Exercise for the Heart Patient, for Postop Patients, and for the Hospitalized - Basic program

While every postcoronary exercise program must be tailored to the needs and capabilities of the individual patient, some generalizations can be made. An outline of a typical walking-jogging program includes, for example, four basic phases. In each, the regimen includes five weekly sessions, with two days of rest taken at any time during the week.

1. Adjustment phase: In this phase, the patient works into the program by gradual stages. For two weeks he may be asked to walk a mile in 30 minutes. In each of three follow-up two-week periods, he walks 1.5 miles in 42 minutes, 2 miles in 50 minutes, and 2.5 miles in 57.5 minutes.

2. Action phase 1: In action phase 1, beginning with the conclusion of the adjustment phase, the patient walks a mile in 20 minutes, continuing that routine for two weeks. For two additional weeks he walks two miles in 40 minutes; then for a final two weeks he covers a three-mile course five times weekly in 60 minutes. The time allotted for each walk is slightly higher for the patient who is over 45 years of age.

It should be noted that patients with higher levels of maximum oxygen consumption may be allowed to pass through the three stages with shorter time prescriptions. The patient with a very good level of consumption would probably be allowed to complete the three-mile course in as little as 42 minutes. In approaching the target, he would be moving through a walking-jogging phase of training. The point at which full-time jogging becomes part of the regimen is usually reached where the patient faces the task of covering a mile in 14 or 15 minutes.

3. Action phase 2: In this phase, the patient graduates to jogging exclusively. The transition may take many months. The exercising patient should always watch for adverse heart symptoms. He may have to make adjustments in his program on the basis of what he observes.

In action phase 2, the patient again increases the intensity of the workout while simultaneously decreasing the distance covered. Starting out, for example, the patient might walk-jog over a one-mile course in 18 minutes. After two weeks he might allow himself 16 minutes to walk-jog a mile, then continue that program for two weeks. By such easy stages he increases the pace to one mile in ten minutes. He then goes back to the 18-minute mile, but covers a two-mile course. In the end, having gradually reduced the number of minutes per mile, he is covering a three-mile course in 30 minutes, jogging all the way.

4. Action phase 3: Using the same gradual approach, the patient progresses to the point where he is jogging five miles in 50 or 60 minutes. The process requires, normally, one year. The ability to undertake such long-distance jogging represents a major accomplishment. In most cases it pays off in terms of high levels of cardiorespiratory fitness. Some heart attack patients have progressed to the point where they have entered marathons.