Table 3.
Contraindications for training, signs of excessive strain and safety criteria (phase II)
| Contraindications | Excessive strain | Safety criteria |
|---|---|---|
| • Progressive increase in heart failure symptoms | • Severe fatigue or dyspnoea out of proportion to the level of exertion |
• ICD Cardiologist informs physiotherapist about safe heart rate range First 6–8 weeks after implantation no (submaximal) strength training of the upper extremitiesa |
| • Severe ischaemia of the cardiac muscle upon exertion | • Angina | |
| • Respiratory frequency of more than 30 breaths per minute | • Unexpected increase in breathing rate (>40 breaths per minute) | |
| • Dyspnoea while speaking | • Pulse pressure reduction (≥10 mmHg) |
• Diabetes mellitus Check for wounds and sensory defects (monofilament test) Check blood glucose values before, during and after the exercise session. Blood glucose values ≤5 and ≥15 mmol/L are relative contraindications for exercising Retinopathy of grade ≥3 is a relative contraindication for training |
| • Heart rate at rest >110 bpm | • Reduction of systolic blood pressure during exercise (>10 mmHg) | |
| • Peak VO2 < 10 mL/kg/min | • Increasing ventricular or supraventricular arrhythmias | |
| • Ventricular tachycardia upon increasing exertion | • Vegetative reactions such as dizziness or nausea | |
| • Poorly controlled diabetes mellitus (in consultation with patient’s internal medicine specialist) |
• Pulmonary problems No desaturation; this usually means that O2 saturation (SaO2) should remain ≥90 % during exercising (and should not fall by ≥4 %)+ |
|
| • Fever | ||
| • Acute systemic diseases | ||
| • Recent pulmonary embolism (<3 months ago) causing severe haemodynamic strain | ||
| • Thrombophlebitis | ||
| • Acute pericarditis or myocarditis | ||
| • Haemodynamically serious aortic stenosis or mitral valve stenosis | ||
| • Heart valve failure constituting an indication for surgical intervention | ||
| • Myocardial infarction less than 3 weeks before the start of the training | ||
| • Atrial fibrillation with rapid ventricular response at rest (>100 bpm) | ||
| • Serious cognitive problems (memory, attention and concentration) | ||
| • Weight gain of >3 kg within a few days, whether or not accompanied by increased dyspnoea at rest |
aSymmetrical functional movements below the patient’s pain threshold (with comfortable rather than forceful movements and controlled breathing) can be started within 6 weeks after surgery (which can also help to prevent the development of a frozen shoulder)
+The physiotherapist should consult the patient’s pulmonologist or cardiologist to decide on the minimum individual saturation value