Manager/Physiotherapist University of Ottawa Heart Institute Ottawa, Ontario, Canada
Background: Pericarditis, an inflammatory disorder of the pericardium, is a condition that is being increasingly seen by our Cardiovascular Rehabilitation (CR) program. Many of these patients are young and active, eager to return to their normal levels of physical activity (PA), making safe exercise progression a critical concern. CR programs, traditionally focused on secondary prevention for coronary artery disease, are adapting to include individuals recovering from peri/myocarditis, providing tailored exercise prescriptions, gradual reconditioning, and education to patients on how to self-monitor. Given the risk of recurrent symptoms and potential for lingering myocardial involvement, a multidisciplinary approach and standardized messaging involving cardiologists and the CR team is critical in optimizing patient outcomes.
METHODS AND RESULTS: The CR multidisciplinary team reached out to the Director of the Pericardial Care clinic to provide education on best practice for pericarditis patients. A key focus of the session was return-to-exercise guidance. The team reviewed key studies and expert consensus documents addressing physical activity in inflammatory pericardial disorders. The best available evidence was synthesized, with particular attention to inflammatory markers, symptom resolution, and imaging findings that inform safe return-to-exercise timelines. Given the absence of formal robust evidence-based guidelines for safe return to exercise for this patient population, we collaborated to develop a standardized table, based on existing evidence and including variables that our institution uses to prescribe exercise. The table provides guidance for 3 distinct stages and includes a timeline, recommended exercise intensity, duration, and conditions to be met to progress to the next stage. During Stage 1 or early recovery (2-4 weeks) very light activity is advised, building up from 5-10 minutes to 30 minutes. At Stage 2 (4 weeks to 3 months) when symptoms are resolved and C-reactive Protein, electrocardiogram and echocardiogram are normalized and the patients are tolerating light exercise for 30 minutes, intensity can be progressed to moderate, building from 30-60 minutes. Stage 3 (3 months from time of onset for pericarditis or 6 months when the myocardium is involved) graduates the patient to higher intensity, gradually returning to normal activities. Advice is provided with specific intensity and timeline indicators.
Conclusion: As there are currently no specific robust evidence-based guidelines in this patient population, our teams reviewed the existing literature and collaborated to develop an easy-to-use tool to help our centre’s Cardiologists and CR clinicians communicate safe return to exercise recommendations for peri/myocarditis patients.
