(File Date: 2026-02-20 10:24:03) الدليل السعودي لبرامج إعادة التأهيل القلبي والو

Exercise Training; Baseline Assessment Perform exercise stress or tolerance tests as appropriate, with repeats based on clinical changes. The test should assess: o Heart rate and rhythm. o Blood pressure response. o Symptoms (e.g., shortness of breath, chest pain, dizziness, leg fatigue). o ST-segment changes. o Exercise capacity (via 6MWT, METs, peak VO2 in ml/kg/min; 1 MET = 3.5 ml/kg/min). 2.2.10.1 Maximum Exercise testing by Cardiopulmonary Exercise Testing (CPET): CPET is the current gold standard for objectively defining exercise capacity (EC), by measuring the maximum oxygen uptake (VO2 max). CPET plays an essential role in cardiac rehabilitation by accurately assessing a patient’s functional capacity and identifying the limitations of the cardiovascular, pulmonary, and muscular systems during exercise. Purpose in Cardiac Rehabilitation  Maximal CPET is essential for:  Baseline assessment of exercise capacity.  Risk stratification.  Detection of ischemia, arrhythmias, or abnormal BP response.  Tailoring an individualized exercise prescription.  Monitoring progress and outcomes in cardiac rehabilitation. Pre-Test Protocol Patient Screening: Detailed history, physical exam, and resting ECG. Assess medications (esp. beta-blockers, antiarrhythmics). Ensure cardiac stability (no angina, recent MI, uncontrolled arrhythmia, or decompensated HF). (105) Pre-Test Instructions: Light meal 2–3 hours prior. Avoid caffeine and smoking. Withhold specific meds if instructed (usually continue beta-blockers unless otherwise advised). Wear appropriate clothing and shoes. Equipment Cycle ergometer (preferred) or treadmill. Metabolic cart for real-time VO₂, VCO₂, VE, RER. Continuous 12-lead ECG monitoring. Automated BP cuff. Pulse oximeter. Emergency equipment and trained resuscitation staff available. CPET Protocol for Cardiac Rehab Exercise Modality: Cycle ergometer is preferred for safety, control, and ease of ECG monitoring. Protocol Type: Ramp or Incremental Protocol o Begin with 2–3 min of unloaded cycling. o Increase workload 10–20 watts/minute, depending on patient condition. o Aim for total test duration of 8–12 minutes. Termination Criteria Per AHA guidelines: Absolute: Onset of angina or significant Anginal symptoms. Drop in systolic BP >10 mmHg with increased workload. Severe desaturation (SpO₂ <80%). Signs of poor perfusion (cyanosis, confusion). Sustained ventricular tachycardia. ST elevation ≥1 mm without Q waves. Relative: Fatigue, shortness of breath, wheezing, leg cramps. Hypertensive response: SBP >250 mmHg or DBP >115 mmHg. Increasing arrhythmias. Exercise-induced bundle branch block. Development of BBB making ST interpretation difficult. Intervention and plan: Key Parameters Measured in Cardiac Rehab Functional Capacity: Peak VO₂ (mL/kg/min): gold standard for aerobic capacity o VO₂ <14 mL/kg/min = poor prognosis in HF. o VO₂ >20 mL/kg/min = low risk.