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Overview of CAD

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CAD develops as a result of progressive narrowing of coronary arteries, which leads to ischemia of the heart muscle. Atherosclerosis is the most common cause for narrowing of the coronary arteries, with numerous other causes of narrowing and obstructions. A number of risk factors have been identified, including physical inactivity, obesity, hypertension, and hypercholesterolemia. Narrowing of the coronary arteries can be treated with a wide range of medications and through angioplasty procedures. Exercise programs have been shown to significantly improve the total mortality of clients with CAD.1 Clients develop impaired endurance due to the heart's inability to maintain blood flow to the myocardium, which limits the heart's ability to increase blood flow to the lungs and extremities.2

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Benefits of Exercise Programs for Coronary Arteries

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Improved endothelial function Improved myocardial oxygen demand
Improved autonomic tone Development of coronary collateral arteries
Decreased inflammatory markers Decreased clotting factors

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Comorbidities to Consider

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  • Clients may have symptoms of chest pain, palpitations, dyspnea, and fatigue related to this condition.

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Client Examination

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Keys to Examination of Clients

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  • Clients may have undergone stress testing along with imaging of their cardiac circulation and heart function.

  • Clients need ongoing assessments of their blood pressure, heart rhythms, and heart rate.

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Recommended Baseline Testing of Fitness Levels

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  • Aerobic capacity can be assessed with graded exercise testing, walking, and cycling tests.

  • Estimate resistance training levels using one repetition or 10-repetition maximum testing.2

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Exercise Prescription

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Type: Walking, treadmill walking, cycle ergometry3,4

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Intensity: 60%–80% of maximum heart rate3,5

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Duration: 30 minutes

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Frequency: Five times per week

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Getting Started

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Aerobic activities can be started with two 20-minute bouts of exercise, with a 10-minute rest period. Heart rate is not recommended as the sole determinant for measuring the intensity of exercises, as many clients use a beta-blocker drug that diminishes the heart rate response to activities and limits blood pressure and myocardial contractility. A client's rate of perceived exertion at a level of 12 to 16 can be used in conjunction with heart rate measurements. Resistance training with the upper and lower extremities has been used in combination with aerobic exercises.6 A circuit of resistance training of 8 to 10 upper and lower exercises can be prescribed using 2 to 3 sets of 15 repetitions at 60% of a one-repetition maximum, using 30 to 60-second rest periods between sets.6,7 Resistive training that emphasizes eccentric muscle contractions has been proposed as a method that produces muscle strength changes with less demand on cardiovascular function.8 Aquatic exercise has ...

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