and the British Association for Cardiac Rehabilitation
Supplementary statement on
Automated External Defibrillators (AEDs) and exercise
This supplementary statement clarifies aspects of the recommendations made in the joint statement on resuscitation training and facilities (BACR and the Resuscitation Council (UK), November 2008). The drive for the original statement came from inconsistencies in the management of cardiac patients taking part in community-based exercise programmes. This supplementary statement addresses issues raised by cardiac rehabilitation (CR) staff seeking clarification on training and equipment in Phase IV programmes.
It is well documented that the survival rate from out-of-hospital cardiac arrest is very low (<10%) and there is a clear need to improve the likelihood of survival from cardiac arrest wherever possible. Venues with no clear emergency procedures or equipment have the poorest outcomes in terms of survival from cardiac arrest. Prior to our statement there was no agreed best practice guidance on staff training and equipment requirements in relation to resuscitation. Practice ranged from advanced life support training for staff with emergency equipment and oxygen available at all exercise sessions (irrespective of risk classification) to the other extreme where patients with moderate-to-high risk were carrying out group exercise in remote venues with no emergency equipment or staff trained in resuscitation.
Strenuous exercise carries a degree of risk and the risk is much greater for patients with cardiovascular disease. Strenuous activity may be defined as physical exertion greater than 6 metabolic equivalents (METs) - less vigorous than jogging - but could be lower than this if a person has a low exercise capacity. For example, walking briskly at 3 mph (4 METs) could be considered strenuous for someone older than 65 years or for those who are unfit.
An area of uncertainty with the interpretation of this statement has been the requirement for a community-based exercise programme to have an AED and staff trained in its use. If a patient has completed Phase III rehabilitation, has shown stable haemodynamic response, can exercise regularly at an appropriate intensity without symptoms, and is in the low risk category (AHA, ACSM guidelines), an AED is not a requirement for community-based exercise. If, on the other hand, community-based exercise programmes are seeing patients that are in the moderate risk or high risk category, or have a poor haemodynamic response to exercise, then it would be best practice to have an AED in the location. Where this situation exists, the Phase IV programme would require at least one individual trained in the use of the device.
Where exercise sessions are running in remote settings with no immediate emergency response team or equipment it would be best practice to inform the local emergency service of the exercise venue (preferably in writing) so that they are aware of the programme and its location. There is no obligation for emergency services to do anything specific with the information but they have a duty to improve the outcome from cardiac arrest.
Independent exercise venues and exercise instructors who are exercising moderate to high risk people may benefit
(in terms of clinical support and funding) by having closer working relationships with their local CR programmes.
Patient groups (e.g. local cardiac support groups) or other charities are often very keen to support Phase IV
exercise classes in the local community and may be able to fund AEDs.