[Differentiated approach to prescription of physical activity in patients with left ventricular dysfunction]. / Diferencovaný prístup k preskripci fyzické aktivity u nemocných s dysfunkcí levé komory srdecní.

Correctly indicated physical exercise performed and controlled on a regular basis is an inseparable part of treatment and rehabilitation of patients with left ventricular dysfunction. In order to guarantee the best effect and safety of physical exercise, it is necessary to adopt a differential approach to its prescription to patients with different degrees of functional damage. In addition, a number of conditions should be fulfilled, among which, in the first place, the determination of functional classification of patients used in practice and described in the relevant literature (NYHA, AMA, Goldman, Weber). Physical exercise cannot be differentiated only with respect to the degree of dysfunction; other conditioning factors should be taken into consideration, too, among which the relative contraindication of physical strain, somatic condition, physical exercise anamnesis and others (i.e. sex, age, motivation, etc.), causing a high degree of patient heterogeneity. Also described are additional conditions for differentiation and correct application of physical training, which involve the selection of suitable types of exercise and their energetic demands, adequate intensity, frequency and duration; it is also important to determine the available effective and safe methods, programmes and means of training. The article contains examples of the above conditions, as well as classification of physical exercise into functional classes NYHA I-IV. In conclusion, the authors point out the necessity of differentiation of physical training and of cooperation of the cardiologist with the physiotherapist in its indication, implementation and monitoring.

CIRCADIAN BLOOD PRESSURE VARIABILITY AND EXERCISE THERAPY.

The objective of this study was to find if there was a relationship between the time when cardiovascular rehabilitation was running in the patients after myocardial infarction and an average daily value of systolic and diastolic blood pressure at 7-day ambulatory blood pressure monitoring.Systolic and diastolic pressures significantly increased in patients who underwent cardiovascular rehabilitation in the morning from 9.00 a.m. to 10.15 a.m., and significantly decreased in those who did their physical exercise in the afternoon from 1.30 p.m. to 2.45 p.m., compared to their blood pressure values on days without rehabilitation.