Prescription for physical activities in the hospital, home or world of work requires an evaluation of the whole person and his disease and an analysis of each activity and its physical and emotional requirements. The fitness of a patient recovering from an acute myocardial infarct varies with age, previous training, psyche and the disease process and should be related to the magnitude of the activities undertaken. The physician can approximate the caloric level of the patient's fitness from the type of life activities performed without distress. The functional classification of the New York Heart Association should be used because of its excellent correlation with physical fitness, ability to perform at various levels of energy expenditure and prognosis. The physiologic costs of activity should be assessed in terms of heart rate, caloric expenditure, cardiac output, electrocardiogram, blood pressure and heart work. Clinical tests (amplified Master's tests, Valsalva maneuver or Bruce's test) afford a good basis for evaluating circulatory function and fitness. The requirements of an activity should be considered in terms of kilogrammeters or foot pounds, environmental stresses, skills, dexterity and muscle groups required. The validity of work prescription can be tested by simple on-the-job measurements, such as blood pressure, recovery pulse and resting pulse rates during the working day and subjective reactions of the patient. When requirements of work and life activities, emotional and social pressures and mature clinical and laboratory evaluation are integrated, the physician has the information necessary for a comprehensive prescription for life activity. By prescription, and not proscription, the coronary patient is permitted to return to a life as full as his cardiovascular capabilities permit. This positive philosophy requires knowledge and application of ergonomics, physiology, vocational and social counseling, psychiatry and clinical medicine. It is hoped that physicians assume this comprehensive role in the treatment of patients with myocardial infarction.
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