Adapting Exercise For Cardiac Clients With Multi-Morbidities Flashcards
What can impose greater constraints on exercise ability than cardiac status?
The ageing process for some individuals.
What additional clinical problems are reviewed for exercise adaptations?
- Obesity
- Hypertension
- Diabetes
- Intermittent claudication
- Osteoarthritis
- Rheumatoid arthritis
- Osteoporosis
- Pulmonary disease
What do BACPR instructors need to be familiar with regarding exercise prescription?
Guidelines for aerobic training, resistance training, and flexibility training.
For individuals at higher risk during exercise, what should be considered?
Lower training heart rate ranges.
Who may need higher training heart rate ranges?
Individuals at low risk of further events or those whose work is physically demanding.
What should be the upper limit of the training heart rate range for individuals with ongoing myocardial ischaemia?
10 bpm below the ischaemic threshold.
What should BACPR instructors do if there is no ECG ETT information?
Ensure that core rehabilitation personnel have stipulated a conservative heart rate range.
What indicates a potential change in angina status?
Any change in the established pattern of angina could indicate unstable angina.
What may clients who experience angina at very low levels of exertion (<3 METs) need?
Individual supervision.
What should be done if a client has a higher than usual pre-exercise systolic blood pressure?
Reduce the training heart rate for that particular session.
What tool may be appropriate for monitoring heart rate during exercise?
Heart rate monitors that offer alarms for upper and lower heart rate limits.
What type of exercise should be avoided for individuals with exertional ischaemia?
Isolated high-intensity upper body work.
What is the purpose of prophylactic use of glyceryl trinitrate (GTN) prior to exercise?
To prevent complications during exercise, but it should be cleared with the referring clinician.
What should BACPR instructors ensure regarding clients with chronic heart failure?
Clients are stable with no new signs or symptoms of fluid retention or worsening cardiac status.
What are signs of fluid retention that BACPR instructors should monitor?
- Increasing breathlessness
- Rapid weight gain
- Swollen ankles
- Pitting oedema
What pre-exercise heart rate should BACPR instructors ensure for clients with chronic heart failure?
Heart rate is < 100 bpm.
What type of training is usually better tolerated in clients with chronic heart failure?
Interval training.
How does cardiac output respond to increased work rate?
Cardiac output increases directly in proportion to the increase in work rate.
What may happen to heart rate in clients with chronic heart failure when stroke volume cannot increase?
Heart rate may rise rapidly to maintain cardiac output.
What is the most common cause of sudden cardiac death in individuals with chronic heart failure?
Ventricular arrhythmias.
What is more important for training duration in clients with chronic heart failure?
Extending the duration of training rather than the intensity.
What should be the approach when increasing the intensity of exercise for clients with chronic heart failure?
Introduce gradually and in small increments.
What is Atrial Fibrillation (AF) a part of in terms of cardiovascular disease management?
One of the three CVD ambitions along with blood pressure and cholesterol.
What types of medications are clients with AF likely to be on?
- Beta blockers
- Calcium channel blockers
- Digoxin
- Amiodarone
- Anticoagulation therapy (warfarin, rivaroxaban, dabigatran, apixaban)
What are the risks associated with rate-controlling medications in clients with AF?
They can reduce heart rate too much and cause hypotension and dizziness.
What should BACPR instructors be cautious about concerning anticoagulant therapy?
It can increase the risk of bleeding.
What may palpitations indicate in a client with AF?
The rate may not be well controlled.
What effect can uncontrolled irregular heart rate have during exercise?
It may drop blood pressure.
What is the recommended intensity of exercise for clients with AF?
Moderate intensity based on Rating of Perceived Exertion (RPE).
What is a limitation of heart rate monitors for clients with AF?
They will not work with an irregular rhythm.
How should manual pulses be taken in clients with AF?
For a full minute to ensure accuracy.
What principle applies to clients with AF just like to individuals in normal sinus rhythm?
The FITT principle.
What is happening to the number of patients receiving implanted permanent pacemakers or cardioverter defibrillators?
It is growing, along with the sophistication of the devices implanted.
What has been established regarding exercise training in cardiac patients?
Exercise training has been established in this group of cardiac patients.
Reference: Lampert et al., 2017
What type of pacemakers are most common?
Most pacemakers are rate responsive and detect the need to increase heart rate during exercise.
What should BACPR instructors obtain information about for clients with pacemakers?
Detailed information about the core rehabilitation (Phase lll) exercise prescription, especially the training heart rate range.
What should BACPR instructors do if a client shows signs of ischaemia?
Bring any signs or symptoms of ischaemia to the attention of the GP.
What is the purpose of implantable cardioverter defibrillators (ICDs)?
ICDs monitor heart rate and rhythm to determine if it is a normal acceleration or requires pacing or shock.
What is important for BACPR instructors to know about ICD therapy settings?
Information about anti-tachycardia pacing or shocks.
What is the recommended heart rate for clients with ICDs during exercise?
Clients should remain at least 10 bpm below the ICD therapy settings.
What is contraindicated if beta-blocker medication has not been taken?
Exercise is contraindicated.
What should be avoided during exercise for clients with pacemakers?
Excessive end-of-range shoulder movement and/or highly repetitive vigorous shoulder movements.
What sensation might someone feel if an ICD administers a shock?
A mild tingling sensation.
What should clients report regarding their devices?
Any incidents with their devices for review by a cardiac technician/electrophysiologist.
Why is an extended warm-up required for heart transplant patients?
The transplanted heart is no longer innervated by sympathetic and parasympathetic fibres.
What happens to heart rate at the onset of exercise for heart transplant patients?
Heart rate does not rise rapidly due to loss of sympathetic neurotransmitter effects.
What is the usual resting and pre-exercise heart rate for heart transplant patients?
90-100 bpm.
Why might myocardial ischaemia go undetected in heart transplant patients?
Denervation means there is an absence of anginal symptoms.
What common conditions may arise from immunosuppressive drug therapy in heart transplant patients?
Diabetes, hypertension, and lipid abnormalities.
What is the importance of resistance training for heart transplant patients?
It helps offset the loss in muscle mass and strength from prolonged inactivity.
What has led to a decline in mortality rates from coronary artery disease?
Improved diagnostic techniques, treatments, and management of risk factors.
Why are more elderly people benefiting from rehabilitation programs?
Patients are less likely to be excluded from programs based on age.
What should elderly people with heart disease be encouraged to achieve?
The same exercise prescription recommended to younger cardiac patients.
What limits the ability to exercise in individuals with cardiac disease?
procesS per se or deconditioning from low levels of habitual activity
Deconditioning can be as limiting as cardiac disease itself.
What is necessary for the development of safe and effective exercise prescriptions?
Knowledge of the effects of ageing on physiological function both at rest and during exercise.
At what age do men typically reach their peak height?
25-29 years
At what age do women typically reach their peak height?
16-29 years
What causes the faster decline in height for women compared to men?
Increased prevalence of osteoporosis in women, depressing the vertebrae.
What contributes to the loss of height with increasing age?
Increasing compression of the cartilaginous discs between the vertebrae.
What trend is observed in weight and body composition from late middle age?
Men’s weight declines and women’s stabilizes while lean body mass decreases and body fat increases.
What percentage of total lean body mass do sedentary individuals lose between the ages of 40 and 80?
Men: approximately 20%, Women: approximately 10%
How does the loss of lean body mass affect older individuals?
Affects capacity to perform work and basic activities of daily living.
What happens to total body water with ageing?
It decreases.
What are older adults less able to do due to increased body fat percentage?
Stabilize their body temperature in extremes of environmental temperature.
What type of training can partially offset the loss of lean body mass associated with ageing?
Regular physical activity including both endurance and strength training.
What types of endurance training are recommended for older individuals?
Walking, stationary cycling, swimming with an emphasis on longer duration and moderate intensity.
What precautions should elderly individuals take when performing physical activity in extreme weather?
Encourage regular intake of water in hot and humid conditions.
What starts to exceed the rate of bone formation from the mid-thirties onwards?
Rate of bone reabsorption.
What is the average rate of bone loss in women compared to men?
Women: about 1% per year, Men: about 0.5% per year.
What are the three main factors influencing bone loss?
- Withdrawal of oestrogen at menopause
- Deficiency in calcium intake
- Decreased physical activity levels
What types of activities should be encouraged for older adults to prevent bone loss?
Weight-bearing activities that involve some impact but exclude high-impact activities.
What specific activities should middle-aged women be encouraged to perform?
Stepping, stair climbing, fast walking (especially on uneven terrain).
What type of work should elderly women perform, considering orthopaedic limitations?
Brisk walking, stair climbing, and stepping.
What type of training conserves bone mineral density?
Strength training.
What are the most vulnerable sites targeted for hip flexors and extensors, back extensors and the wrist?
spine, femur, and bones of the wrist
What factors can lead to deterioration in cardiovascular and pulmonary function?
disease, inactivity, or the ageing process
How does aerobic exercise impact older athletes regarding age-related deterioration?
Minimises age-related deterioration
What is the average decline in maximal aerobic capacity per decade?
10%
What happens to systolic and diastolic blood pressure with age?
Both increase, with systolic increasing more than diastolic
What is the formula for predicting maximal heart rate?
220 minus age (years)
What is the average decline in maximal heart rate per decade?
10 bpm
What is maximal cardiac output (CO) calculated as?
CO = HR x SV
What factors contribute to the decrease in stroke volume with age?
- Reduction in preload
- Increase in afterload
- Reduced myocardial contractility
Does resting heart rate change significantly with age?
No
What age-related change occurs in pulmonary function?
Loss of elasticity in lung tissues and chest wall
How does the elderly person typically increase ventilation during exertion?
By increasing the rate of breathing
What is the FITT principle in the context of exercise for older populations?
Frequency, Intensity, Time, Type
How should training intensity be approached for older adults?
Initially at the lower end of the normal prescription range
What is the typical age range during which maximum strength is achieved?
20 to 30 years
What is the approximate strength decline rate in individuals moving into their sixties?
10-15% per decade
What percentage of men aged 65 to 74 years cannot lift 50% of their body weight?
30%
What percentage of women aged 65 to 74 years cannot lift 50% of their body weight?
50%
Which muscle groups experience greater strength losses with age?
Lower extremities more than upper extremities
What is a significant consequence of age-related loss of strength?
Decreased quality of life and independence
What specific problem can result from weakness in pelvic floor muscles?
Urinary stress incontinence
What is the primary reason for age-related loss in muscle strength?
Substantial loss of muscle mass
What is the general trend in muscle fiber composition with advancing age?
There is a shift towards a higher percentage of slow-twitch fibres.
How can the muscular strength of older people be improved?
Through a training programme of specific resistance exercises.
What range of improvements in muscular strength has been observed in older adults following resistance training?
Improvements ranging between 1.9% and 72%.
What are the implications of improving strength in older adults?
Reduction in falls and accidents and retaining independence.
What changes occur in connective tissues as individuals age?
Fascia, ligaments, and tendons become less extensible.
What effect do gait abnormalities have on physical activity in older adults?
They can increase the metabolic cost of physical activity by as much as 50%.
What does the FITT principle stand for in exercise programming?
Frequency, Intensity, Time, Type.
What exercise recommendations does the American College of Sports Medicine provide for individuals aged 65 and older?
- 8-10 exercises using all major muscle groups
- Beginners: 1 set at a load allowing 10-15 repetitions (40-50% 1-RM)
- Progress to 1-3 sets of 8-12 repetitions (60-80% 1-RM)
- 2 times per week.
Why are elderly individuals more vulnerable to fatigue during exercise?
They use a relatively high proportion of available muscle mass.
What types of exercises should be avoided for elderly individuals regarding urinary incontinence?
Exercises that could aggravate stress urinary incontinence.
What breathing technique should be encouraged during exercise?
Breathing out with the effort.
What is the Valsalva manoeuvre?
Forced exhalation against a closed epiglottis, which raises blood pressure.
Why is flexibility training important for older adults?
To maintain joint range.
How does aging affect an individual’s motor skills?
Deterioration in balance, reaction times, and motor coordination.
What is the estimated fall rate for individuals over the age of 65?
Between one-third and one-half will fall at least once per year.
What are the consequences of falling for elderly individuals?
- Fractures
- Hospitalization
- Loss of independence
- Fatalities.
What should be emphasized regarding posture during exercise for older adults?
Good posture and alignment at all times.
What type of movements should be avoided to ensure safety during exercise?
Rapid changes in direction or crossing the legs over.
What is important to provide when introducing movements that demand balance?
A source of support for those who may need it.
How do hearing and eyesight typically change with age?
They tend to deteriorate.
What may impaired hearing or vision lead to in older adults?
Anxiety and lack of confidence.
What is the most effective means of communicating instructions?
Visual demonstration combined with verbal explanation
This approach is particularly effective for individuals and groups.
What should be minimized during exercise instructions?
Outside noise
If music is used, it should not drown out the instructor’s voice.
What environmental conditions are emphasized for exercise areas?
Well-lit, free of unnecessary equipment, and personal belongings
The instructor should be easily visible to participants and vice versa.
What should written handouts or exercise cards ensure?
They are easy to read and diagrams are clear
This is important for effective communication.
What emotional and social issues may older adults face regarding exercise?
Reduction in self-confidence and self-esteem
These issues can be exacerbated by health problems and societal views on aging.
What impact can health problems have on older adults’ body image?
Difficulties in maintaining a positive body image and self-efficacy
This is particularly challenging for those who have not participated in structured exercise programs.
What clothing should be encouraged for exercise?
Comfortable and familiar clothing that allows freedom of movement
Clothing should also be effective for heat dissipation.
How should instructors dress for exercise sessions?
Appropriately for the age group under their supervision
This promotes a comfortable environment for participants.
What type of atmosphere should be created in group exercise sessions?
Social, welcoming, relaxed, and non-threatening
This encourages participation and interaction.
What should instructors provide to participants during exercise?
Encouragement and recognition of genuine improvement
Instructors should avoid condescension.
What psychological burdens do individuals with obesity often face?
Social isolation, low self-esteem, depressive cycles, and binge eating
These factors are important to consider in exercise program development.
What is the definition of body mass?
An index of body fatness, based on weight for height
This is crucial for assessing health risks.
List the health risks individuals with obesity are predisposed to.
- Type 2 diabetes mellitus
- Hypertension
- Stroke
- Hyperlipidaemia and low HDL-C
- Osteoarthritis
These risks are particularly significant for those with coronary artery disease.
True or False: Older adults generally maintain a positive body image easily.
False
Age-related physical changes are often viewed negatively by society.
Fill in the blank: The current population of older adults may not have taken part in structured exercise programs since their _______.
schooldays
This highlights a gap in experience that can affect confidence.
What is the most effective means of communicating with individuals and groups during exercise instruction?
Visual demonstration combined with verbal explanation
What should be minimized during exercise sessions to enhance communication?
Outside noise
If music is used during exercise instruction, what should it not do?
Drown out the instructor’s voice
What environment is recommended for exercise sessions?
Well-lit area free of unnecessary equipment and personal belongings
What should be ensured if written handouts or exercise cards are used?
They are easy to read and diagrams are clear
What emotional issues may older adults face that can influence their exercise performance?
Reduction in self-confidence and self-esteem
How does society generally view age-related physical changes?
Negatively
What specific concerns may women have in group exercise situations?
How they look and about appearing foolish or clumsy
What type of clothing should be encouraged for exercise participants?
Comfortable and familiar clothing that allows freedom of movement
How should instructors dress for exercise sessions?
Appropriately for the age group under their supervision
What type of atmosphere should be provided in group exercise sessions?
Social, welcoming, relaxed, and non-threatening
What should instructors encourage to foster group interaction?
Group interaction and involvement of partners and spouses
What psychological challenges do individuals with obesity often face?
Social isolation, low self-esteem, depressive cycles, and binge eating
What is body mass an index of?
Body fatness based on weight for height
What are the health risks that individuals with obesity are predisposed to? (List 3)
- Type 2 diabetes mellitus
- Hypertension
- Stroke
How does obesity affect the risk of osteoarthritis?
Individuals with obesity are more likely to suffer from it
What is a common psychological burden faced by individuals with obesity?
Low self-esteem
Fill in the blank: Individuals with obesity may suffer from _______ cycles.
depressive
True or False: The current population of older adults may not have participated in structured exercise programmes since their schooldays.
True
What is the BMI range for underweight individuals?
< 18.5
What BMI range is considered normal?
18.5-24.9
What BMI range indicates overweight?
25-29.9
What BMI range is classified as Class I obesity?
30-34.9
What BMI range is classified as Class II obesity?
35-39.9
What BMI is classified as Class III obesity?
> 40
What type of exercise is recommended for cardiac clients with multimorbidities?
Aerobic exercise but exclude high-impact exercises
What is the recommended aerobic exercise for individuals with obesity?
Walking and cycling
Why might swimming be a disincentive for some individuals with obesity?
Swimwear may be a disincentive
What is the recommended frequency of exercise for cardiac clients with obesity?
Daily
What is the recommended duration of moderate intensity physical activity per week?
150 minutes progressing to 250-300 minutes
What intensity range is recommended for physical activity (HRR RPE)?
40-60% HRR RPE 11-13
What is the rationale behind more frequent activity for individuals with obesity?
Compensates for lower intensity
What is the impact of resistance training on individuals with obesity compared to diet alone?
Does not minimize loss of fat-free mass or resting energy expenditure compared with diet alone
What is the risk of co-morbidities associated with a BMI < 18.5?
Low (but risk of other clinical problems increased)
Fill in the blank: The classification of obesity includes Underweight, Normal, Overweight, _______.
Obese
What is the classification for individuals with a BMI of 30-34.9?
Class I obesity
What is the classification for individuals with a BMI of 35-39.9?
Class II obesity
What is the classification for individuals with a BMI > 40?
Class III obesity
True or False: Individuals with obesity benefit from resistance training in the same way as healthy adults.
True
How many kilocalories does a person weighing 100 kg expend by walking 1 mile?
Approximately 150 kilocalories
50 kilocalories are accounted for by basal metabolic rate.
What is the ACSM’s recommended overall additional weekly energy expenditure?
2,000 kcal per week
How many miles per week would a person need to walk to meet the ACSM’s recommendation?
35 miles per week
How many kilocalories are equivalent to 1 lb of fat?
3,500 kcal
What is the initial weight loss percentage recommended for clients living with obesity?
3-5% of their total bodyweight
What are the clinical benefits associated with an initial weight loss of 3-5%?
- Reductions in blood pressure
- Reductions in blood glucose
- Improvements in lipid profiles
What is the combined effect of weight loss drugs, healthy eating, and exercise?
Reduces total bodyweight by 10-15%
What type of exercise is considered first-line therapy in clients with hypertension?
Aerobic training
List some beneficial aerobic activities for clients with hypertension.
- Walking
- Swimming
- Cycling
- Jogging
- Dancing
- Gardening
What is considered second-line exercise therapy in clients with hypertension?
Resistance training
What are the recommended frequency and intensity for exercise in clients with hypertension?
F: 3-7 times per week, I: 40-60% HRR, RPE 11-13
What health risks are hypertensive individuals predisposed to?
- Stroke
- Peripheral vascular disease
- Heart failure
- Kidney failure
What is the resting SBP threshold for when individuals should not exercise?
> 180 mmHg
What is the resting DBP threshold for when individuals should not exercise?
> 100 mmHg
What common condition can occur due to medication in hypertensive individuals?
Postural hypotension
What should be avoided during exercise to prevent raising blood pressure significantly?
The Valsalva manoeuvre
What type of training has recent guidelines from the ESC recommended for reducing blood pressure?
Isometric resistance training
What should be emphasized during cardiac rehab classes instead of isometric training?
Functional dynamic resistance exercises
What is the recommended duration for exercise sessions in clients with hypertension?
20-45 minutes per session
What is the total recommended exercise duration per week for clients with hypertension?
150-300 minutes per week
Why is more frequent activity beneficial for clients with hypertension?
Compensates for lower intensity and increases overall time spent in a relative ‘hypotensive’ state
What is important for activities of daily living in clients with hypertension?
Higher repetitions with low-to-moderate resistance
What are the two main types of diabetes mellitus (DM)?
Type 1 DM (T1DM) and Type 2 DM (T2DM)
T1DM is caused by total or near total destruction of insulin-secreting beta cells, while T2DM is characterized by insulin resistance.
What is the cause of Type 1 Diabetes Mellitus (T1DM)?
Total or near total destruction of insulin-secreting beta cells in the pancreas
This results in lost insulin production, requiring regular injections.
What characterizes Type 2 Diabetes Mellitus (T2DM)?
Insulin resistance
Insulin is produced but becomes less effective at promoting glucose entry into cells.
What are common risk factors for developing Type 2 Diabetes Mellitus (T2DM)?
- Overweight and obesity
- Inactivity
- Ethnicity
- Family history
These factors contribute to the multifactorial nature of T2DM.
What types of exercise are recommended for clients with diabetes? List them.
- Aerobic exercise
- Resistance training
- Motor skills training
Motor skills training includes movements that challenge balance.
How often should exercise be performed according to BACPR guidelines for diabetes clients?
4-5 times per week
This frequency is recommended to improve glycaemic control.
What additional health risks are people with diabetes predisposed to?
- Musculoskeletal conditions
- Kidney disease
- Peripheral arterial disease
- Retinopathy
- Peripheral neuropathy
- Autonomic neuropathy
These conditions can complicate diabetes management.
What percentage of cardiac rehabilitation participants have diabetes?
More than 25%
Over 90% of these participants are living with Type 2 diabetes.
What type of diabetes has the greatest risk of exercise-related dysglycaemia?
Type 1 Diabetes Mellitus (T1DM)
Participants with T1DM require the greatest level of individualized management.
What is the aim for weekly activity in kcal for individuals with diabetes?
A minimum of 1000 kcal
This goal supports glycaemic control and overall health.
What effect does a single bout of exercise have on blood glucose levels?
The effect lasts less than 72 hours
This necessitates frequent and regular exercise.
What are the two levels of risk for participants with Type 2 Diabetes Mellitus (T2DM) on insulin or insulin secretory medications?
They warrant moderate to similar levels of observation as those with Type 1 Diabetes Mellitus (T1DM)
This includes those on sulphonylureas and meglitinides.
What is the monitoring recommendation for individuals requiring capillary blood glucose (CBG) monitoring?
They should learn their own responses to exercise/physical activity
This helps identify and prevent potential issues.
What is required for individuals with T1DM before and after exercise?
They need to test their CBG pre/post and mid exercise session if exercise duration is 230 minutes.
What increases the likelihood of hypo-/hyper-glycaemia in T1DM?
Exercise.
For individuals with T2DM prescribed insulin secretagogues, when should CBG testing occur?
Pre/post exercise and, if necessary, mid exercise session.
How long can the increase in insulin sensitivity last after exercise?
Up to 72 hours.
What should individuals at risk of hypoglycaemia do post-exercise?
Monitor their CBG more closely.
When is exercise contraindicated for cardiac rehabilitation participants with DM?
When one of the following states persists:
* Recent history of brittle/uncontrolled glycaemic control
* Low glucose level (<5 mmol/L) not reversed by nutrition in <30 min
* CBGs <4 mmol/L
* Severe hypoglycaemic episode in the last 24 hrs
* Hyperglycaemia >15 mmol/L with ketones present >1.5 mmol/L.
What are the criteria for participants with T2DM not on insulin regarding hyperglycaemia?
Hyperglycaemia is >17 mmol/L with ketones present >1.5 mmol/L.
Where should insulin be injected if administered just before activity?
Into the abdomen or upper buttock.
What is the relationship between age and hypoglycaemia risk?
Increased age is associated with greater risk of hypoglycaemia.
Does exercise typically improve glycaemic control in T1DM?
No, it does not typically improve glycaemic control substantively.
What are common symptoms of hypoglycaemic episodes?
Feeling shaky, weak, confused, anxious, sweaty, aggressive, dazed, and less coordinated movements.
What should be established during exercise induction for individuals living with DM?
Their characteristic response to low blood glucose levels.
What strategies can prevent hyperglycaemia or hypoglycaemia?
Lighter intensity aerobic activity, perform aerobic exercise before strength activities, nutritional supplements for low glucose levels, and treat hypoglycaemia with rapid acting carbohydrates.
What is the recommended carbohydrate intake for those in a lower glycaemic state (<5.0 mmol/L) before exercise?
15 to 30 g of simple carbohydrates 30 minutes pre-exercise plus 25 to 30 g for every additional 30 minutes of activity.
What should be done if hypoglycaemia occurs during exercise?
Treat with 15 to 30 g of rapid acting carbohydrate and resume exercise once glucose levels rise >5.0 mmol/L.
How does the time of day influence glycaemic regulation in DM?
Morning exercise is recommended for those at risk of post-exercise hypoglycaemic events, and afternoon/evening exercise is preferable for those prone to hyperglycaemia.
What should be monitored for individuals new to exercise or increasing intensity or duration?
CBG levels should be checked every 30 minutes during exercise.
How many grams of extra carbohydrate are generally required for 1 hour of moderate-intensity exercise?
About 15 grams.
When should exercise be avoided in relation to insulin?
During the peak action of insulin.
What is cardiac autonomic neuropathy (CAN)?
A condition more prevalent in those with a longer history of diabetes that may lead to abnormal heart rate and blood pressure responses.
CAN can affect exercise tolerance and cardiovascular responses.
What should clients with peripheral neuropathy do before and after exercise?
Check their feet to monitor for blisters due to lack of sensation.
This is crucial as neuropathy may prevent awareness of foot injuries.
What issue may arise for clients with decreased proprioception in their hands?
They may be unable to grip equipment properly, such as dumbbells.
This can affect their ability to perform resistance training safely.
How does diabetes affect heart rate response in clients prescribed beta-blockers during exercise?
Diabetes attenuates the heart-rate response to exertion and oxygen uptake responses.
This means that clients with diabetes may experience a further reduction in heart rate responsiveness compared to those without diabetes.
What types of aerobic exercises are recommended?
Weight-bearing and non-weight-bearing exercises, such as:
* Walking
* Stepping
* Stair climbing
* Cycling
* Swimming
Both types of exercise are important for cardiovascular health.
What should be the focus of resistance training for cardiac clients with multimorbidities?
Work the larger muscle groups, with a focus on the lower limbs if time is limited.
This helps to improve overall strength and functional capacity.
What is the recommended approach for weight-bearing exercise in patients with intermittent claudication?
Undertake weight-bearing exercise for as long as leg pain can be tolerated, aiming for Grade 3 pain on the pain scale.
After reaching this pain level, clients should rest or switch to non-weight-bearing activities.
What lifestyle management strategies have been shown to improve symptoms of claudication?
Smoking cessation and exercise.
These strategies are vital for managing Peripheral Arterial Disease (PAD).
What are the potential benefits of weight-bearing activities for patients with PAD?
- Increase peripheral blood flow
- Improve oxygen delivery via reduced blood viscosity
- Enhance capillarisation
- Improve oxygen extraction
- Change gait efficiency
These benefits can lead to better exercise performance and reduced symptoms.
What should clients do once the pain from intermittent claudication alleviates during exercise?
Resume the period of exercise.
This is crucial for building endurance and improving symptoms over time.
True or False: Resistance training is the sole training mode recommended for patients with intermittent claudication.
False.
Resistance training only modestly improves walking distance and should not be the only focus.
Fill in the blank: Patients with intermittent claudication are often advised to walk through their _______.
pain.
However, this does not guarantee that the pain will ease.
What happens to pain with extended duration or increased activity in patients?
The pain increases with extended duration or increased activity.
What is the recommended pain tolerance goal for patients during exercise?
Aim at Grade 3 on the pain scale.
Name two peripheral vasodilators that may be prescribed for patients.
- Pentoxifylline
- Naftidrofuryl oxalate
What are some side effects relevant to exercise for patients taking peripheral vasodilators?
- Tachycardia
- Angina
- Hypotension
How can cold weather affect a client’s symptoms?
Cold weather may worsen a client’s symptoms.
What should be increased due to cold weather when exercising?
A longer warm-up may be needed.
What condition leads to reduced blood flow to the legs, increasing the risk of ulcers or gangrene?
Intermittent claudication.
What role does the exercise instructor play for patients?
Provide exercise guidance, reassurance, and motivation.
What factors may affect compliance in exercise programs for patients?
- Monotonous nature of exercises
- Fear of onset of pain
What strategies may improve compliance in exercise programs?
- Use of peer support
- Music
- Interspersing weight-bearing and non-weight-bearing exercise modes
What is osteoarthritis?
The most common type of arthritis, a degenerative joint disease characterized by progressive loss of joint cartilage.
What percentage of people over 75 are affected by osteoarthritis?
At least some joints in 95% of people.
What joints are most commonly affected by osteoarthritis?
- Hips
- Knees
- Finger joints
- Toe joints
- Cervical facet joints
- Lumbar facet joints
What has been recognized about inactivity in patients with osteoarthritis?
Inactivity leads to loss of muscle strength, joint stability, and functional capacity.
What are the therapeutic effects of exercise for osteoarthritis patients?
Significant improvements in both pain and function.
What are the goals of an exercise program for individuals with osteoarthritis?
- Improve/preserve range of motion
- Increase muscle strength
- Improve aerobic fitness
- Maintain good joint protection
What is rheumatoid arthritis?
A chronic inflammatory disease where the body attacks its own tissues, particularly the synovial membrane and cartilage of peripheral joints.
Who is most commonly affected by rheumatoid arthritis?
Young and middle-aged women.
What effects does rheumatoid arthritis have on the body?
Inflamed, thickened synovial membrane, warmth, redness, swelling, and pain.
What happens to cartilage and bone as rheumatoid arthritis progresses?
They may be destroyed, leading to pain and deformities.
What traditional advice was given to rheumatoid arthritis patients regarding exercise?
To rest and avoid exercise.
What has recent research shown about exercise and rheumatoid arthritis?
Exercise does not exacerbate the disease process and can improve aerobic capacity, muscle strength, and joint mobility.
What physical capabilities are often reduced in rheumatoid arthritis patients compared to the healthy population?
- Joint flexibility
- Muscle strength
- Endurance
- Aerobic capacity
What type of aerobic exercise is recommended for cardiac clients with multimorbidities?
Low impact activities such as swimming, aqua aerobics, walking, cycling, or low impact aerobics.
High impact activities should be avoided, especially for individuals with joint stability issues.
What should be avoided in deconditioned individuals regarding aerobic exercise?
Long continuous bouts of aerobic exercise.
This is to prevent excessive fatigue and promote safety.
What are the key components of resistance training for cardiac clients?
Working the larger muscle groups using machines, free weights, resistance bands, tubing, and body weight.
Resistance training helps to improve strength and functionality.
What does the FIT principle stand for in flexibility training?
Frequency, Intensity, Time.
This principle guides the structuring of flexibility workouts.
What is the recommended frequency for flexibility training?
Daily.
Consistent flexibility training helps maintain range of motion.
What is the intensity range for aerobic exercise according to the FIT principle?
40-60% HRR, RPE 11-13.
Progression should be to 60% HRR, RPE > 13.
How many minutes per week of moderate intensity activity are recommended?
150 minutes per week.
Alternatively, 75 minutes per week of vigorous physical activity is also acceptable.
What is the recommended initial intensity for resistance training?
50-60% 1RM.
This can be progressed to 60-80% 1RM.
How many sets and repetitions are recommended for resistance training?
1-3 sets of 8-12 repetitions.
This structure is effective for strength building.
What are the benefits of aerobic exercise for cardiac clients?
Improves weight control, lessens disability, improves sense of well-being, increases joint stability.
These benefits contribute to overall health and functionality.
True or False: Muscle weakness does not affect joint stability.
False.
Muscle weakness leads to reduced joint proprioception, which decreases stability.
What is the impact of improved balance in cardiac clients?
Reduces the risk of falls and fractures.
Improved balance is crucial for maintaining independence.
What does flexibility training aim to counteract in individuals with osteoarthritis?
Stiffness by counteracting the shortening of muscles, tendons, ligaments, and joint capsules.
This helps maintain mobility and reduces pain.
Fill in the blank: The recommended duration for holding static stretches is _______.
10-30 seconds.
This duration helps improve flexibility effectively.
How many repetitions are recommended for dynamic movements in flexibility training?
10 repetitions.
Dynamic movements are important for warming up and improving functional flexibility.
What should be the range of motion for strengthening exercises in the presence of pain?
Limited to the pain-free zone
Subsequent attempts should be made to extend the range of motion to prevent strength increases being limited to certain angles of movement.
What should be avoided during flare-ups of pain?
Strenuous exercise
Where appropriate, move joints through their full range of movement.
What can cause damage to inflamed or unstable joints?
Overstretching and hypermobility
These conditions must be avoided.
What is an indication that exercise intensity should be reduced?
Post-exercise discomfort persisting for more than one hour
Other indications include unusual or persistent fatigue, increased muscular weakness, decreased range of motion, and increased swelling of symptomatic joints.
What type of footwear should clients wear to maximize shock absorption?
Appropriate footwear
This is particularly important for clients with cardiac conditions and multimorbidities.
What is osteoporosis characterized by?
Reduction in bone strength and increased susceptibility to fractures
One in 3 women and 1 in 12 men over the age of 50 have osteoporosis.
What process maintains the skeleton?
Remodelling
This involves the balanced activity of osteoclasts, osteoblasts, and osteocytes.
What happens when the rate of resorption exceeds the rate of deposition in bones?
Osteoporosis results
The structure of the bone becomes fragile and liable to break easily.
Which bones are most commonly affected by fractures due to osteoporosis?
Wrist, spine, and hip
Osteoporosis usually affects the whole skeleton.
What is the estimated increase in bone mineral density from exercise in adults?
About 1%
This increase could result in a 10% decrease in fracture risk.
What are the three major issues that exercise programming should address for older adults?
Falls prevention, maintenance of bone mineral density, reduction in risk of chronic illnesses
This is crucial to counteract the effects of inactivity.
What is the principal cause of injury leading to death or hospitalization among individuals aged over 65?
Falls
The impact of a fall extends beyond immediate pain and suffering.
What percentage of fallers who fracture their hips are never functional walkers again?
Approximately half
One in five will die within six months after a hip fracture.
What type of exercise is recommended for individuals without vertebral fractures or multiple low-trauma fractures?
Moderate impact aerobic exercise such as brisk walking, stepping, jogging, skipping, Scottish dancing or Zumba.
For a cardiac circuit class or general aerobic training, what should be incorporated?
Brief bursts of moderate impact physical activity.
How many impacts should be targeted in a session for aerobic exercise?
50 impacts (e.g. 5 sets of 10 stamping, jogging, low level jumping, hopping).
What is the recommended weekly goal for aerobic exercise for those with vertebral fractures?
150 minutes per week at a level up to brisk walking.
What may be a barrier to performing impact exercise?
Urinary incontinence.
What should resistance training target for individuals at risk of fracture?
All major muscle groups to load skeletal sites such as the spine, proximal femur, and forearm.
List some exercises that can be performed in resistance training.
- Weighted lunges
- Hip abduction/adduction
- Knee extension/flexion
- Plantar-dorsiflexion
- Back extension
- Reverse fly
- Abdominal exercises
What types of equipment can be used for resistance training?
- Weight machines
- Free weights
- Resistance bands
- Bodyweight
What types of exercises should be avoided due to the risk of vertebral fractures?
Exercises involving end range, sustained, repeated or loaded flexion, and excessive or loaded twisting.
What is the FIT principle for aerobic exercise?
F: 3-5 days per week, I: 40-70% HRR, R: RPE 11-13, T: 20-30 minutes.
What is the minimum recommendation for daily physical activity?
Spread across the day, avoiding prolonged periods of sitting.
What is the FIT principle for resistance training?
F: 2-3 sessions per week, I: 8-12 RMs or 8 reps at 80-85% of 1RM, T: 2-3 sets.
What should be the starting intensity for resistance exercises?
Lower intensity to ensure good technique.
How should intensity and resistance be progressed in resistance training?
Increase resistance or reduce repetitions.
What are safe moving and lifting techniques that should be regularly practiced?
Hip hinges for safe bending.
What significant changes have been observed with supervised resistance exercise?
Great changes in bone mineral density.
What are some benefits of resistance training?
- Maintains bone mass
- Reduces myocardial work at rest and during submaximal activities
- Lessens disability in activities of daily living
What is the relationship between muscle strength in lower limbs and falls?
Decline in muscle strength is associated with increased incidence of falls.
How does improving muscle strength affect bone mass?
Helps to conserve bone mass.
What does muscle weakness lead to regarding joint proprioception?
Reduced joint proprioception and stability during activities requiring balance.
What is the outcome of improved balance in relation to falls?
Reduces the risk of falls and fractures.
What is the primary goal of flexibility exercises?
To counteract static stretches and shorten muscles, especially pectorals
Flexibility exercises help improve range of motion and reduce muscle tightness.
What type of movement challenges static and dynamic balance?
Motor skills
Motor skills include activities that require coordination and balance.
How often should exercise be performed for cardiac clients with multimorbidities?
At least 3 times per week
Regular exercise is crucial for managing multiple health conditions.
What is the recommended duration and repetition for exercise in cardiac clients?
34 repetitions for 10-30 seconds
This duration helps in improving muscular endurance.
What should be prioritized in exercise programs for people living with osteoporosis?
Falls prevention
Falls prevention is critical to avoid injuries in individuals with osteoporosis.
What are the two general categories of pulmonary diseases?
Chronic obstructive pulmonary disease and restrictive pulmonary disease
These categories help in understanding different respiratory issues.
What distinguishes asthma from other chronic obstructive pulmonary diseases?
Asthma is episodic and reversible
Asthma has different triggers and responses compared to chronic obstructive pulmonary diseases.
What are common triggers for asthma attacks?
- Tree/grass pollen
- Cigarette smoke
- House dust mite
- Animal fur
- Dust
- Exercise
These triggers can provoke airway narrowing in asthmatic individuals.
What are the main symptoms of asthma?
- Shortness of breath
- Wheezing
- Cough
- Chest tightness
Symptoms typically worsen at night and during physical exertion.
What is a common misconception about the first symptom of chronic obstructive pulmonary disease?
A cough may be dismissed as a normal part of aging or a ‘smoker’s cough’
Early symptoms can be misinterpreted, delaying diagnosis.
What is the single most important risk factor for chronic obstructive pulmonary disease?
Cigarette smoking
Smoking accounts for six out of seven cases of COPD.
What happens to the airways in chronic obstructive pulmonary disease?
They become inflamed and thickened
This inflammation leads to reduced airflow and increased resistance.
What is a characteristic of restrictive lung disease?
Diminished lung volume
This condition can result from various disorders affecting the chest wall and respiratory muscles.
What can trigger acute flare-ups of symptoms in chronic obstructive pulmonary disease?
Viral or bacterial infections
These exacerbations may require hospital treatment in severe cases.
What is the primary focus of strength and balance exercises for individuals with osteoporosis?
To build confidence and stability
This helps in preventing falls and injuries.
What are restrictive lung disorders?
Conditions that affect the pleura, lung tissue, and include examples such as muscular dystrophy, ankylosing spondylitis, morbid obesity, fibrosis, and effusion.
Restrictive lung disorders are typically chronic and progressive.
What is a common breathing pattern adopted by patients with chronic restrictive lung disease?
Rapid, shallow breathing pattern.
This is an attempt to overcome the ‘stiffness’ of the lung.
What are common symptoms experienced by patients with chronic restrictive lung disease?
Shortness of breath on exertion and reduced exercise capacity.
Symptoms become evident at progressively lower levels of exertion.
How does exercise training benefit clients with chronic obstructive pulmonary disease?
Improves exercise tolerance, reduces breathlessness and fatigue.
Exercise training should be part of a general approach to improving lifestyle and rehabilitation.
What types of exercise are recommended for clients with pulmonary disease?
Aerobic exercise (walking, cycling, swimming) and resistance training.
These exercises derive direct benefits for patients.
What improvements have been reported in clients with chronic restrictive lung disease after exercise training?
Improved efficiency of breathing, improved oxygen transport, and reduced lactic acid build-up.
This reduces the stimulus to ventilation and consequently the work of breathing.
For clients with exercise-induced asthma, how do exercise recommendations differ from standard BACPR prescriptions?
They do not differ for those controlled by medication or with mild asthma.
The same principles apply for moderate asthma and restrictive lung disease.
Fill in the blank: The recommended frequency of exercise sessions for pulmonary disease clients is _____ sessions per week.
1-2 sessions 3-7 days per week.
What is the recommended duration of exercise for pulmonary disease clients?
20-30 minutes, with encouragement to increase to at least 30-40 minutes before progressing intensity.
Shorter sessions may be necessary.
What are the benefits of exercise according to BACPR guidelines?
- Increases VO2 peak and endurance
- Increases ventilatory threshold
- Decreases sensitivity to dyspnea
- Improves ability to perform activities of daily living
- Increases lean body mass, including respiratory muscles.
Muscles may be adversely affected due to corticosteroids and/or disuse atrophy.
True or False: The Rating of Perceived Exertion (RPE) refers only to overall perceived exertion.
False.
If individual sensations like breathlessness dominate, the Borg CR10 scale is used.
What do patients with severe lung disease do to assist their breathing?
They fix their shoulder girdle to allow accessory muscles to exert greater force on the rib cage during ventilatory effort.
What exercise equipment can assist patients with severe lung disease during exercise?
Handlebars on a bike.
What type of exercises should be avoided for patients with respiratory problems?
Exercises requiring major contribution from upper body musculature.
Which accessory muscles are involved in assisting breathing?
- Intercostals
- Scalenes
- Sternomastoids
What are common side effects of prolonged use of corticosteroids?
- Loss of bone density
- Thinning of skin
- Weight gain
What precaution should be taken when using equipment with patients on long-term steroids?
Care should be taken not to damage the skin.
What condition may patients on long-term steroids develop that increases fracture risk?
Osteoporosis.
What is a natural feeling clients may have about exercise?
Anxiety about undertaking exercise.
How much of total VO2 do healthy individuals use for respiration at rest?
Approximately 1-2%.
How much total VO2 do patients with chronic lung disease use for respiration at rest?
Up to 15%.
What is the VO2 utilization during moderate exercise for patients with chronic lung disease?
Up to 35-40%.
What should asthma sufferers do before exercise?
Take bronchodilator medication about 10 minutes before exercise.
What environmental condition should asthma sufferers avoid to prevent bronchoconstriction?
Extremes of temperature.
Which type of exercise may be particularly beneficial for asthma sufferers?
Swimming.
Why is swimming beneficial for asthma sufferers?
The warm, humid atmosphere is unlikely to provoke bronchoconstriction.
