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Clinical Exercise Prescription > Cardiac Exercise > Flashcards

Cardiac Exercise Flashcards

1
Q

What does cardiac rehab consist of?

A 
Exercise training
Counselling
Dietary advice
Medication/treatment advice
Risk factor modification
Social reintegration
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2
Q

What are the percentage reductions in mortality, cardiac mortality and hospital re admission for cardiac rehab?

A

13-26
26-46
23-56

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3
Q

What are the four stages of cardiac rehab and when are they?

A

Phase 1 - pre discharge - assess needs, make plan, give info and advise
Phase II - early post discharge - assess risk and needs, review plan, provide lifestyle advice and interventions
Phase III - same as above plus structured exercise sessions
Phase IV - long term maintenance - follow up, support groups, refer to specialists as needed

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4
Q

How much is peak VO2 reduced in CAD patients?

A

50%

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5
Q

What would a 1ml VO2 increase and 1 MET in fitness increase do for survival?

A

10% reduction in cardiac mortality

15%

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6
Q

Why is peak VO2 reduced in cardiac patients?

A

Cardiac output is decreased due to a decrease in stroke volume

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7
Q

At what intensity does stroke volume become reduced and why?

A

60%

TPR is increased as there is poorer sympathetic regulation and less NO thus increasing afterload

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8
Q

Why may HR increase be blunted?

A

Right coronary artery stenosis

Decreased SNS

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9
Q

Why can exercise cause coronary vasoconstriction and what are the consequences?

A

Reduced NO and increased endothelium

Less blood to myocardium causes heart to become hypokinetic

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10
Q

How is blood redistribution during exercise different in cardiac patients?

A

It is impaired to more goes to viscera and less to muscles

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11
Q

What are the exclusion criteria for cardiac rehab? (9)

A 
Unstable angina
>200/110 BP
>120bpm
ST depression at rest
Uncontrolled arrhythmia
Aortic stenosis
Febrile illness
Embolism
Congestive heart failure
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12
Q

What is the cardiac effect of aerobic training normally?

A

Increase stroke volume via an increase in contractility due to more calcium proteins
Increased LV volume - eccentric - myocyte elongation
Increased LV mass - concentric - more myocytes
Increase plasma volume by 10%

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13
Q

What is La Place’s law? How does this apply to the heart?

A

Tension = (pressure difference x radius) / wall thickness

If the hearts volume increases, so too must the thickness

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14
Q

What affects myocardial oxygen consumption?

A

Heart rate
Contractility
Tension development

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15
Q

What stimulates an increase in LV mass?

A

GH, IGF, cortisol, thyroxine, Noradrenaline, RAAS

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16
Q

How do IGF and thyroxine get produced and how do they work?

A

IGF is produced in response to stretch and increases the hearts sensitivity to Ca2+
TSH is produced in response to exercise which produces thyroxine which stimulates hypertrophy

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17
Q

How does mechanical stress cause the heart to grow?

A

Increased pressure causes hypertrophy

Increased volume causes lengthening

18
Q

Explain pathological hypertrophy

A

LV grows as a result of chronic overload (high BP) and greater preload
Reduced contractility and no Ca2+ sensitivity increased

19
Q

Why does contractility improve after aerobic training?

A 
Increased % shortening, quicker time to peak shortening and relaxing
More calcium binding sites
More NCX speeds up calcium removal
Greater calcium stores in SR
Increased sensitivity
20
Q

What are the overall changes a cardiovascular patient may expect to see after aerobic training?

A 
0-18% increase in SV due to increased blood volume, hypertrophy, contractility, ejection fraction
Reduced viscosity as less fibrinogen
More coronary collaterals and blood flow
May regress vascular stenosis
Less endothelial dysfunction
21
Q

How may myocardial hypertrophy differ in a cardiac patient compared to a normal adult?

A

May shorten the myocyte length to return it to a normal length and thus increase contractility

22
Q

How else does exercise improve cardiovascular health?

A 
Lower resting HR
Increase maximal SV
Reduced systolic BP response due to increased NO
Reduce myocardial demand
Increase A-VO2 difference
23
Q

How does exercise affect muscles in cardiac patients?

A 
Increased A-VO2 difference
More mitochondria and enzymes
More aerobic
Less blood flow as oxygen used more efficiently but higher maximum
Increased fibre recruitment
Low lactate concentration
24
Q

What are the percentage changes in VO2, exercise capacity and angina threshold after cardiac rehab?

A

10-50% mean 20%
18-35%
10-20%

25
Q

How is mortality affected by a 1000 calorie per week increase and decrease in exercise?

A

Reduced by 19%

Increased by 24%

26
Q

Why does the angina threshold increase?

A

In submax exercise there is lower Q and TPR, lowering systolic BP and a lower HR. This means the myocardial oxygen demand is lower

27
Q

What are the priorities for cardiac rehab in the first 48 hours?

A

Self care
Establish range of motion
Low resistance
Very minimal

28
Q

What are the priorities for cardiac rehab before discharge?

A

Establish safe activities

Exercise plan

29
Q

What are the broad benefits of cardiac rehab?

A

Physiological benefits
Increase self confidence
Decrease dependency

30
Q

For weeks 1-6 how far (miles) and how often (days per week) should people walk?

A 
1/4 - 4
1/2 - 4
3/4 - 4-5
3/4 - 4-5
1 - 5
1 - 5
31
Q

What are the rules for walking?

A 
Walk at a comfortable pace - RHR +20
Take GTN spray
Know chest pain rules
Flat route
Go with someone at first and let others know the route later
32
Q

For the Bruce exercise stress test what are the VO2 and MET requirements for the 6 stages

A 
15 and 3-4
20 and 5-7
35 and 7-9
45 and 9-11
55 and 11-13
70
33
Q

What are the MET values for: walking, cycling, dancing, gold, jogging, football, tennis and swimming?

A 
3-10
3-8
4-8
4-7
8-10
5-12
4-9
4-8
34
Q

What is the equation for predicting max HR with and without beta blockers?

A

B blocked: 203-(1.49*age)

252-(1.91*age)

35
Q

How much exercise should they do?

A

3 days a week 10-15 at the start up to 30-60 with 10 minutes of warm up and 10 of cool down
50% peak HR, HRR, 5 METs

36
Q

How much resistance training should be done?

A 
60% of 1RM
6-10 exercises
8-20 reps
2-3 days
Light
Alternate legs/arms and sit/stand
37
Q

How should aerobic and resistance training progress?

A

10% increase every 2 weeks
Duration then intensity
Reps then intensity

38
Q

What are the improvements from strength training?

A

20-30% increase in strength

Increased efficiency and VO2

39
Q

What are the advantages and disadvantages of water based exercise?

A

Less joint compression and good for overweight individuals

Increased BP, diuretic effect. Can cause arrhythmias and ST depression due to increased SNS

So be careful!!

40
Q

What should someone’s MET capacity be to do a white collar job?

A

7

41
Q

For what conditions is cardiac rehab indicated?

A 
Post MI
Pre/post CABG
Pre/post PTCA
Angina
Valve replacement

Clinical Exercise Prescription (12 decks)

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