, using heart rate zones to measure exercise intensity needs to be altered, or use an RPE scale instead to improve accuracy.
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Tiredness/fatigue
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Cold fingers or toes
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Sleep disturbances
Statins
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High cholesterol
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Cardiovascular disease
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Aim to decrease LDL (bad cholesterol) and triglycerides, and increase HDL (good cholesterol)
A patient may need more rest throughout the session due to ‘achy legs’ being a side effect.
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Muscle aches and pains
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Headache
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Gastrointestinal issues
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Achy legs
ACE inhibitors
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Heart failure
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Post myocardial infarction
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High blood pressure
Help regulate blood pressure by reducing constriction and fluid retention.
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Dry, annoying cough
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Hypotension
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Often an increase in exercise capacity as it can improve ejection fraction (volume of blood contracted by the heart with each beat)
Anticoagulants
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Post myocardial infarction
Blood thinning medication reduce the risk of clotting in valve disease.
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Haemorrhage (ruptured blood vessel)
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Risk of internal bleeding
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High risk of bruising- extra careful with exercise and equipment
Common Diagnoses
High blood pressure (hypertension) is a often a result of factors including unhealthy lifestyle choices, underlying medical conditions or genetic predisposition. It is categorised by a persistent blood pressure reading of 140/90 or higher. It is important to monitor daily to get a accurate measure. Anxiety can result in elevated readings and as such a one off reading may not be reliable.
Heart failure is often a result of underlying conditions that damage the heart muscle or impair its ability to pump blood effectively, such as coronary artery disease. It is typically categorised as poor ejection fraction. An ejection fraction refers to how much blood is pumped from the heart with each beat. A normal ejection fraction reading is typically 50-60%, whereas in those with heart failure it is generally below 40%.​
Low density lipoprotein (LDL) cholesterol is often the result of a combination of unhealthy lifestyle factors, genetics and certain medical conditions. It is categorised by LDL molecules building up as fatty deposits in the walls of your arteries, and this plaque build up can increase the risk of heart attacks and stroke.
Arrhythmia’s- e.g. atrial fibrillation or an irregular heartbeat, is often the result of problems with the heart’s electrical conduction system, where the signals controlling the heart are disrupted. It is crucial any arrhythmia is medicated to keep the heart in sinus rhythm (normal rhythm of the heart), ensuring it is safe to exercise. If this does not happen, there is an increased risk of ventricular fibrillation, which can likely result in a cardiac arrest.
Role of Physical Activity & Guidelines for Exercise
Individuals who are physically active have a lower risk of developing cardiovascular disease. The precise amount of physical activity is unclear, but the World Health Organisation recommends amount of physical activity is 75 minutes of vigorous activity, or 150 minutes of moderate activity per week (WHO). The mechanisms by which physical activity may decrease the risk of developing cardiovascular disease include the positive effects exercise has on:
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Decreased LDL (bad) cholesterol, and increased HDL (good) cholesterol
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Improved glucose dynamics and better sensitivity to insulin
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Reduced total body fat
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Reduced blood pressure
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Additionally, exercise can reduce triggers for cardiac events by:
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Preventing thrombus formation (blood clots forming in an artery or vein)
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Improving endothelial function (lining of the artery by regulating blood flow, blood pressure and the exchange of materials between blood and tissues)
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Reducing risk of serious arrhythmias (abnormal heart rhythms that can cause cardiac arrest)
Prior to exercising, the heart, lungs and muscles should be well perfused with blood and the joints and muscles should be as warm and flexible as possible. Vasodilation (widening of the blood vessels to allow more blood flow) can take longer in cardiac populations. Therefore, a minimum of a 15-minute warm up is recommended to slowly increase heart rate and to gently encourage blood flow. If the warm up is not sufficient it can result in ischemia (a lack of oxygen to the heart).
The cool down should be gradual and a minimum of 10 minutes is required. Exercises that involve lying down should be performed after the cool down to reduce myocardial workload (stress on the heart muscle) and the risk of arrhythmias.
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In those with heart disease there is an increased risk of orthostatic hypotension- a form of low blood pressure that can occur upon standing after a period of sitting and/or lying down. This can lead to individuals feeling dizzy and nauseas. Therefore, to reduce this risk, it is recommended to group floor work exercises together and encourage moving from sitting to standing slowly.
Whilst performing upper body exercises such as bicep curls, it is very important to keep the feet moving. This constant motion acts as a muscle pump for the flow of blood back to the heart whilst working smaller muscle groups. It is important to ensure all prescribed medications have been taken to reduce the risk of adverse effects during or after exercise.
Contraindications
It is important not to exercise if you experience any of the following symptoms:
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Angina- chest pain that is new, not predictable, and will not reduce with the use of medication e.g. GTN spray (used to widen blood vessels and increase blood flow)
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Unstable heart failure- severe breathlessness, rapid weight gain, pitting oedema. A review of medications may be necessary
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Unstable diabetes- having hypoglycaemic episodes (low blood sugar) below 4mmol/L
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New or uncontrolled arrhythmias (irregular heart beat)
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Pre exercise tachycardia (increased resting heart rate > 100 BPM)
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Hypertension (high blood pressure) of > 180/1007.
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Illness/fever
The Vitruvian Team.
BHF Heart statistics, 2021
Dalal H.M., Doherty P., Taylor R.S. Cardiac rehabilitation. BMJ. 2015;351
WHO guidelines
Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta- analysis of randomised clinical trials
Tasuku Terada et al., 2024
Xanthos PD, Gordon BA, Kingsley MIC. Implementing resistance training in the rehabilitation of coronary heart disease: A systematic review and meta- analysis. Int J Cardiol 2017;230:493–508.
Vona M, Codeluppi GM, Iannino T, et al. Effects of different types of exercise training followed by detraining on endothelium- dependent dilation in patients with recent myocardial infarction. Circulation 2009;119:1601–8.