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

Stratification for risk of cardiac events After gathering relevant outcome measures, we can stratify the level of risk for the patients and choose an appropriate protocol accordingly: Level of risk Description Low risk -No complex ventricular dysrhythmias, no headedness or dizziness during exercise testing. -No angina. -VO₂ >14mL/kg/min -Functional capacity ≥ 7 METS. -Normal hemodynamics during exercise testing. -Gradual raises and drop HR and Systolic Blood Pressure with increasing workloads. - No signs or symptoms of post-event/post-procedure ischemia - No CHF. - No complicated ventricular dysrhythmias at rest. -Uncomplicated MI or revascularization procedure. -Resting Ejection fraction ≥50%. Moderate Risk -Angina or other significant symptoms such as unusual Short of Breathing, lightheadedness or dizziness, occurring only at high levels of exertion ≥ 7 METS). -Mild to moderate level of silent ischemia during exercise testing or recovery (ST-segment depression <2 mm from baseline). -Resting Ejection fraction 40 – 49%. -Functional capacity <5 METS. High risk - Clinical depression. - Symptoms of post-event/post-procedure ischemia. - Presence of CHF. -VO₂ <14mL/kg/min. - Revascularization procedure or Complicated MI. - Complex dysrhythmias at rest. - History of cardiac arrest. - Resting EF <40%. - Abnormal hemodynamics with exercise testing (i.e. chronotropic incompetence or flat or decreasing SBP with increasing workloads) or recovery (severe post exercise hypotension). - High level of ischemia (ST-segment depression > 2mm from baseline) during exercise testing. - Complex ventricular dysrhythmias during exercise testing. - Angina or other significant symptoms (for example unusual Short of Breath, lightheadedness or dizziness at low levels of exertion (<5METS). Physical therapist can select the following program Program Type of training Intensity Duration and frequency of sessions Program length American Aerobic training (treadmill, cycling) 40–80% VO2peak or HRmax based on maximal exercise Test, RPE 11–16 20–60 minutes per session 3–5 sessions per week 12 weeks Resistance training (e.g. calisthenics, hand weights, pulleys, dumbbells, free weights, machine weights). To moderate fatigue (RPE 11–13) 50% 1RM progressing to 60–70% 1RM 1–3 sets of 10–15 reps for 8–10 different exercises 2–3 sessions per week (non-consecutive days) Flexibility training (Static stretching with emphasis on lower back and thigh) To point of mild discomfort 3–5 reps per exercise, 30–90 seconds for each stretch as tolerable 2–3 sessions per week (non-consecutive days) British Aerobic endurance training Moderate intensity 40– 70% HRR RPE 11–14 20–60 minutes per Session weeks (Depending on the status of the patient) Resistance training 30–40% 1RM for upper body 50–60% 1RM for lower body Progress to 50–80% 1RM for both 2–4 sets of 8–12 reps for 8–10 muscle groups 2–4 sessions per week Flexibility training (Static, ballistic or PNF stretches) To point of tightness 2–4 reps, accumulating 60 seconds per stretch 2–3 sessions per week European Aerobic endurance training Walking, jogging, cycling 50–80% VO2 or 40– 60% of heart rate reserve; 10/20–14/20 of the Borg Rating of Perceived Exertion 45–60 min at least 3 days/week 3 months Resistance training 30–40% of the 1- repetition maximum for the upper body and 40–50% of the 1-repetition maximum for lower body exercises, 12 to 15 repetitions in 1 set repeated two to three times weekly 2 months