CH ER 7 Methods of tertiary pr 213 Table 17-3 Core Components of Cardiac RehabiLitation (post-ACS and post-PCI) Component Established/Agreed Issues Class(Level) Issues? Patient assessment Clinical history: review clinical courses of ACs I(A) Physical examination: inspect puncture site of PCI and emities for presence of arterial pulses. by bicycle ergometry or treadmill maxi stress test(cardiopulmonary exercise test if available)within 4 weeks after acute events, with maximal testing at 4-7 weeks Physical activity Exercise stress test guide: With exercise capacity more than 5 Should resistance METs without symptoms, Patients can resume routine physical activity 2 physical activity; otherwise, patients should resume physical days per week be activity at 50% of maximal exercise capacity and gradually Physical activity: Slow, gradual, progressive increase of moderate ass IIb [C))(21 intensity aerobic activity, such as walking, climbing stairs, and cycling, supplemented by an increase in daily activities (e.g. gardening, housework Exercise training Program should include supervised, medically prescribed, I(B Low risk patients: At least three sessions of 30-60 min/wk rcise at 55%0-70% of m workload (METs 二 HR at onset of symptoms; 21500 kcal/wk to be expend Resistance exercise: At least I hr/wk with intensity of 10-1 repetitions per set to moderate fatigue. I(C) (physical activity) to avoid weight gain Weight control Mediterranean diet with low levels of cholesterol and saturate I (B) anagement Statins for all patients, intensified to a lipid profile of cholesterol: <175 mg/dL, or <155 mg/dL in high-risk patients LDL-C: <100 mg/dL, or <80 mg/dL in high-risk patient Triglycerides: <150 mg/dL Blood I(B) lifestyle modification and drugs if necessary to treat to cessation bout tobacco and intervene according to stage of change Psychosocial for distress and intervene if necessary I(B) Modified from Piepoli MF et al: Eur J Cardiovasc Prev Rehabil 17: 1-17, 2010. ACS, Acute coronary syndrome; HR, heart rate; LDI-C, low-density lipoprotein cholesterol; METS, metabolic equivalent tasks; PCI, Primary percutaneous coronary intervention If resting systolic BP is 140 mm Hg or greater or if dia a Assess for psychosocial factors that may impede success. stolid BP is 90 mm Hg or greater, initiate drug therapy. Intervention: provide structured follow-up Offer behav- Expected outcomes are BP less than 140/90 mm Hg(or ioral advice and group or individual counseling <130/80 mm Hg if patient has diabetes or heart or renal Offer nicotine replacement therapy, bupropion, varen- failure)and BP less than 120/80 mm Hg in patients with cline, or both. The expected outcome is long-term absti left ventricular dysfunction nence from smoking a Manage psychosocial issues SMOKING CESSATION Screen for psychological distress, as indicated by clinically All smokers should be professionally encouraged to stop usin ignificant levels of depression, anxiety, anger or hostility, all forms of tobacco permanently. Follow-up, referral to special socialisolation, marital/family distress, sexual dysfunction rograms,and pharmacotherapy(including nicotine replace adjustment, and substance abuse of alcohol and/or other nent)are recommended, as a stepwise strategy for smoking psychotropic agents cessation Structured approaches are to be used(e. g, five"As Use interview and/or other standardized measurement ask, advise, assess, assist, arrange; see Box 15-2) Offer individual and/or small group education and coun a Ask the patient about his/her smoking status and use seling on adjustment to heart disease, stress management, other tobacco products. Specify both amount of smoking and health-related lifestyle change(profession,motor (cigarettes per day) and du num ber of vehicle operation, sexual activity resumption) Whenever possible, include spouses and other family a Determine readiness to change; if ready, choose a date for members, domestic partners, and/or significant others in quitting. such sessions