Cardiovascular Disease (General)

Cardiovascular disease (CVD) here means established conditions such as coronary artery disease, prior myocardial infarction, angina, heart failure, peripheral artery disease, or post-revascularisation status. Exercise reduces mortality and improves function and quality of life, but risk during exercise is higher in this group, so structure and supervision matter.

Framework — cardiac rehabilitation: medically supervised, individualised exercise + education + risk-factor management is the standard entry point after a cardiac event/diagnosis. The AHA/AACVPR 2024 update of the cardiac-rehab core components lists aerobic exercise training and strength training as separate core components, alongside physical-activity counselling, risk-factor and psychosocial management, and nutrition.

Long-term target: the U.S. Physical Activity Guidelines (2018) say adults with chronic conditions who are able should work toward the same 150–300 min/week moderate (or 75–150 min vigorous) aerobic activity and muscle-strengthening on ≥2 days/week, be under the care of a health care provider, and otherwise be as active as their abilities allow.

Typical early prescription in cardiac rehab (individualised by the team after clearance):

• Aerobic: most days, building toward 20–60 min/session at a moderate intensity set from clinical testing (HR reserve, RPE, or below an ischaemic/symptom threshold). Start low; many begin with intervals/short bouts.
• Resistance: typically introduced after an initial aerobic-conditioning period, 2–3 days/week, lighter loads/higher reps, avoiding Valsalva; usually deferred for a defined period after a cardiac event or sternotomy.
• Warm-up/cool-down: extended and emphasised to reduce arrhythmia/ischaemia risk.

• Use RPE and symptom monitoring alongside HR; many are on beta-blockers (blunted HR) — see RPE and the Borg Scales (6–20 and CR10).
• Keep intensity below the angina/ischaemic threshold if one is known.
• Watch for and avoid exercising during unstable symptoms; account for medications (nitrates, beta-blockers, antiplatelets/anticoagulants — bleeding/bruising).
• Peripheral artery disease: supervised walking to moderate claudication pain is therapeutic.

• Medical clearance and (ideally) supervised cardiac rehab are essential before independent exercise. ACSM's 2015 screening model bases referral on current activity level, known cardiovascular/metabolic/renal disease or symptoms, and the intended intensity — someone with known CVD who is inactive should get medical clearance before starting (Medical Clearance & Pre-Participation Screening).
• Stop immediately and seek emergency care for: chest pain/pressure, radiating arm/jaw pain, severe breathlessness, dizziness/syncope, palpitations/irregular rhythm, cold sweat, nausea (Cardio Safety, Contraindications & Warning Signs).
• Clinical teams treat unstable states — such as unstable angina, uncontrolled arrhythmias, decompensated heart failure, recent MI/active ischaemia, severe symptomatic aortic stenosis, or acute systemic illness — as reasons not to exercise until stabilised and cleared.

• Start within supervised cardiac rehabilitation; benefits are large but exercise risk is higher.
• AHA/AACVPR 2024: aerobic training and strength training are both core components of cardiac rehab.
• Typical early dose: most days, build to 20–60 min, moderate, below symptom/ischaemic threshold; resistance added later, lighter, no Valsalva.
• Use RPE + symptoms (beta-blockers blunt HR); extended warm-up/cool-down.
• Clearance essential; stop for any cardiac warning signs.