A new paradigm for post-cardiac event resistance exercise guidelines.

Existing guidelines for resistance exercise in cardiac rehabilitation are vague and/or overly restrictive, limiting the ability of cardiac rehabilitation programs to help patients achieve their desired levels of daily activity in a timely manner after cardiac events. This study examines the illogical nature of the existing guidelines in relation to the activities of daily living patients are expected or required to carry out during the period of cardiac rehabilitation and the existing recommendations for dynamic exercise in cardiac rehabilitation. An improved method is proposed for prescribing resistance exercise in cardiac rehabilitation. A tool is presented that stratifies the risk associated with each of 13 common resistance exercises for 3 cardiac rehabilitation diagnosis groups (myocardial infarction [MI], pacemaker or implantable cardioverter defibrillator implantation, and coronary artery bypass graft surgery) that, if used in conjunction with blood pressure and heart rate measurements, will safely facilitate more efficacious resistance training in cardiac rehabilitation patients. In conclusion, changing the approach to resistance exercise in cardiac rehabilitation will accelerate patients' return to their desired levels of daily activity, improving patient satisfaction and decreasing cardiac rehabilitation program attrition.

Challenging traditional activity limits after coronary artery bypass graft surgery: a simulated lawn-mowing activity.

PURPOSE: Physician advice and restrictions to patients following a cardiac event can, in some instances, lead patients to be fearful regarding their activities even to the point of inactivity. The purpose of this study was to test whether lawn mowing, one of the activities most strongly discouraged after coronary artery bypass surgery, could be safely performed in a supervised setting. METHOD: Subjects participated in a 6-session simulated lawn-mowing protocol, calibrated to match the push and pull forces of using an outdoor nonpropelled lawn mower. Plain chest radiographs were taken before and after the protocol period. During each session, subjects' sternums were carefully palpated and electrocardiograms, heart rates, and blood pressures were monitored. RESULTS: None of the 13 subjects experienced adverse arrhythmia events or detrimental heart rate, blood pressure, or sternal palpation findings that led to study discontinuation. The radiographs taken after protocol completion showed stable sternal wires with no evidence of sternal dehiscence. CONCLUSION: Simulated lawn mowing did not negatively affect the sternal incision, electrocardiogram findings, blood pressure, or heart rate in this small sample.