Cardiac and Pulmonary Rehab

Question 1

During screening a direct accessibility patient, psychosocial or behavioral risk factors are ______ flags and underlying pathologies or biomedical risk factors are _____ flags. Unstable angina is an example of a _____ flag

Answer 1

yellow
red
red

Question 2

During the anamnesis it is important to find out the patient’s current _____ and _____. Then find out about patient’s ____ level beforehand, their overall ___ situation and then the specific _____ of the patient.

Answer 2

concerns
goals
activity
health
complaints

Question 3

When would you hypothesize dyspnea in a patient that changes with body position?
When would you expect to see swelling in the ankles and wrists?

Answer 3

During a left sided congestive heart failure when an edema forms in the lungs

during a right sided congestive heart failure when venous blood pools in the extremities

Question 4

When would you use the Borg scale?

Answer 4

To measure the patient’s perceived exertion level

Question 5

When would you use the 6-minute walk test?

Answer 5

To assess the patient’s aerobic and functional capacity

Question 6

The patient evaluation consists of ____ instruments followed by an analysis of what?

Answer 6

measurement

the current status
Co-morbidities (for example an infarct that is then followed by congestive heart failure)
Negative contextual factors (Is there a positive support that encourages positive change?)
Expectations
Attainability of goals
Improvement of health status

Question 7

When creating a treatment plan which two goals are of outmost importance?

The diagnosis must correlate what with what?

Answer 7

1. The patient must learn to find his/her own physical limit
2. Reducing fear of movement

It must correlate symptoms with objective disorders when considering the results of the aerobic capacity evaluation

Question 8

What are the 3 objectives that the treatment plan should cover?

Answer 8

1. Achieveing secondary prevention
2. Acquiring emotional balance
3. Learning to cope with heart disease in a functional manner

Question 9

What are the general effects of cardiac treatment?

Answer 9

Less angina pectoris
better psychological functioning
better social functioning
reduction of risk factors
more active lifestyle

Question 10

Name 5 effects of aerobic training

Answer 10

increases heart pump output volume
increases heart minute volume during maximum-intensity exercise
increases blood volume and hemoglobin level
increases artery-vein oxygen differential
lowers blood pressure
increases VO2-max
increases anaerobic threshold
increases maximum respiratory minute volume
increases ventilation
increases lung diffusion capacity
increases lung volume and capacity
Lowers heart rate

Question 11

Name 3 effects of strength training

Answer 11

functional hypertrophy
increased mitochondrial numbers (mitochondrial hypertrophy)
increased capillary circulation
increase in muscle enzymes
increased energy-rich phosphate level

Question 12

What is the type of treatment for cardiac patients? TIFT

Answer 12

Type= Aerobic (HIIT or endurance)
Intensity= 55-90% of HR-max (should be able to still have a conversation during this intensity)
Frequency= 3-5 times a week
Time= 20-60min

Question 13

Is HIIT or endurance training better for stable cardiac patients?
How do you apply it?

Answer 13

HIIT
an interval of high intensity followed by a shorter interval of low intensity training
intensity is determined by HR-max

Question 14

What would be the type of treatment for relaxation? TIFT

Answer 14

Type= progressive muscle relaxation or mindfulness (breathing)
Intensity= Low
Frequency= 3 times a day (high)
Time= 5-15 minutes

Question 15

How do you calculate exercise intensity?

Answer 15

First find the max heart rate:
220-age or 208-(0.7xage)
then find heart rate reserve:
Hrmax-HRrest=HRR
then calculate minimal required HR:
HRrest+40% of HRR
Then calculate threshold HR:
HRrest+75% of HRR

Question 16

What are the components of a re-evaluation?

Answer 16

1. Information= process and results
2. Advice= continue or terminate treatment
3. Aftercare= Maintaining healthy lifestyle

Question 17

What is the difference between arterial and venous vascular disease concerning the following: 
type of pain
presence of edema
presence of pulse
types of sores and their locations

Answer 17

arterial:
intermittent claudication pain
No edema
No pulse of very weak pulse
No drainage
round and smooth sores that are black usually on the toes and feet

Venous:
Dull, aching, pain
lower leg edema
pulse present 
drainage
sores with irregular borders that are yellow usually around the ankles

Question 18

What the steps of the diagnostic process

Answer 18

1. Anamnesis
2. Evaluation
3. Differential diagnosis
4. .co-morbidities
5. Indication for physiotherapy
6. Treatment plan

Question 19

When screening for intermittent claudication which symptoms are relevant?

Answer 19

intermittent muscle discomfort with exercise
patient experience fatigue, aching, cramping
discomfort is released by short-term rest
foot ulcers and limb pain

Question 20

How do you functionally assess for peripheral vascular disease using a treadmill?

Answer 20

patient walks on treadmill at a speed of 3.2km/hr with an increasing incline of 2% every 2 minutes up to a maximum of 10% for a duration of max 30 min

Question 21

What are possible differential diagnosis for intermittent claudication?

Answer 21

Spinal canal stenosis
diabetic neuropathies
osteoarthritis
chronic venous insufficiency
chronic compartment syndrome
Bakers cyst

Question 22

What are possible co-morbidities of intermittent claudication?

Answer 22

Diabetes mellitus
COPD
chronic heart failure
angina pectoris
CVA
Chronic arthritis
hip and knee joint complaints 
feet problems

Question 23

What is the classification used to diagnose severity of intermittent claudication?
What is stage 2b?

Answer 23

Fontaine

Intermittent claudication symptoms start at less than 200m of walking distance

Question 24

What are possible treatment goals?

Answer 24

Reduce limb symptoms
Improve exercise capacity
Prevent/lessen physical disability
Reduce the occurrence of cardiovascular events
Increase problem insight
Increase pain free walking distance
Increase pain tolerance
Overcome fear for exertion

Question 25

What are possible treatment tactics?

Answer 25

walking for at least 30 min under supervision for the first 4 weeks of treatment. Then patient walks by themselves 1-2 times a week.

Using a treadmill to induce a level 2 on the claudication rating scale (symptoms are present with slight discomfort) within 3-5 minutes.
Then taking an active rest until symptoms subside and continuing in this manner for at least 30 min

Question 26

What are some alternative treatment methods?

Answer 26

Brisk walking
strength training of lower extremities
stair climbing

Question 27

Describe the claudication scale

Answer 27

1- no pain
2- Discomfort
3- Mild pain
4- Moderate pain
5-severe pain

Question 28

What is orthopnea?
paroxysmal nocturnal dyspnea?
cheyne stokes?

Answer 28

orthopnea= trouble breathing when laying down
paroxysmal nocturnal dyspnea= Shortness of breath that awakens patient at night and is usually relieved when coming into a sitting position
Cheyne stokes= Abnormal breathing pattern where patient breaths progressively deeper sometimes very fast and then the breathing is slowed to the point of apnea

Question 29

Which muscles tend to be short with COPD?

Answer 29

Neck muscles (STM, scalenes)
pectoralis minor
sometimes shoulder muscles like levator scapulae

Question 30

What are the most common tests/measures used to assess COPD?

Answer 30

HR, BP, O2 saturation, shortness of breath.
Dyspnea, Borg Dyspnea scale, VAS
Height, weight, and lung volumes (peakflow measurement or spirometer)

Question 31

What do you observe/inspect with COPD?

Answer 31

Ventilation: inhalation and exhalation, observing use of accessory muscles, ratio, frequency and duration
Airway clearance
Thorax abnormalities (hoovers sign, barrel chest)
Cyanosis
Digital clubbing

Question 32

for a normal 6MWT result the patient must match at least____% of their predicted distance.
What do you do if they do not match it?

Answer 32

70

refer to specialist for CPET

Question 33

According to the KNGF flowchart, what is the first thing you must determine when evaluating a patient with COPD?

Answer 33

If they have had an exacerbation (severe inflammatory response) that required hospitalization if yes they require interdisciplinary pulmonary rehabilitation screening

Question 34

According to the KNGF flowchart when would the patient require a combined lifestyle intervention?

Answer 34

If they did not have an exacerbation or if they scored 70% or more of their predicted value on the 6MWT (physical capacity) and had 5000 steps/day or more on the physical evaluation

Question 35

According to the KNGF flowchart when does the patient require only primary therapeutic treatment (unless they are very vulnerable)?

Answer 35

1. If they have matched 70% or more of their predicted distance on the 6MTW, but had less than a 5000 steps/day score
2. If they did not match 70% of their predicted distance of the 6MWT, and had more, less, or exactly 5000 steps/day

Question 36

What is the general rehabilitation and exercise prescription for COPD?

What is the o2 saturation rule for setting the intensity?

What other factors can be used to set the intensity?

What should be the duration and frequency?

Answer 36

Aerobic exercise (HIIT) that can be walking, jogging, cycling, free weights
General strength training
ventilatory strength training
Active cycle of breathing techniques
Pursed lip breathing 
relaxation

If the O2 saturation drops 5% then it is too intense

%VO2max, target HR range, Borg,

20-30min, 3-5 times a week for endurance