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

Specific Emergency Protocols In despite the same principles for exercise training suitable for all individuals, special considerations and adaptations for specific population can be found in the following: Hypertension  Isometric exercises are not allowed.  Reduced intensity of 40% up to 60% HRR (VO2 max).  No training allowed if resting SBP ≥180mmHg and/or DBP ≥110mg Hg.  Must be prescribed appropriate antihypertensive drugs before they handle exercise training.  Check for hypotension or orthostatic hypotension due to anti-hypertensive agents. Angina  Carrying GTN tablets or sprays always is crucial.  No supine position.  Sudden posture changes are not allowed that can raise intrathoracic pressure. Ischemia  Anginal symptoms (chest pain, Nausea, sweeting…etc.) should be monitored in term of identifying frequency, severity or triggers.  It is essential that program involves relaxation and stress management components. Open heart surgery The following common post-operative manifestations impact on physical recovery and should therefore be considered before prescribing exercise:  Fatigue, persistent sternal pain, Sleep disturbance, dyspnea, pleural effusion, Neck, shoulder, thoracic spine, and lumbar spine discomfort.  Anemia; significantly more common in geriatric individuals.  High resting HR  Postural exercises should be encouraged 24 hours after surgery  Should perform lower limbs exercises only for 8 weeks’ post-surgery.  Avoid traditional resistive training. Atrial fibrillation Exercise intensity should ideally be prescribed according to METs and perceived exertion levels. The use of HR may be inappropriate. Heart failure  training HRs zoon for HF population will be approximately 10 – 20 beats lower than in individuals without heart failure.  Intensity of exercise should be low-moderate levels (35-60% VO2), RPE 10-14 (6-20 scale), 40% or less of HRR. The progressive of resistive training should be: - 5-10 reps at < 30% 1RM (RPE <12) x 2-3 week - to learn technique. - 12-25 reps at 30-40% 1RM (RPE 12-13) x 2-3 week - to improve endurance and coordination. - 8-15 reps at 40-60% 1RM (RPE <15) x 2-3 week- to enlarge muscular mass.  Excessive accessory muscle use and muscle fatigue with arm and upper body exercise in very de-conditioned individuals should be avoided.  Avoid breath holding and Valsalva maneuver.  Avoid sudden postural changes and stopped activities.  Avoid keeping legs stationary.  Encourage leg and calf muscle movements to increase venous return. Implantable cardiac device  Activities which may lead to damage to the device itself, or lead displacement must be restricted.  Start exercise training a minimum of 6 weeks post device implantation to ensure Integrity and safety.  Keep the exercise HR 10 bpm below shock level.  Avoid extra end ranges of shoulder movement and/or repetitive vigorous  shoulder movements.  Horizontal and seated arm exercises should be kept to a minimum.  Avoid Valsalva maneuver and sustained isometric work.  Particularly of the abdominal region, should be avoided especially during arm exercise.  If patient experiences a shock during an exercise session:  Sit or lie the individual down  If the individual recovers quickly and feels well after a shock, referring to physician to device settings may be altered.  If the individual is still unwell after a shock, local emergency procedures (if in hospital) should be activated, or an ambulance should be called. Congenital heart disease  Most patients with ACHD can safely engaged in most forms of activity of low to moderate intensity (4 – 6 METS, 35-55% VO2).  dynamic exercise is more suitable than static exercise.  Avoid sudden acceleration or deceleration over short distance.  Avoid Activity in extreme environmental conditions due to alterations in blood volume, and hydration. Peripheral arterial disease Non-weight-bearing exercise (cycle ergometry, arm ergometry, rowing ergometry) may be preferable due to leg pain. Patients with COPD Patients with measurable obstruction should be advised to use a bronchodilator agent before starting the exercise. Chronic renal failure 1-To avoid injury of the arteriovenous fistula and pain in the shunt-arm: the puncture area should be protected with dressing while training. 2-training should be accomplished on the day between hemodialysis treatments 3-No stretching exercises for the upper part of the body.