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Make physiotherapy prescription and 2 months physiotherapy treatment protocol according to my clinic
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"cardiac rehabilitation"[MeSH Terms] AND "myocardial infarction"[MeSH Terms]
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2025 cardiac rehabilitation exercise prescription post myocardial infarction outpatient guideline AACVPR
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https://iacronline.ie/wp-content/uploads/2026/03/IACR-Guidel…
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PMID: 41089802
The records indicate a 61-year-old man with acute inferoposterior STEMI (3 Aug 2026), PCI with drug-eluting stent to proximal OM1, triple-vessel CAD, planned staged revascularisation, and LVEF about 45%.
A 2-month protocol should be a supervised cardiac rehabilitation prescription, not a routine physiotherapy plan. Because staged coronary treatment was advised, begin or progress exercise only after written cardiologist clearance, confirmation that there is no active angina or heart-failure worsening, and a clinic baseline assessment.
Please choose the format so I can prepare the final clinic-ready prescription:
- Generic editable template - no clinic name/logo
- Clinic-branded prescription - send clinic name, physiotherapist name/credentials, address/phone, and logo if available
- Both - a branded patient prescription plus a detailed therapist treatment chart
Also confirm whether the staged PCI/revascularisation has been completed and whether the cardiologist has cleared him for supervised exercise.
Make a detailed 8-week cardiac rehab treatment chart
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"cardiac rehabilitation"[MeSH Terms] AND "coronary disease"[MeSH Terms]
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cardiac rehabilitation exercise prescription 2025 guideline warm up cool down resistance training termination criteria
8-Week Supervised Cardiac Rehabilitation Treatment Chart
Patient profile from records: 61-year-old male, acute inferoposterior STEMI on 03 Aug 2026, PCI with drug-eluting stent to proximal OM1, triple-vessel coronary artery disease, mild LV dysfunction with LVEF about 45%, and advice for staged revascularisation.
Mandatory entry criteria
This chart is conditional on written cardiologist clearance. Do not start or progress outpatient exercise if staged PCI/revascularisation is pending without explicit clearance, or if there is chest pain, worsening breathlessness, fluid retention, fever/acute illness, uncontrolled BP, new arrhythmia, or medication changes causing symptoms.
He should initially be treated as moderate-to-high exercise risk because of LVEF 45%, recent STEMI/PCI, and documented residual triple-vessel disease. Exercise should be ECG-monitored where available, with physician emergency support and a defibrillator accessible.
Cardiac rehabilitation is indicated after STEMI and PCI, but screening for contraindications and individual risk stratification are required before training. Fuster and Hurst's The Heart, 15th Edition, pp. 689-692. Recent evidence also supports comprehensive rehabilitation after PCI, though the exact exercise dose must be individualised (2025 systematic review).
Baseline assessment: before Session 1
| Domain | Record / action |
|---|---|
| Cardiologist clearance | Date, exercise restrictions, whether staged PCI is planned/completed, angina threshold, permitted HR/BP limits |
| Symptoms | Resting chest pain, dyspnoea, palpitations, dizziness, syncope, fatigue, ankle swelling, orthopnoea |
| Medications | Reconcile all drugs. Confirm antiplatelets must not be stopped independently. Note beta-blocker use because HR response may be blunted. |
| Resting measures | BP, HR/rhythm, SpO₂, weight, oedema, pain score, Borg RPE, glucose if indicated |
| Functional assessment | 6-minute walk test only if clinically stable and cleared, or ECG-monitored exercise test/CPET if available. Record walking aid, distance, symptoms, BP/HR response, RPE. |
| Physical examination | Posture, gait, balance, sit-to-stand, joint ROM, muscle strength, fall risk, access-site healing |
| Patient education | Angina plan, exertion monitoring, medication adherence, low-salt heart-healthy diet, tobacco abstinence, sleep, stress management |
| Programme goals | Improve walking tolerance and daily function, build safe independent activity, manage risk factors, return to appropriate domestic/community activity |
Intensity prescription
Use RPE and talk test as the primary guide, particularly if he takes a beta-blocker.
- Weeks 1-2: RPE 9-11/20, very light to light. Able to speak full sentences.
- Weeks 3-5: RPE 11-12/20, light to somewhat hard.
- Weeks 6-8: RPE 11-13/20, somewhat hard, only if stable and cardiologist-cleared.
- Do not use high-intensity intervals, maximal exercise, heavy resistance, sustained isometric work, or breath-holding/Valsalva in this 8-week plan.
- If an exercise test identifies an ischaemic/angina threshold, keep training HR at least 10 bpm below that threshold, as directed by the cardiologist.
Every session should have at least a 10-minute warm-up and cool-down. Current CR guidance supports supervised sessions at least twice weekly, individual risk stratification, and a FITT-VP exercise prescription (IACR cardiac rehabilitation guidance).
Standard supervised session format
| Component | Week 1-2 | Week 3-5 | Week 6-8 |
|---|---|---|---|
| Pre-exercise screen | 5-10 min | 5-10 min | 5-10 min |
| Warm-up | 10 min | 10 min | 10 min |
| Aerobic conditioning | 10-20 min | 20-30 min | 25-40 min |
| Resistance / functional exercise | None or very light technique only | 10-15 min, 2 days/week | 15-20 min, 2 days/week |
| Balance/flexibility | 5-10 min | 5-10 min | 5-10 min |
| Cool-down and recovery check | 10 min | 10 min | 10 min |
| Education/behaviour counselling | 5-10 min | 5-10 min | 5-10 min |
Preferred aerobic modes: level walking, treadmill walking at low grade, stationary cycle, seated stepper, or low-intensity corridor walking. Select the safest mode based on gait, balance, musculoskeletal symptoms, and equipment.
Week-by-week treatment chart
| Week | Supervised sessions | Aerobic prescription | Strength / functional programme | Home activity | Education and review |
|---|---|---|---|---|---|
| 1 | 2-3 sessions, ECG/telemetry monitoring if available | 10-15 min total, continuous or 2-3 short bouts. Level walking or cycle. RPE 9-10. No incline. | Breathing control, ankle pumps, marching on spot with support, sit-to-stand from higher chair 1 x 5-8 if symptom-free. Mobility only, no weights. | 5-10 min easy walk once or twice daily on level ground, only if symptom-free. | Teach RPE/talk test, pulse/BP record if equipment available, warning symptoms, medication adherence. Confirm stent access site fully healed. |
| 2 | 2-3 sessions | 15-20 min continuous or intermittent. RPE 9-11. Increase duration before speed. | Sit-to-stand 1-2 x 6-10; supported heel raises 1 x 8-10; light theraband rows only if cleared. Relaxed exhalation during effort. | 10-15 min walk on 4-5 days/week. Avoid heat, hills, rushing, and walking immediately after a heavy meal. | Energy conservation, safe pacing, sleep, constipation avoidance, hydration as medically appropriate. |
| 3 | 3 sessions | 20-25 min. RPE 10-11. Add very small speed increase or low cycle resistance, not both in same session. | Begin light resistance only with clearance: 6-8 exercises, 1 set of 10-15 reps, very light band/0.5-1 kg load. Examples: seated row, biceps curl, wall push-up, knee extension, calf raise. | 15-20 min walk on 5 days/week at easy pace. | Heart-healthy diet: reduce salt, fried foods, refined sugar; adequate fruit, vegetables, pulses, whole grains. Referral to dietitian if available. |
| 4 | 3 sessions | 25-30 min. RPE 11-12. May use 2-3 min moderate effort alternating with 2-3 min easy effort, but no high-intensity intervals. | 1 set of 10-15 reps for 6-8 exercises, 2 non-consecutive days/week. Continue functional sit-to-stand. No overhead heavy lifting. | 20-25 min walking, 5 days/week. One rest/recovery day as needed. | Stress, anxiety and depression screening. Teach diaphragmatic breathing, relaxation, and family support. |
| 5 | 3 sessions | 25-30 min. RPE 11-12. Progress only if all prior sessions were symptom-free and recovery HR/BP is appropriate. Light treadmill grade up to 1-2% only if cleared and no angina. | 1-2 sets of 10-15 reps, 6-8 exercises. Increase resistance only if 15 repetitions are completed with RPE no more than 11-12 and no BP/symptom concern. | 25-30 min walk on 5 days/week. | Discuss diabetes/lipid/BP targets with physician, medication side effects, smoking/alcohol avoidance, adherence to dual antiplatelet therapy. |
| 6 | 3 sessions | 30-35 min. RPE 11-12. Incorporate chosen modalities: walking + cycling if desired. Maintain steady, controlled effort. | 1-2 sets, 8-10 exercises, 10-15 reps. Include step-ups to a low step with rail only after balance assessment and no symptoms. | 30 min moderate-easy activity on 5 days/week, divided into bouts if fatigued. | Community ambulation, stair strategy, travel, sexual activity questions referred to cardiologist as needed, return-to-work planning. |
| 7 | 3 sessions | 30-40 min. RPE 11-13 only if stable and cardiologist clearance remains valid. Gradual low-grade hill/stair practice may be included under supervision. | 2 sets of 10-15 reps, 8-10 exercises, 2 days/week. Emphasise breathing, slow controlled repetitions, and no straining. | 30-40 min activity on 5 days/week. Continue one lighter recovery day. | Develop long-term weekly exercise plan, identify barriers, self-monitoring diary. |
| 8 | 2-3 sessions plus discharge assessment | 35-40 min at a sustainable RPE 11-13. Confirm safe independent walking/cycling dose. No progression if residual ischaemia or staged PCI remains unresolved. | Maintain light-to-moderate resistance programme: 8-10 exercises, 1-2 sets of 10-15 repetitions, 2 days/week, non-consecutive days. | Build toward 150 min/week of moderate activity only after formal discharge review and cardiologist approval. | Repeat 6MWT or approved functional test. Compare baseline BP, HR, RPE, symptoms, walking capacity, sit-to-stand, weight, and goals. Provide maintenance plan and cardiology follow-up date. |
Resistance and functional exercise menu
Perform on two non-consecutive days/week, beginning in Week 3 only after stability and clearance.
- Seated theraband row
- Wall push-up
- Seated biceps curl
- Seated triceps extension with very light band
- Sit-to-stand
- Seated knee extension
- Supported calf raise
- Supported mini-squat to chair
- Low step-up with rail, later phase only
- Gentle trunk mobility and postural exercises
Technique rules: exhale on effort, no breath-holding, no sustained gripping/straining, no heavy lifting, stop before fatigue causes poor form.
Session monitoring chart
| Time point | Record |
|---|---|
| Before exercise | Symptoms, BP, HR/rhythm, SpO₂ if available, weight/oedema if indicated, medication changes, glucose if diabetic, RPE |
| During exercise | HR/rhythm if monitored, BP at appropriate intervals, RPE, talk test, angina/dyspnoea, gait/balance, ECG changes if telemetry is available |
| Recovery | BP and HR after cool-down and before discharge, symptom resolution, RPE, any adverse events, home programme issued |
| Weekly | Total aerobic minutes, attendance, home-walk completion, angina episodes/nitroglycerin use, weight, BP trend, medication adherence |
| Week 4 and 8 | Functional reassessment, goals review, progression decision, cardiologist communication if any warning signs or plateau |
Stop exercise immediately and obtain urgent medical review
Stop the session, seat/lie the patient safely, record vitals and ECG if available, and follow the clinic emergency protocol for:
- New chest pressure, heaviness, pain, or pain radiating to arm, jaw, back, or epigastrium
- New unusual breathlessness, wheeze, cyanosis, pallor, cold sweat, nausea, or marked fatigue
- Dizziness, near-syncope, confusion, new palpitations, or sustained arrhythmia
- New ECG ischaemic changes or significant arrhythmia where monitoring is available
- A fall in systolic BP with increasing workload, especially with ischaemic symptoms
- Excessive hypertensive response or an abnormal BP response based on cardiologist/clinic limits
- New ankle swelling, rapid weight gain, orthopnoea, or signs of decompensated heart failure
- Resting or worsening angina, uncontrolled atrial/ventricular arrhythmia, or acute infection/fever
The textbook lists worsening chest pain, decompensated heart failure, uncontrolled atrial arrhythmia, complex ventricular arrhythmia, recent thromboembolism, and other unstable conditions as contraindications to cardiac rehabilitation. Fuster and Hurst's The Heart, 15th Edition, p. 690.
Discharge targets at 8 weeks
- Completes 30-40 minutes of low-to-moderate aerobic activity safely at prescribed RPE.
- Demonstrates correct warm-up, cool-down, RPE/talk-test monitoring, and warning-sign response.
- Performs light resistance exercises with correct breathing and no Valsalva.
- Shows improved 6-minute walk distance or other approved functional measure.
- Has a written maintenance programme, cardiology follow-up, medication plan, nutrition plan, and plan for staged revascularisation if still pending.
Important: This is a therapist-facing rehabilitation chart, not a substitute for the cardiologist’s exercise clearance. The residual triple-vessel disease and planned staged revascularisation make independent unsupervised progression inappropriate until the treating cardiologist has documented the safe exercise limits.
Make physiotherapy prescription
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"cardiac rehabilitation"[MeSH Terms] AND "myocardial infarction"[MeSH Terms]
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cardiac rehabilitation exercise prescription supervised exercise contraindications guideline 2025
PHYSIOTHERAPY PRESCRIPTION
Supervised Phase II Cardiac Rehabilitation
Patient: Mr. Mathura Prasad
Age/Sex: 61 years / Male
Medical Diagnosis:
Age/Sex: 61 years / Male
Medical Diagnosis:
- Acute inferoposterior STEMI, status post PCI with drug-eluting stent to proximal OM1
- Triple-vessel coronary artery disease
- Mild LV dysfunction, LVEF approximately 45%
- Staged coronary revascularisation advised
Physiotherapy Diagnosis: Reduced exercise tolerance and deconditioning following acute myocardial infarction and PCI.
Date: ____ / ____ / 2026
Referring Cardiologist: __________________________
Physiotherapist: ________________________________
Referring Cardiologist: __________________________
Physiotherapist: ________________________________
Treatment prescription
Cardiac rehabilitation programme: Supervised outpatient cardiac rehabilitation for 8 weeks, subject to treating cardiologist’s written clearance and confirmation of exercise restrictions.
| Parameter | Prescription |
|---|---|
| Frequency | 2-3 supervised sessions per week for 8 weeks |
| Session duration | Begin at 30-40 minutes; progress toward 50-60 minutes including warm-up and cool-down |
| Setting | Cardiac rehabilitation clinic with trained staff, emergency protocol, defibrillator access, and ECG monitoring where available |
| Monitoring | Symptoms, resting and recovery BP, HR/rhythm, RPE, SpO₂ if indicated; ECG/telemetry during early sessions or as advised |
| Aerobic mode | Level-ground walking, treadmill walking, stationary cycling, seated stepper, or corridor walking based on safety and tolerance |
| Initial aerobic dose | 10-15 minutes total, continuous or intermittent short bouts |
| Progression goal | 30-40 minutes continuous low-to-moderate aerobic exercise by Week 8 |
| Intensity | RPE 9-11/20 during Weeks 1-2; RPE 11-12/20 during Weeks 3-5; maximum RPE 13/20 during Weeks 6-8 only if asymptomatic and cleared |
| Talk test | Patient must be able to speak comfortably in full sentences during exercise |
| Warm-up | 10 minutes: slow walking/cycling, upper-limb mobility, ankle pumps, gentle active ROM |
| Cool-down | At least 10 minutes of gradually reduced activity, breathing control, recovery monitoring |
| Resistance training | Start only from Week 3 if stable and cardiologist-cleared: light resistance bands or 0.5-1 kg weights, 1 set of 10-15 repetitions, 6-8 exercises, 2 non-consecutive days/week |
| Flexibility/balance | Gentle ROM, calf/hamstring/chest stretches, balance and gait exercises as clinically indicated |
| Home programme | Daily level walking, initially 5-10 minutes once or twice daily; progress toward 30 minutes on 5 days/week as advised |
Goals of treatment
- Improve safe walking and functional exercise tolerance.
- Improve confidence with activities of daily living.
- Reduce cardiac risk through structured physical activity and education.
- Improve lower-limb strength, balance, posture, and endurance.
- Teach exertion monitoring using Borg RPE and talk test.
- Establish a safe independent maintenance exercise programme.
- Promote adherence to medication, nutrition, tobacco abstinence, sleep, stress-management, and cardiology follow-up.
Suggested treatment components
- Supervised aerobic conditioning
- Breathing control and relaxation training
- Gait training and pacing instruction
- Functional strengthening: sit-to-stand, supported heel raises, mini-squats, low step-ups as tolerated
- Light upper- and lower-limb resistance training after clearance
- Balance and fall-prevention exercises
- Education regarding cardiac warning signs and emergency response
- Lifestyle counselling and activity diary
Precautions
- No high-intensity interval training during this initial 8-week protocol.
- No heavy lifting, forceful pushing/pulling, sustained isometric exercise, or breath-holding/Valsalva manoeuvre.
- Avoid exercising in extreme heat/cold, immediately after a heavy meal, or during acute illness.
- Because the patient may be taking a beta-blocker, do not depend on heart rate alone. Use symptoms, RPE, talk test, BP, and medical exercise limits.
- Continue all prescribed cardiac medicines. Antiplatelet medicines must not be stopped without cardiologist instruction.
- Confirm that staged revascularisation status and cardiologist clearance are documented before progression.
Stop exercise immediately and seek medical review if any occur
- Chest discomfort, chest heaviness, arm/jaw/back pain, or angina equivalent
- New or worsening breathlessness, wheeze, pallor, sweating, nausea, or unusual fatigue
- Dizziness, faintness, confusion, palpitations, or new irregular pulse
- Abnormal BP response, new ECG changes, or significant arrhythmia if monitored
- New ankle swelling, sudden weight gain, orthopnoea, or worsening heart-failure symptoms
- Resting angina, fever, acute infection, or an unwell feeling before exercise
Emergency instruction: Stop activity, sit the patient comfortably, check BP/HR/SpO₂ and ECG if available, follow the clinic emergency protocol, and obtain urgent medical help for suspected acute coronary symptoms.
Review schedule:
- Physiotherapy review: weekly
- Functional reassessment: Week 4 and Week 8
- Cardiologist follow-up: as scheduled, and immediately for warning symptoms or inability to progress
Physiotherapist Signature: __________________________
Registration No.: _________________________________
Cardiologist Clearance Verified: Yes / No
Date: ____ / ____ / 2026
Registration No.: _________________________________
Cardiologist Clearance Verified: Yes / No
Date: ____ / ____ / 2026
Cardiac rehabilitation is appropriate after STEMI and PCI but requires individual screening and risk stratification. Fuster and Hurst's The Heart, 15th Edition, pp. 689-692. Recent systematic reviews support comprehensive rehabilitation after PCI, including exercise training plus risk-factor management (PCI rehabilitation review).
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