Advanced exercise RX and Symptom behavior

Question 1

What exercise parameters can we use to dose movement ?

Answer 1

ACSM guidelines
FITT principle
american heart association
Use of RPE, Borg, Reps in Reserve

Question 2

How can ACSM guidelines be used for?

Answer 2

ACSM is a framework for healthy people

Question 3

When can the FITT principle be used?

Answer 3

can be used as a general exercise guidance

- can be used for gait, transfers (sit> stand) or neuroMSK

Question 4

When can guidelines set out by the american heart association be used ?

Answer 4

improve cardio vascular health

rec’d to exercise 30 mins a day 5 days a week with mod- max intensity

Question 5

When would you implement the use of RPE, Borg, or reps in reserve ?

Answer 5

when we are dosing more intense exercise, we can use these scales

Question 6

What is the ACSM guideline for MT?

Answer 6

it varies

Question 7

What is the ACSM guideline for Strength? endurance ? power?

Answer 7

strength 8-12 reps (10-15 for middle-older aged adults)
endurance- 15-20
power 2-4

Question 8

What is the ACSM guideline for CV?

Answer 8

5 days/ week @ mod intensity
3days/wk @ vigourous
or combo
- < 10 mins for deconditioned individuals or broken up into 10 min intervals

Question 9

What is the ACSM guideline for flexibility?

Answer 9

10-30 second holds 2-3x/week
daily recomdation with up to 60 sec holds 2-4 reps
- this is for a healthy population
- 30-60 sec holds for older adults

Question 10

What is the ACSM guideline for Neuromoter?

Answer 10

unknown- 2-3days/ wk
PNF 3-6 second bouts of 20-75% contraction followed by assisted stretch

• nuero ed helps older adults with risks of falls

Question 11

Name the levels of the RPE scale with activities and effort rating

Answer 11

10= max effort ; out of breath and not able to talk
8- extremely difficult; can hardly talk
6- almost feels uncomfortable
5- hard; short sentences
3- moderate bking, running and can conversation
2- light job- easy talking
1- ADLs

Question 12

How are rps in reserve differnt from RPE ?

Answer 12

specific to resistance exercise and can be used for 1 RM test and see if the patient can do more
- used with higher level pts or athletes

Question 13

What is the scale used in reps in reserve

Answer 13

10 = max effort, cant do any more 
8= extremely difficult could do 2 more 
5-6= could do 4-6 more 
3-4= light effort, easy 
1-2 = very easy

Question 14

What is the patient presentation and response scale?

Answer 14

Using SINNS to dose exercise

• severity is realted to the impact of symptoms on life
• irritability related to the amount of activity + intensity of symptoms and item to ease
• Nature; working with a hypothesis or dx
• Stage subacute, acute, or chronic
• Stability improving, unchanged or worsening

Question 15

what are considerations for high irritability

Answer 15

Increased severity and irritability implies decreased reps, # of exercises, and MT grades.
- Focus on quality of movement and controlling pain

Question 16

what is considered high irritability

Answer 16

> 30-60 min to calm down

• disturbed sleep that is frequent and for a long duration
• normal ADLS cause high pain levels
• constant unrelenting pain

Question 17

What is considered low irritability and how should you dose exercise ?

Answer 17

Presentation: Symptoms resolve quickly and/or are provoked slowly, min pain with ADLs, Lower intensity of symps, short duration of symps

• use increased grades of MT, increased tolerance of ex means more exercises and variety can be introduced bc of low severity and irritability

Question 18

Can we modify symptoms, body mechanics and activity level with exercise ?

Answer 18

yes

Question 19

Shoudl we only consider SINNS with exercise Rx

Answer 19

no, consider agg factors

Question 20

How do we know Ex Rx is effective?

Answer 20

• educate on ex intention and link to the patient goal
• develop and talk about progression/ regression guidelines with pt
• HEP rx the RIGHT way

Question 21

what should be included in HEP Rx ?

Answer 21

• should match the session focus to max gains
  ideal number of exercises
• ideal # of Ex
  Shoudl change over time & maybe each visit to resolve impairments and progress STGs and LTGs

Question 22

What are hollistic considerations ?

Answer 22

• sleep
• stress level
• Breathing/ mindfullness
• Proper nutrition
• Social support

Question 23

complete the analogy: dosing movement is to __

Answer 23

changing lives

Question 24

How can we hold ourselves accountable in measuring effectiveness?

Answer 24

test- assess- retest model

Question 25

what are we re-testing in the test- retest model?

Answer 25

• objective measures: ROM, Strength, Asst level
• Subjective measures: NPRA, Sleep quality, ADL performance
• Observation measures: quality of ROM, gait and transfer asst or IND

Question 26

What are otehr measures we can use?

Answer 26

tolerance to activity
- time, distance, speed, quality

Fxn outcomes score change
- set goals based off this, insurance justification, can be a objective red flag if pt does not get better

Question 27

What should be on your check list for each TX?

Answer 27

• mini subjective exam
  chck fxn and objective asterisk
  encourage patient autonomy and responsibility at end of each visit
• note what will be worked on in future visits to keep working towards unmet goals

Question 28

What do you do if no change is being made ?

Answer 28

• reframe the pain experience
• redirect focus
• deliver hop and encouragement
• use words that heal and empower