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

Risk factor control 2.2.7.1 Lipid Management Assessment Measure fasting HDL, LDL, and triglycerides. Review history for modifiable factors affecting lipids (e.g., diet, medications, substance use). Evaluate current lipid-lowering therapy and adherence. Monitor liver function and creatine kinase in patients on lipid-lowering drugs. Assess dietary fat intake. Intervention and plan Initiate nutrition counselling and weight management for patients with LDL >130 mg/dL; consider medication for LDL 100–130 mg/dL. Implement lifestyle or medical interventions to raise HDL >35 mg/dL. Aim for long-term lipid targets: LDL <100 mg/dL; HDL >35 mg/dL; triglycerides <200 mg/dL. 2.2.7.2 Hypertension Management Assessment Measure resting blood pressure. Review current antihypertensive therapy and adherence. Evaluate sodium and other nutrient intake affecting BP. Intervention and plan For BP 130–139/85–90 mm Hg: implement lifestyle changes (exercise, sodium reduction, weight control, smoking cessation); consider medication. For BP >140/90 mm Hg: initiate both lifestyle changes and pharmacologic treatment: Monitor medication use and effectiveness regularly. Educate on home BP monitoring. Adjust interventions until BP <130/85 mm Hg is achieved. 2.2.7.3 Smoking Cessation Assessment Determine smoking status (current, former, never); record daily use and duration, including cigars, pipes, chewing tobacco, and second-hand exposure. Review tobacco use history, past quit attempts. Assess aggression and hostility (Buss–Perry Aggression Questionnaire). Evaluate nicotine dependence (e.g., Cigarette Dependence Scale). Assess readiness to quit; motivate those not ready. Reassess smoking status at every visit. Identify psychosocial barriers to cessation. Intervention and plan  When the patient confirms smoking, the practitioner selects following suitable strategies: -Minimum intervention. -Provide relapse prevention problem solving, anticipated threats, practice scenarios. -Provide education session. Optimum intervention If ready to quit, tailor strategy: Minimum intervention: (brief advice, relapse prevention, and education). Optimal intervention: structured cessation programs (individual/group counselling), pharmacotherapy (e.g., bupropion, NRT, varenicline, e-cigarettes if appropriate). Provide follow-up via visits or phone for at least 6–12 months. Advise avoiding exposure to smoke at home and work. 2.2.7.4 Weight Management Assessment Measure BMI, height, weight, and waist circumference. Review patient’s weight history. Assess physical activity using the General Practice Physical Activity Questionnaire (GPPAQ). Inactive Sedentary job, no exercise or cycling. Moderately inactive Sedentary job with <1 hour/week of exercise or cycling. Moderately active Sedentary job with 1–3 hours/week of exercise or cycling, OR. Standing job with <1 hour/week of exercise or cycling, OR. Physical job without additional exercise. Active Sedentary job with ≥3 hours/week of exercise or cycling, OR. Standing job with 1–2.9 hours/week of exercise or cycling, OR. Physical job with some additional exercise, OR. Heavy manual job. Intervention and plan For patients with BMI >25 kg/m² and/or waist circumference >102 cm (men) or >88 cm (women): Set realistic short- and long-term weight goals, aiming for a 10% reduction over 3–6 months, considering individual risk factors. Develop a comprehensive plan including diet, physical activity, and behavioural strategies to achieve a daily energy deficit of 500–1000 kcal, while ensuring adequate nutrient and fibre intake. Monitor progress toward weight goals through regular follow-up with a nutrition counsellor. Encourage daily physical activity, including extended walking (e.g., 90 minutes), tailored to fitness level. Target body weight goals: BMI 18.5–24.9 kg/m² and waist circumference <85 cm (men), <90 cm (women). Refer to an obesity clinic if weight goals are not met within the planned timeframe. 2.2.7.5 Diabetes Management Assessment Review patient history, current diabetes medications (type and dose). Perform fasting plasma glucose test and assess frequency/type of glucose monitoring. Screen for hypoglycemia symptoms (e.g., confusion, sweating, tachycardia, nausea) and hyperglycemia signs (e.g., fatigue, neuropathy, thirst). Monitor HbA1c and fasting glucose to guide treatment. Evaluate dietary intake and nutrition. Intervention and plan Develop a comprehensive plan including diet, weight control, oral hypoglycemics, insulin, and risk factor management. Prescribe and monitor medication at the primary care level. Educate on prevention and management of post-exercise hypoglycemia: 1. Check glucose before and after exercise. 2. Avoid exercise during peak insulin activity. 3. No hot showers post-training; avoid late evening workouts. 4. Consume pre-exercise snacks. Insulin Start Peak End Hum/Nov/Apidra 10–20 m 1.5–2.5 h 4.5–6 h Regular 30–45 m 2–3.5 h 2–3.5 h NPH 1–3 h 4–9 h 14–20 h Lantus 1–2 h 6 hr 18–26 h Levemir 1–3 h 18–26 h If there is hypoglycaemia during exercise: 1. Stop activity. 2. Rest, eat a snack, hydrate. 3. Resume when glucose >100 mg/dL. 4. Warn of possible delayed hypoglycaemia (24–48 hrs post-exercise). Avoid exercise if blood glucose >300 mg/dL. Target fasting glucose: 80–110 mg/dL. Prescribe diabetic medications as indicated. Train patients on proper glucometer use and self-monitoring, especially during unsupervised physical activity. Advise insulin-dependent patients to avoid exercise during peak insulin times and inject insulin into the abdomen.