Uncontrolled physical training.

Many patients cannot attend controlled physical training (PT), because the cardio-rehabilitation program is unavailable to them or it is inconvenient for them to attend controlled physical training (PT). Despite this, all patients with coronary artery disease should be recommended training to improve cardiovascular prognosis.

Patients without orthopedic problems of the lower limb should be recommended to walk fast as a method of FT. Patients in unsupervised programs should train before they develop mild dyspnea. This approach eliminates the need to control the pulse. Many patients either cannot control their heart rate accurately, or become overly concerned with pulse interruptions caused by atrial or ventricular extrasystoles. Patients who train independently can be recommended to use the “conversational test” (that is, to train with a load that allows comfortable conversation) to assess the intensity of the FN. This level of load corresponds to the training recommended for cardiac patients.

Other components of comprehensive cardiac rehabilitation. In 1994, the American Heart Association recommended the expansion of cardiac rehabilitation programs with the inclusion of other strategies aimed at reducing cardiovascular risk. Among them are nutritional, psychological and social-labor counseling, as well as correction of such RFs as DLP, increased blood pressure and smoking. These components of secondary prevention of KBS, of course, are very important. It has repeatedly been shown that a decrease in lipid levels during treatment with statins leads to a decrease in the frequency of repeated cardiac events in patients with coronary heart disease (CHD). A review of 20 prospective cohort studies showed that in patients with CHD who give up smoking, the overall mortality rate decreases by 36%.

The inclusion of these aspects in cardiac rehabilitation programs requires a balance between the role of the staff of the cardiac rehabilitation program and the role of the polyclinic doctor. Cardiac rehabilitation program personnel usually provide advice on managing the FR, and also provide information on the interpretation of laboratory results and doctor’s instructions. In relation to the correction of lipid levels, the program staff can evaluate the results of laboratory tests and invite the patient to ask the attending physician for more stringent tactics to achieve the target cholesterol level.

Cardiac rehabilitation programs vary in counseling and patient education. Assessing the ability of patients to learn can increase the potential of educational programs. In many programs, the aerobic part of FT, when the patient is on the simulator, is used for training. In some programs, patients simply provide printed materials. Other programs use televisions and special video programs that provide information on risk factors and risk reduction. But in some programs, FT has been replaced by educational programs. We oppose this approach, given the positive physiological effects of physical training (FT).

Training programs can be creatively modified depending on the needs of patients, but should be complementary to the FT. Ideally, the components of the educational program on nutrition, lipid correction, smoking cessation and psychological problems should be provided by specialists from relevant fields of medicine, but usually all the components of the educational program are provided by the rehabilitation program staff.

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