Appropriately prescribed exercise is indicated for most people with a clinically stable heart condition after relevant screening. Conditions where exercise is contra-indicated or should be undertaken with caution, are detailed in the table below. In most instances, light-to-moderate intensity exercise offers a very high benefit-to-risk ratio, and is much safer than a prolonged sedentary lifestyle. However, some cardiovascular conditions require stabilisation and further medical intervention before exercise can safely be performed. Also see Guidelines for exercise program participation regarding indications for program entry and details on programming for different clinical conditions.
Table 1: Conditions where exercise is contra-indicated
Absolute contra-indications |
Relative contra-indications |
1. Progressive worsening of exercise tolerance or dyspnoea at rest or on exertion over previous 3-5 days
|
1. 2kg increase in body mass over previous 1-3 days
|
2. Significant ischaemia at low exercise intensities (<2 METS, or ~50W) |
2. Concurrent continuous or intermittent dobutamine therapy |
3. Uncontrolled diabetes |
3. Decrease in systolic BP with exercise |
4. Acute systemic illness or fever |
4. NYHA functional class IV |
5. Recent embolism (<4 weeks) |
5. Complex ventricular arrhythmia at rest or appearing with exertion |
6. Thrombophlebitis |
6. Supine resting HR ≥100 bpm |
7. Active pericarditis or myocarditis |
7. Pre-existing co-morbidities |
8. Severe aortic stenosis |
8. Moderate aortic stenosis |
9. Regurgitant valvular heart disease requiring surgery |
9. BP >180/110 mmHg (evaluated on a case-by-case basis) |
10. Myocardial infarction (MI) within previous 3 weeks |
|
11. New onset atrial fibrillation (AF) |
|
12. Resting HR >120 bpm |
|
Patients should not undertake exercise training until they have undergone medical review and their condition is stabilised. |
Carefully review the situation and proceed with caution.
Some patients will be unable to undertake exercise without stabilisation or medical review, while others may undertake exercise, though usually at a reduced level under close supervision. |
bpm = beats per minute; HR = heart rate, METS = metabolic equivalents, NYHA = New York Heart Association, W = watts
Adapted from the American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs[#american-association-of-cardiovascular-and-pulmonary-rehabilitation.-2013]