Cardiac rehabilitation

Question 1

Types of muscle fibers

Answer 1

• type 1 (slow)

- type 2 (fast)

Question 2

Causes of muscle fatigue

Answer 2

1) Metabolic byproducts
- with brief intense exercise pH falls (lactic acid)
2) Depletion of high energy stores (short term exercise)
3) Depletion of glycogen substrate (endurance)

Question 3

Where is lactate threshold

Answer 3

“40% of VO2 max predicted in normal individuals

Question 4

Heart rate and O2 consumption with training vs. with no training

Answer 4

-with training HR increased at lower VO2

Question 5

Cardiac adaptation to training

Answer 5

1) Resting heart rate decreases
2) Left ventricular mass increases (hypertrophy)
3) Left ventricular chamber enlargement
4) VO2 max increases

Question 6

What is VO2 max

Answer 6

Is the maximal ability to take in, transport and use oxygen

Question 7

Systemic circulation changes with exercise

Answer 7

1) Increase systolic BP (due to sympathetic arterial vasoconstriction)
2) Diastolic BP increases or stays the same
3) Systemic vascular resitance decreases due to skeletal muscle vasodilation

Question 8

Benefits of exercise to cardiac rehabilitation - what have observed

Answer 8

• exercise training reduces HR and SBP response to any given submaximal workload thereby dealaying angina
• exercise training increases peak coronary flow (endothelial function)

Question 9

Risks of exercise

Answer 9

-reduce rate pressure product = HRx SBP
-acutely increases risk of medical event:
a) with vigorous exercise
-increase sympathetic (catecholamine)
-decrease vagal stimulation
-increase MVO2
Net = increase ischemia
b) Outpatient cardiac rehab
-1 major CV complication per 50,000 to 1 per 120 000 pt-hrs
-2 fatalities reported per 1.5 million pt -hrs

Question 10

Other way that exercise is beneficial in cardiac rehabilitation

Answer 10

Decreases other diseases (diabetes, stress, obesity, HTN, LDL..) that increase risk of another cardiac event

Question 11

How exercise reduces CAD risk factors

Answer 11

1) Reduced resting systolic and diastolic pressures
2) Increase HDL-C, decrease triglycerides
3) Reduce body fat, waist circumference
4) Reduce insulin needs, improve GT

Question 12

How much exercise

Answer 12

1) Brisk walking 30 min, 5 days per week
2) Jogging 20 min, 3 days per week
3) Resistance training 2 days per week
(from American heart association)

Question 13

Heart rate prescription

Answer 13

=

• maximal heart rate should be 220-age
• heart rate prescription is 60-80% max predicted

Question 14

Rate of perceived exertion

Answer 14

rate of perceived exertion Sing-Talk- Gasp test :

a) maximal effort - can only gasp (breathing heavily)
b) Hard to moderate effort (enough breath to carry a conversation)
c) easy to nothing at all enough breath to sing

Question 15

FITT plan

Answer 15

Frequency: 3-5 times per week
Intensity: rate of perceived exertion 3-4
Time: 30-45 minutes (can be performed in intervals and progressed to one session)
Type: aerobic, muscle strengthening, flexibility