The New Participant With a Cardiac History

The core judgment is that a physician clearance statement is not the same as a fitness assessment, and you cannot verify her current capacity. So:

1. Do not promise a 'beginner-safe' experience you cannot deliver in a class that is programmed as hard intervals. Be honest: tell her the class is interval-based and that she should expect to work at a lower intensity than the group.
2. Place her at the back or side, near the door, with a clear view of you - easier to monitor and to exit if needed.
3. Teach her the bike setup and the resistance knob first, and specifically how to reduce resistance fast. A new rider's biggest risk is being unable to disengage from a flywheel.
4. Use the heart rate monitor as a ceiling tool, not a target. Ask her what her doctor's guidance was; if she has no specific number, use a conservative talk-test ceiling (she should be able to speak in short sentences) rather than a calculated max-HR percentage, which is unreliable for someone on beta-blockers or with cardiac history.
5. Modify the workout for the whole room by offering a 'base' option in every interval - this is good instruction anyway and avoids singling her out.
6. Check in at the 15-minute mark with a quick visual and a thumbs-up signal.

Critically: if she reports chest pain, unusual shortness of breath, dizziness, or palpitations at any point, stop her, keep her seated and calm, and follow your emergency action plan - do not have her 'push through.'

This is a stop-the-class-for-her moment, not a coaching moment.

Sequence:

1. Stop her pedaling safely - have her reduce resistance gradually and stop, or if she is unstable, bring the flywheel to a controlled stop. Do not let her stand up abruptly.
2. Keep her seated, head neutral, and have her breathe slowly. Do not have her lie flat on the floor immediately if she is lightheaded - seated with support is safer until you know more.
3. Ask targeted questions: Is there chest pain or pressure? Radiating pain to arm or jaw? Shortness of breath at rest? Does she feel like she might faint? Did she eat and drink today? Is she on any medication that affects heart rate or blood pressure?
4. Delegate. Ask a regular participant to keep the class moving at low intensity or to fetch a colleague/phone. You must stay with her.
5. Escalate if red flags are present - chest pain, syncope, persistent palpitations, or breathlessness at rest means activate EMS per your facility's emergency action plan. 'Fluttery' plus lightheadedness in a post-stent participant is a red flag until proven otherwise; err toward calling.
6. Document what happened, what she reported, and what you did, and follow your facility's incident-report process.

The judgment being tested: lightheadedness alone might be dehydration or a sudden stop, but in a participant with known cardiac history and a report of palpitations, you do not coach through it and you do not send her home alone to 'see how she feels.'

You should not simply say 'sure, see you next week.' Use it as a programming and communication moment:

• Recommend she confirm with her cardiologist what intensity range and heart rate ceiling is appropriate, and ideally get that in writing. You are not qualified to set her cardiac parameters.
• Suggest a lower-intensity format first - a beginner or 'intro to cycling' session, or arriving 15 minutes early for a private bike-fit and technique walkthrough.
• Ask her to hydrate and eat appropriately before class and to tell you before class if she is not feeling well that day.
• Build the class so a base option exists in every interval, and use perceived exertion and the talk test as your primary intensity gauge rather than a percentage of estimated max HR.
• Keep a simple record of her attendance and any symptoms reported so patterns are visible.

The professional-responsibility point: informed consent to participate is an ongoing conversation, and your role is to create a safe environment and refer, not to diagnose or clear her yourself.