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THE ROLE OF THE THERAPIST IN CARDIO-VASCULAR AND DIABETES REHABILITATION
What can the Sports Therapist
learn from the Sports Cardiologist?
Matthias Wilhelm
University Clinic for Cardiology
Cardiovascular Prevention,
Rehabilitation & Sports Cardiology
My declaration of interest:
I have nothing to declare.
„Prescribing“ exercise is an interdisciplinary approach
Sports Scientist
Sports Cardiologist
(Cardiologist, involved in
exercise prescription as
prevention and therapy
for CVD)
Sports Therapist
Sports Science: Evidence from athletes
Change in peak oxygen uptake (VO2peak) scores for
three types of high-intensity intervall training (G1-3)
compared to conventional training (GCON)
2x4 weeks training
* P < 0.05 vs GCON; † P < 0.05 vs G3.
Sports Cardiology: Translation to cardiac rehabilitation
27 patients with CAD post MI
Mean age 76 years,
EF 29%, VO2peak 13 ml/min/kg
Circulation 2007; 115:3086
Frequency:
3x/week
Intensity:
90-95%/50-70% HRmax vs.
70-75% HRmax, isocaloric
Sports therapy: Implementation in cardiac patients
High-Intensity Interval Training
Interval
90-95%
90-95%
90-95%
90-95%
4 Min.
4 Min.
4 Min.
4 Min.
Intensity as % of maximum heart rate
Cool-down
50-70%
3 Min.
Interval
Active pause
50 - 70%
3 Min.
Interval
Active pause
50 - 70%
3 Min.
Interval
Active pause
50 - 70%
3 Min.
Warm-up
60-70%
10 Min.
Wisloff et al., Circulation 2007; 115:3086
What is the contribution of the cardiologist?
Sports Scientist
Sports Cardiologist
• Patient selection
• Exercise testing
(risk assessment,
determination of training zones)
• Recommendations
(medication, devices,
interventions,
cardiovascular risks in sports)
Sports Therapist
Patient selection
• Prevention of Atherosclerotic Vascular Disease
• Reduction of Atherosclerotic Risk Factors
• Treatment for Patients With Diagnosed CAD
• Treatment for Patients With Heart Failure
• Treatment for Patients With Peripheral Arterial
Disease and Claudication
Exercise testing
• Diagnosis of ischemia and
arrhythmias
• Risk assessment (especially in
CHF patients)
• Chronotropic response
• Pulmonary vs. cardiac vs.
muscular limitation
• Determination of exercise
capacity
Wassermann, Principles of Exercise Testing, 2005
• Determination of the aerobic
and anaerobic thresholds
(AeT, AnT) and training zones
• Training recommendations
AeT
AnT
Zone
Zone
Zone
Zone
I
II
III
IV
AeT
AnT
Case 1: The fragile patient with heart failure
H.K., male, 72 years, NYHA class III
CABG operation 1996
Ischemic cardiomyopathy, EF 25%, apical aneurysm
Spiroergometry prior to CHF Rehabilitation:
10 Watt/min ramp protokoll
Exercise induced ventricular tachycardia
ICD Implantation, Cordarone
Training recommendations?
Exercise-induced VT
Termination 31 J shock
Exercise in patients with an ICD
prevention of inadequate shocks
H.K., NYHA class III
Ischemic cardiomyopathy, EF 25%
High-intensity training planned:
ICD intervention zone
Maximum heart rate
M.R., NYHA class II
Dilated cardiomyopathy, EF 30%
Uncontrolled atrial fibrillation:
Maximum heart rate
ICD intervention zone
Case 2: The overmotivated patient after MI
Competitive sports after
myocardial infarction?
36th Bethesda Conference, JACC 2005:
Conclusion
• Prescribing exercise for cardiovascular diseases
is an interdisciplinary approach, involving
partners from sports science, sports cardiology
and sports therapy.
• The contribution of the sports cardiologist is
patient selection and exercise testing with risk
stratification and definition of training zones.
• Training recommendations should be given in
close cooperation with the sports therapist.
Thank you
Inselspital, University Hospital Bern
University Clinic for Cardiology
Cardiovascular Prevention,
Rehabilitation & Sports Cardiology
Anna-Seiler Haus
www.sportkardiologie-bern.ch