Exercise Physiology for Cardiovascular Disease
After a stent, a bypass, a first heart failure diagnosis or a blood pressure reading your GP wasn't happy with, someone will tell you to exercise more. Cardiovascular disease treatment and exercise physiology meet at that point: turning "do some exercise" into a specific weekly plan with intensities, durations and progressions that account for your medications, your symptoms and what you can actually fit into a week in Five Dock.
An accredited exercise physiologist (AEP) is a university-trained allied health professional who prescribes exercise for people with chronic medical conditions. Cardiac and vascular conditions are a core part of that scope, usually working alongside your GP, cardiologist and hospital cardiac rehab team rather than instead of them.
Conditions this commonly suits
People referred for cardiovascular work usually come in with one or more of the following:
- Coronary artery disease, including after angioplasty, stent placement or coronary artery bypass grafting
- Chronic heart failure, with reduced or preserved ejection fraction
- Hypertension, often alongside high cholesterol and raised blood glucose
- Atrial fibrillation, including after ablation or cardioversion
- Peripheral arterial disease with claudication pain in the calves when walking
- Post-stroke deconditioning, where cardiovascular risk and mobility both need attention
Many of these sit alongside type 2 diabetes, osteoarthritis or chronic kidney disease. Programming has to respect all of it, not just the heart.
What the first assessment covers
The initial session runs about an hour and starts with history: what happened, when, what the cardiologist said, what your discharge summary or hospital cardiac rehab program included, and what you were doing physically before the event.
Measurements typically include resting heart rate and blood pressure, then blood pressure and heart rate response during and after activity. Functional testing depends on what you can manage. A six-minute walk test gives a distance and a symptom profile. A 30-second sit-to-stand test gives a leg strength baseline. For claudication, the useful number is how many metres you cover before calf pain starts and how long it takes to settle.
We also work through symptoms in detail. Chest tightness, breathlessness out of proportion to effort, light-headedness on standing, palpitations, ankle swelling and unusual fatigue all change how a program is written and what we watch for. The Borg rating of perceived exertion scale, 6 to 20, gets introduced here, because for anyone on rate-limiting medication it's more useful than a heart rate number.
How programs are usually built
Australian physical activity guidelines for adults set 150 to 300 minutes of moderate aerobic activity a week plus muscle strengthening on two days. That's the destination, not the starting point. If you're currently walking eight minutes before you need to sit down, the first month is about accumulating minutes in short bouts.
A typical structure has three parts. Aerobic work, often interval-style walking on the Bay Run or a stationary bike, progressed by time first and intensity second. Resistance training two to three days a week covering legs, hips, back, chest and grip, because losing leg strength is what ends up limiting walking distance in most people. Then the practical items: getting up from a low chair, carrying shopping from the car, managing stairs without holding the rail.
Exercise and Sports Science Australia's position statement on exercise for cardiovascular disease supports combining aerobic and resistance training rather than aerobic alone. Sessions are reviewed and adjusted based on how you respond, what your blood pressure does over a few weeks, and any changes your cardiologist makes.
Medications change the plan
Beta blockers such as metoprolol and bisoprolol blunt heart rate, so a target heart rate is often meaningless and perceived exertion does the job instead. Some antihypertensives increase the chance of a blood pressure drop after exercise, so cool-downs matter and standing up quickly from the floor is worth avoiding. Diuretics affect fluid balance on hot days. If you carry GTN spray, it comes to every session.
Bring a current medication list to the first appointment. If your cardiologist has set limits on exertion, sternal precautions after bypass surgery or a timeframe before resistance training resumes, bring that in writing.
Funding through Medicare and private health
If your GP manages your cardiovascular condition under a Chronic Condition Management plan, you may be eligible for Medicare-rebated allied health sessions, capped at five services per calendar year across all allied health providers combined. Your GP decides eligibility and how many of those services go to exercise physiology. A gap payment usually applies.
Private health extras cover exercise physiology on many policies. Check the item under "exercise physiology" rather than "physiotherapy", as they're separate. DVA referrals and some workers compensation and NDIS arrangements also fund sessions.
Home visits around Five Dock
Getting to a clinic isn't realistic for everyone early on, particularly after cardiac surgery or while driving restrictions apply. Home visits cover Five Dock, Drummoyne, Russell Lea, Abbotsford, Concord and the surrounding Inner West suburbs, and let us set up a program using your stairs, your chairs and your local footpaths.
When to stop and get advice
Stop exercising and contact your GP if you get chest pain or tightness, unusual breathlessness, dizziness, an irregular racing heartbeat at rest, or new swelling in both ankles. Chest pain that doesn't settle with rest or GTN, or comes with sweating, nausea or arm and jaw pain, is a 000 call.
If you'd like a program written around your diagnosis, medications and current capacity, you're welcome to book an initial assessment.