News and Perspectives > Medscape Medical News > ACC LATAM 2023
Dr. Natalia Martínez Medina
The American Heart Association (AHA) recommends at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or a combination of both, preferably spread throughout the week, to prevent cardiovascular disease. How well do doctors prescribe exercise , and how should patients be assessed to recommend appropriate physical activity?
Dr. Thelma Sánchez Grillo
Dr. Thelma Sánchez Grillo, a cardiologist at Hospital Clínica Bíblica in San José, Costa Rica, during the session "Patient Evaluation and Exercise Prescription in Primary Prevention," presented the benefits and risks of exercise and recommendations for conducting an adequate patient evaluation before prescribing physical activity. [ 1 ]
"Exercise has cardioprotective, emotional, antiarrhythmic and antithrombotic benefits and reduces stress," he emphasized.
He also pointed out that the risk must be assessed from both a cardiopulmonary and musculoskeletal perspective because exercise alone can trigger coronary events, and the last thing anyone wants when prescribing exercise is to cause complications. "Recommending exercise should be progressive; you can't propose a high-intensity regimen to a patient without prior conditioning to generate collateral circulation and improve pulmonary and cardiac capacity."
According to the American Heart Association, patients should be categorized as follows: those who have exercised and those who have not, those with a history of cardiovascular, metabolic, or kidney disease, and those with symptomatic or asymptomatic diseases, in order to consider the parameters when recommending exercise, added Dr. Sánchez.
"If the patient has symptoms and engages in light physical activity, such as walking, they can continue with this exercise and do not require further evaluations. However, if they have a disease and are symptomatic and do not exercise, evaluations should be performed after the exercise prescription, not only clinically, but also considering some diagnostic method; likewise, in a patient who engages in physical activity and wants to increase the intensity, the recommendation is to perform a detailed clinical study and, if necessary, complementary imaging studies."
| Alarm data |
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| Dizziness, orthopnea, heart rate abnormalities, lower limb edema, chest pain (especially with exercise), intermittent claudication, heart murmurs, dyspnea, decreased performance, fatigue |
Parameters of frequency, intensity, time and type
The parameters of frequency (number of sessions per week), intensity (perceived effort measured through the heart rate achieved), time and type (aerobic activity and muscle strength), called FITT, must be considered to make an adequate exercise prescription, indicated Dr. Sánchez.
"The big problem is that most doctors don't know how to prescribe it properly, and beyond knowing how, the important thing is that during the consultation, when we are in front of the patient, we must do more than create a routine; we must be motivators, identify obstacles and the patient's interest in exercise, because it is clear that having physical activity associated with daily life helps improve the quality of life and life expectancy," added the specialist.
The recommendations are clear: for a population aged 18 to 64, 50 minutes of moderate-intensity activity, whether aerobic, strength, or a combination, should be recommended each week. "We need to promote moving more and sitting less, recommending comprehensive programs that also include coordination, balance, and muscle strengthening. If a sedentary lifestyle is a risk, it's necessary to encourage people to start with one to two minutes of physical activity every hour, because all exercise should be gradual and progressive to avoid complications," he emphasized.
Evaluate before recommending
The specialist emphasized the importance of individualized prescriptions, caution, and proper evaluation to determine the appropriate exercise routine. "Furthermore, patients should be involved in their self-care, including proper nutrition and hydration, and it should be stressed that if they have an infection, they should avoid exercise due to the risk of myocarditis and sudden death," she added.
Dr. Rafaellina Concepción
Dr. Rafaellina Concepción, a cardiologist from the Dominican Republic and Vice President for Central America and the Caribbean of the Inter-American Society of Cardiology (SIAC), agreed on the importance of risk assessment for individuals seeking consultation before recommending an exercise routine, verifying risk factors. "For example," she explained, "it has been shown that exercise can reduce the progression to diabetes in patients with prediabetes. The key is to stratify the risk and know what type of exercise to recommend: aerobic, strength, or a combination, to improve functional capacity without reaching the heart rate threshold, thus reducing the risk of other comorbidities such as hypertension , obesity, and elevated lipids, and achieving lifestyle changes."
Dr. Carlos Franco
Dr. Carlos Franco, a cardiologist from El Salvador, emphasized that there is no such thing as zero risk when evaluating a patient. "Of course, there's a difference between an athlete and someone who doesn't exercise, but we must thoroughly profile all patients, carefully assess risk factors, not overlook subclinical cardiovascular disease, and determine if they need a stress test or additional imaging to evaluate cardiac function. Furthermore, we must prescribe a gradual training regimen and verify their nutritional status."
As doctors, we must know how to prescribe basic exercise and make small interventions, with simple intensity, give practical advice and, if possible, rely on specialists such as physiatrists, sports specialists, and physiotherapists, concluded Dr. Franco.