4.2.1. General Remarks

Phase II of cardiac rehabilitation typically commences within 1–3 weeks following hospital discharge [1]. Phase II is offered as a hospital- or center-based outpatient program of 2–6 months duration; however, residential programs prevail in some countries—e.g., in France, Germany and Poland [10]. Residential cardiac rehabilitation programs include medically supervised exercise sessions 5–6 days a week and last for 3–5 weeks. They are particularly suitable for high-risk patients—i.e., [2]:


Indications for exercise training include [2]:


Contraindications to supervised exercise training [11]: Absolute contraindications:


Relative/temporary (at the discretion of the cardiologist):


4.2.2. Components of the Exercise Training

Exercise training should include the following components [12]:


An exercise training session comprises [8]:

1. **Warm-up**, usually 5–10 min of light-to-moderate intensity exercise at 30%–40% of heart rate reserve, <11 points at RPE Borg scale. The warm-up allows for gradual body adjustment to the physiological demands and precludes the sudden increase in catecholamines level [13]. By the end of the warm-up phase, an exercise intensity level of 40% of the heart rate reserve (or Borg scale 10) should be attained. The warm-up should include pulse-raising activities (for 3–5 min)—e.g., marching on the spot, walking, or low-intensity cycling. It can be followed by the stretching of the major muscle groups (3–5 min) with a subsequent re-warm-up [8].

2. **Conditioning phase,** of 20–60 min duration. The conditioning phase can be executed by utilizing one piece of equipment (e.g., a treadmill) or can take the form of circuit (station) training. Circuit training encompasses training on aerobic stations (usually for 30 s to 2 min each), followed by the use of an active or passive recovery station in the form of resistance work.

3. **Cool-down phase**, of 5–10 min duration, includes light- to moderate-intensity exercises and provides for the gradual recovery of heart rate and blood pressure. A graded cool-down phase precludes post-exertional ischemia, arrhythmia, or

hypotension, which can occur within 5–30 min of exercise cessation. The cool-down phase basically should be a reverse of the warm-up phase. All patients should be supervised for a minimum of 15 min after the cool-down phase [14].
