Exercise is an important part of rehabilitation in a patient with cardiovascular disease. The American College of Physicians (ACP) described risk categories for these patients which can help guide how much exercise is allowed and how it will be monitored.
High risk:
(1) left ventricular ejection fraction < 30% (severely depressed)
(2) history of sudden cardiac arrest
(3) ischemic ECG response during exercise with ST segment depression >= 2 mm
(4) anginal pain during exercise
(5) recent (< 6 month) myocardial infarction with serious ventricular arrhythmia
(6) decrease in systolic blood pressure >= 15 mm Hg during exercise (pre-exercise blood pressure minus exercise blood pressure >= 15)
(7) ventricular arrhythmia that appears or gets worse with exercise
(8) complex ventricular arrhythmia at rest
Intermediate risk:
(1) uncomplicated cardiac event with a maximal functional capacity at 3 weeks after the event < 8 METS
(2) shock or congestive heart failure during a recent (< 6 months) myocardial infarction
(3) unable to self-monitor heart rate because of intellectual or physical impairment
(4) ischemic ECG response during exercise with ST segment depression < 2 mm
(5) failure to comply with the exercise prescription
Low risk - both of the following:
(1) one of the following:
(1a) uncomplicated myocardial infarction
(1b) uncomplicated coronary revascularization procedure
(2) one of the following:
(2a) maximal functional capacity at 3 weeks after the event >= 8 METS
(2b) asymptomatic at rest and able to exercise to a peak workload sufficient to resume most vocational and recreational activities
where:
• 1 MET = 3.5 mL oxygen per kg per minute
• A resting systolic blood pressure > 200 mm Hg is a contraindication to exercise.
