JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease

PAD peripheral arterial disease PCI percutaneous coronary intervention peak V ˙O2 peak oxygen uptake PH pulmonary hypertension PVCs premature ventricular contraction QOL quality of life RCT randomized controlled trial RPE rating of perceived exertion SGA Subjective Global Assessment STEMI ST elevation myocardial infarction TG triglyceride TAVI transcatheter aortic valve implantation VAD ventricular assist device V ˙CO2 carbon dioxide output V ˙E minute ventilation V ˙E/V ˙CO2 ventilatory equivalent for carbon dioxide V ˙E vs. V ˙CO2 slope minute ventilation vs. carbon dioxide output slope V ˙O2 oxygen uptake V ˙O2/HR oxygen pulse capacity is assessed by cardiopulmonary exercise testing (CPX), an exercise prescription is prepared based on the risk in terms of severity of illness, and then a treatment and CR plan is established.If CPX cannot be performed due to complications, low physical fitness, or low left ventricular function, exercise capacity should be confirmed by the 6-minute walk test.For frail patients, after hospital discharge, their living environment, nursing care certification, and use of nursing care services should be confirmed.In addition, a counseling program for lifestyle modification and adherence to medication, assessment and management of comorbidity, and psychological counseling should be provided.It is not rare for patients with cardiac disease to be depressed after hospital discharge due to anxiety about their physical health, financial problems, and concerns about returning to work or sexual potency. 11Regarding recovery phase CR, a comprehensive disease management program that includes exercise training, smoking cessation, diet therapy, appropriate treatment of coronary risk factors, as well as psychological evaluations, return-to-work counseling, and psychological support, are important.In addition, the importance of self-management to prevent recurrence should be explained to patients and their families, and information on treatment goals and the content of the recovery CR program should be shared within the multidisciplinary CR team and discussed at regular conferences.Counseling will be given on appropriate physical activity based on exercise capacity, and excessive or low activity should be adjusted to the appropriate activity level.If there are signs or findings that suggest exacerbation of medical condition/heart failure or excessive exercise load, the exercise prescription must be reviewed with consideration given to intensify the treatment.Admission Acute phase (Phase I) Return to daily life Early mobilization program Comprehensive CR (disease management program) Discharge from hospital, Return to home Maintain comfortable life, Prevention of recurrence Returning to society-workforce, Establish new healthy lifestyle Inpatient rehabilitation program (CCU/ICU/ward) Exercise stress tests (other than CPX) may be considered IIb B C1 III Assessment of balance function In patients with suspected frailty and risk of falling, "Single leg standing time", "Functional reach test", or "Timed up and go test" may be considered IIb B C1 III COR, class of recommendation; CPX, cardiopulmonary exercise testing; CR, cardiac rehabilitation; GOR, grade of recommendation; LOE, level of evidence.* If ≥3 items apply, the patient is considered to be frail.If only 1 or 2 items apply, the patient is diagnosed as pre-frailty