Supervised training may target a higher heart rate (70% to 85% of age-predicted Additional restrictions apply when residual isch- emia is present. Daily walking can be encouraged soon after discharge for most patients. Resource publications on exer- cise prescription in cardiovascular patients are available.456,457 Regular physical activity reduces symptoms in patients with cardiovascular disease, enhances functional capacity, improves other risk factors such as insulin resistance and glucose con- trol, and is important in weight control.456 Questionnaires and nomograms for cardiac patients have been developed to guide exercise prescription if an exercise test is unavailable.459 462 See Section 6.4 and Table 10 for more information. 6.3.2. Patient Education: Recommendations Class I 1. Patients should be educated about appropriate cho- lesterol management, BP, smoking cessation, and life- (Level of Evidence: C) 2. Patients who have undergone PCI or CABG derive benefit from risk factor modification and should receive counseling that revascularization does not obviate the need for lifestyle changes.463 (Level of Evidence: C) Results of testing should be discussed with the patient, the patient s family, and/or the patient s advocate in an under- standable manner. Test results should be used to help deter- mine the advisability of coronary angiography, the need for adjustments in the medical regimen, and the specifics for sec- ondary prevention measures. See Section 6.4 and Table 10 for more information on plan of care. 6.3.3. Pneumococcal Pneumonia: Recommendation Class I 1. The pneumococcal vaccine is recommended for patients 65 years of age and older and in high-risk patients with cardiovascular disease.464 466 (Level of Evidence: B) Vaccination with the 23-valent pneumococcal polysaccha- ride vaccine is recommended for all adults 65 years of age. Adults of any age who are at increased risk, including smok- ers and those with asthma, should also be given the vaccine. 