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No Yes
Is the patient intermittently active? How long has the patient been doing enough regular physical
activity for health benefits?
No
Use motivational interviewing techniques to build partnerships and set the agenda for change
Precautions
Pre-contemplation Contemplation Preparation Action Maintenance All patients should be provided with clear advice on
risks and benefits of physical activity, warm-up and
Help patient move towards Support patient in deciding to Support patient to become Support patient to continue Support patient to continue
cool-down, limiting physical activity to low–moderate
possibility of changing behaviour become more active regularly active regular activity regular activity
intensity, appropriate footwear and clothing, and the
importance of following their symptom (chest
pain/diabetes) management plans.
Advise: Advise: Advise: Advise: Advise:
N On risks of inactivity N Discuss pros and cons N Discuss activity options N Reinforce health benefits N Advise person to maintain
Indications to stop physical activity‡:
N On benefits of activity of activity Assist: Assist: current level
Squeezing, discomfort or typical pain in the centre of
Assist: Assist: N Assist person to develop N Give positive feedback N Reinforce benefits of the chest or behind the breastbone o spreading to
N Offer educational material N Offer written script action plan, set start date etc N Renew script as person activity the shoulders, neck, jaw and/or arms
Arrange: N Suggest ways to be active N Help set realistic goals progresses Dizziness, light headedness or feeling faint; difficulty
N Provide script breathing; nausea; uncharacteristic excessive
N Review at next visit during the day Arrange: sweating; palpitations associated with feeling unwell;
N Set follow-up date undue fatigue
Shakiness, tingling lips, hunger, weakness or
Arrange:
palpitations in people with diabetes
N Consider referral to local physical activity provider
N Consider referral to tertiary services (e.g. exercise practitioner) ‡ Patients should stop the activity and follow their chest pain/
discomfort or diabetes management plan, and stop until reviewed.
for those who would benefit from supervision or request group
support
N Organise follow-up and review
January 2006
1300 36 27 87 www.heartfoundation.com.au
All people with coronary heart disease or capacity in patients with heart failure, the emphasis should be on frequency
diabetes should be given a written action and has been reported to improve (through the day and number of
plan to follow if symptoms occur during survival. Current evidence suggests days), followed by increasing duration.
physical activity.5 that physical activity conditioning,
including resistance training, is safe Cerebrovascular disease
Post acute coronary for people with well-compensated, and PVD
syndrome clinically stable heart failure.1
♥ Regular moderate physical activity is
♥ Patients with clinically stable CVD ♥ Patients with well-compensated, integral to treating stroke, diabetes
after recent acute myocardial clinically stable heart failure should and PVD.1
infarction (AMI), unstable angina, progress over time to achieve
♥ Progressive physical activity is an
coronary artery bypass grafting or 30 minutes of moderate-intensity
effective treatment for improving
percutaneous coronary intervention, physical activity on most days.1 walking distance in patients with
should be offered participation in a Those with New York Heart
♥ claudication.6
supervised exercise rehabilitation
Association (NYHA) Functional Class Patients who have survived a stroke
program for up to 12 weeks.1,3 ♥
III or IV heart failure should attempt and retain sufficient functional
♥ Regular physical activity after an acute shorter intervals of physical activity capacity should be advised to aim
coronary syndrome (ACS)‡ event with interspersed with more rest days.1 over time to achieve the standard
or without coronary revascularisation
♥ For those with symptomatic heart dose of physical activity. The activity
improves functional capacity and
failure, physical activity should may need to be tailored to the
lowers the risk of future cardiovascular
be initiated under supervision. patient’s comorbidities and any
events.1
A reduction, including brief residual neurological deficits.1
abstinence, in the dose of physical
Coronary heart disease activity may be necessary in Diabetes
♥ Patients with well compensated, response to clinical deterioration.1 ♥ Patients with type 1 or 2 diabetes
clinically stable CHD may begin
who have achieved good glycaemic
increasing physical activity by
following the program for AMI Implanted cardiac devices control, and have no complications,
can benefit from the standard dose
survivors (Table 1). The program Clinically stable patients with
♥
of physical activity.1
can be accelerated in those who implanted cardiac devices and
were previously active.1 those with congenital heart disease ♥ The presence of macro- and
microvascular complications may
or valvular disease should aim for
necessitate a dose reduction to
Advanced CHD the standard recommended dose of
prevent further complications.1
♥ Those with advanced CHD physical activity, with dose reductions
for individuals as required.1 ♥ All patients with diabetes should be
should begin with multiple short
(2–10 minutes) sessions of light given a written action plan to use
activity (e.g. stroll on flat ground), if symptoms occur during physical
Elderly patients with CVD activity.1
interspersed with frequent rest
periods, on alternate days. The initial ♥ Regular low- to moderate-intensity ‡. Including the ACS spectrum from ST elevation AMI,
goal should be to increase duration physical activity appears to be safe non-ST elevation AMI, to an accelerated pattern of angina
and frequency (sessions per day and for older people with heart disease.1 without evidence of infarct
number of days per week) gradually ♥ When advising older patients with References:
as tolerated, aiming for 30 minutes CVD about increasing physical 1. Briffa T, Maiorana A, Allan R, et al. On behalf of
per day on most days. Intensity may activity, the emphasis should be on the Executive Working Group and National Forum
then be increased to moderate.1 short daily bouts of low- to moderate- Participants. National Heart Foundation of Australia
physical activity recommendations for people with
intensity activity. The target dose
Heart failure can be reduced, and patients with
cardiovascular disease. Sydney (Australia): National
Heart Foundation of Australia; Jan 2006.
♥ Regular physical activity improves comorbidities may progress slowly 2. Franklin B, Bonzheim K, Gordon S, et al. Safety
symptoms and increases functional to achieve interim targets. Initially, of medically supervised outpatient cardiac
rehabilitation exercise therapy: a 16-year follow-up.
Chest 1998; 114: 902–6.
Table 1. A typical walking program for patients with CVD, 3. National Heart Foundation of Australia and Australian
including AMI survivors, involves:1,4 Cardiac Rehabilitation Association. Recommended
framework for cardiac rehabilitation ‘04. 2004
Week Minimum time (minutes) Times per day Pace 4. National Heart Foundation of Australia. Physical
activity after Heart attack and surgery 2003.
1 5–10 2 Stroll 5. National Heart Foundation of Australia and Cardiac
2 10–15 2 Comfortable Society of Australia and New Zealand. Reducing
risk in heart disease 2004. A summary guide for
3 15–20 2 Comfortable preventing cardiovascular events in people with
4 20–25 1–2 Comfortable/stride out coronary heart disease, 2004.
5 25–30 1–2 Comfortable/stride out 6. Leng GC, Fowler B, Ernst E. Exercise for intermittent
6 30 1–2 Comfortable/stride out claudication. The Cochrane Database of Systematic
Reviews 2000, Issue 2.