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

Specific Medication with exercise considerations  Some beta-blockers may limit sub-maximal and maximal exercise capacity primarily in patients without myocardial ischemia. Using RPE to monitor training intensity is especially essential for those patients.  Antihypertensive medications may lead to sudden excessive decline in post exercise BP. Extend and carefully monitor the cool down period carefully under these circumstances. In order to enhance exercise compliance in those individuals, education about the acute or immediate BP-lowering effects of training (known as post-exercise hypotension) is essential.  Beta-blockers and diuretics may affect thermoregulatory function. Beta-blockers may also cause hypoglycemia. In these circumstances, patients should learn about fluid replacement and precautions when exercising in the heat and the precautions that should be taken to avoid these situations. 2.3 Phase III cardiac rehabilitation; Long term management 2.3.1 By the end of the cardiac rehabilitation program the patient should be aligned with the following criteria:  determine the long-term management goals.  6-12 months one-year follow-up.  Home exercise must be designed according to functional capacity test and clinical assessment.  Combine the home activities with Recreational activities for patients and clarify intensity, frequency, duration, and model.  Involve families (a partner, relative, close friend) to encourage long-term maintenance.  Doctor will assess fitness to coach a care.  Doctor will discuss sexual activity (, level of activity, sexual response cycle, Impact of sexual activity on heart, psychological factors effect on sexual activity, side effect of medication) and prescribe suitable medication.  Doctor will assess return to work and vocational advice as following (return to work, Retired, planning to change job task, and Changed job).  Doctor will assess Normal activities of daily living. 2.3.2 Inclusion criteria  Medically stable  Successfully completed outpatient CR phase 2.  Able to exercise independently, effectively and safely.  Able to achieve an exercise capacity of 5 Mets.  With low risk of cardiac event.  Able to achieve 20-30 minutes of continuous physical activity without symptoms.  Confidence to undertake independent activity 2.3.3 Exclusion criteria. Patients should not be referred to the training component or should stop attending if any of the following occur:  Unstable Angina (defined as any or all the following:  Angina occurring at rest.  A new event of angina within the past four weeks.  Angina occurring more easily on less effort.  Angina does not respond so easily to GTN or fails to respond at all.  Uncontrolled blood pressure where resting systolic is > 180 mmHg and/or Diastolic 100mmHg>.  BP drop > 20 mm/Hg demonstrated during Exercise Tolerance Testing.  Resting pulse rate of greater than 100 beats per minute.  Uncontrolled arterial or ventricular arrhythmia.  Unstable or acute heart failure..  Unstable diabetes  Patient with severe co-morbidity which prevents safe or effective exercise.  Patients with severe psychiatric illness who may endanger themselves or others.  Acute fever or systemic illness.  musculoskeletal deficits which would prohibit exercise. 2.3.4 Exercise prescription Mode Intensity Duration Frequency Flexibility Stretch until mild discomfort. Hold 10 to 30 seconds 3 to 5 reps Before aerobic and strength exercise Aerobic walking, biking, jogging Same previous level of heart rate in phase2. until RPE of 12 to 14 Until tolerance - no symptoms. 45 to 60 minutes. 3 - 4 times a week Strength Same previous level of 1RM in phase2 Same previous repletion in phase2 Same previous Frequency in phase2