Cardio- Exercs And Prescription Flashcards
Can the PT perform Maximal exercise testing ( also known as a Stress test)?
No. Only doctors can.
Ex: treadmill tests w Bruce protocol)
Can the PT perfom Submaximal exercise testing)?
Yes. It’s used as a measure of endurance and exercise capacity.
Ex: 6MWT
How is the 6MWT performed?
- The distance covered by the pt walking at a COMFORTABLE pace for 6 min
-pt is allowed to take breaks as needed
-2 practice trials are required
What ate the parameters for exercise prescription?
FITT
F: frequency
I: intensity
T: time
T: type
The intensity of exercise can be prescribed based on…
- RPE rating of perceived exertion
- percentage of max HR
-percentage of HRR
-percentage of max o2 uptake (Vo2 max)
-Vo2 R reserve
-Mets max
STANDARD intensity ranged based on the following methods: HR max, HRR, Vo2max, Vo2R, METS is…
60-85%
HIGH RISK intensity ranged based on the following methods: HR max, HRR, Vo2max, Vo2R, METS is…
50-75%
How is the percentage of Maximum Heart Rate (HR max) calculated?
Max= 220-age
How is the target HR calculated?
Targer HR= HR max x % intensity desired
How to calculate the Percentage of Heart Rate reserve?
Karvonen equation
Target HR= [( HR max- HR rest) x % intensity desired] + HR rest
What is the canadian physical activity guidelines for exercs?
Adults should accumulate at least 150min of Moderate to vigorous intensity aerobic physical activity per week.
Muscle/bone strengthening activities using major muscle groups at least 2days/week
What is the safety precaution w hypertensive pts?
Upper body exercs may increase SBP.
Avoid high intensive upper body exercs.
What are some indications to terminare exercs session?
-moderately severe or increasing angina
- marked dyspnea
-dizziness,light headedness or ataxia
-cyanosis or pallor
-excessive fatigue
-leg cramps or claudication
- failure of Sbp to rise
-progressively decrease in sbp 10-15mmhg
-hypertensive response
significant chanhes i cardiac rhythm
-blood glucose menor q 60 ou maior d 250
What are some abnorma responses that may be indication to terminate exercs session?
Failure of SBP to rise as exercs continue
Progressive fall in SBP of 10-15mmHG
Hypertensive BP response (SBP more than 200mmHg and or DBP more than 110mmHG
Significant change in cardiac rhythm detected by palpation or ECG
What is the optimal position for V/Q matching when the pt has unilateral lung disease?
Lie on unaffected side “good lung down”
What is the optimal position for V/Q matching when the pt has bilateral lung disease?
Lie in prone
Will improve oxygenation
What is the optimal position for V/Q matching when the pt has pneumonectomy?
Do not lie with affect side up
What is the optimal position for V/Q matching when the pt has ARDS (acute respiratory distress syndrome)?
Lie in prone
What are good positions to decrease dyspnea in COPD pts?
1- standing,leaning back against a wall w hands resting onto thighs
2-standing,leaning against a table
3-sitting,leaning foward w elbows resting on thighs
4-sitting,leaning forward against a table
What are some breathing exercises? Cite 5
Deep diaphragm breathing
Pursed lip breathing for COPD
Inspiratory muscle training
Segmental breathing
Sustained maximal inspiration
How to perform deep diaphragm breathing?
Pt performs long slow breaths.
How to perform pursed lip breathing?
Performed by taking a breath in through the nose and out through tightly pressed pursed lips.
“Smell the roses and blow out the candles”
Exhalation should br 3xlong as inspiration .
What is the benefits of pursed lip breathing technique?
Helps control and reduce RR
More efficient emptying of the lung
Improve gas exchange
Promotes relaxation
What is the purpose of the inspiratory muscle training? What are some contraindications?
Retraining the inspiratory muscles using a IMT (inspiratory muscle trainer) device.
Contraindications: acute respiratory failure, cognitive impairment
How is performed the segmental breathing?
Uses tactile input to increase expansion of specific areas
How is sustained maximal inspiration performed? What is the indication?
Pt performs sustained maximal insp to TLC for 3-5 seconds. They can use a incentive spirometer.
Indicated to prevent atelectasia or airway closure
What are some airway clearance techniques? 6
Postural drainage
Percussion
Vibration
PEP device
Independent breathing techniques
Suctioning
How is performed postural drainage? For how long should it be performed?
Pt is placed in a position that allows drainage of secretions from bronchial airways via gravity.
It should be performed for 5-10min or longer( if tolerated)
What are some contraindications for postural drainage?
Intracranial pressure
Head and neck injury until stabilized
Active hemorrhage
Large pleural effusion
Pulmonary embolism
Untreated pneumothorax
…
Trendeleberg position is contraindicated in adults for…
Pt in whom increased ICP is to be avoided
Uncontrolled hypertension
Distended abdomen
Esophageal surgery
Recent gross hemoptysis related to lung carcinoma
Uncontrolled airway at risk for aspiration
How is perfomed Percussions technique?
Uses rhytmical force of a therapist hands in a cupped position against the thorax of the pt.
What are some contraindications for Percussion/vibration techniques?
Severe osteoporosis
Rib fracture
Pulmonary embolus
Pneumothorax
Anticoagulation therapy
Subcutaneous emphysema
GIa bleeding
How is vibration technique performed?
A vibratory force is applied when the pt is performing exhalation
How is performed the PEP device technique?
Similar to pursed lip breathing technique
How is the independent breathing technique performed?
1-diaphragm breathing 20-30secs
2-deep diaphragm breaths 3-4x
3- diaphragm breathing 20-30secs
4-deep diaphragm breaths 3-4x
5- diaphragm breathing 20-30secs
6- FET huff or cough
How is suctioning performed?
It’s a procedure to remove secretions through the insertion of a catheter or device through the nose,mounth or an artificial airway( endotracheal tube, tracheostomy tube)
What are some contraindications for suctioning?
Severe decrease 02 saturation ( less than 92%)
Increased ICP
Hemoptysis
Malignant arrhythmia
Hyperinflation post CABG and head injury
What is the time limite for suctioning?
10-15seconds per pass and allow recovery time between each pass ~30seconds
If the pt has a traumatic brain injury then 5-10seconds only
What is the forced expiratory technique Cough?
Cough is a forced expiratory technique with a CLOSED glottis that may be used to expel secretions.
Cough=Closed
What is the forced expiratory technique Huff?
Forced expiratory technique with an OPEN glottis
Why is Huffing preferred than Coughing in pts with Obstructive lung diseases?
Cough have the risk of small airway collapse from the intra-thoracic pressure created when coughing.
That’s why Huffing is preferable.
A patient involved in a cardiac rehabilitation program exercises on a treadmill. While exercising the patient reports his level of perceived exertion as a 7 on Borg’s ten-point scale. Which words best describe the patient’s rate of perceived exertion?
A. weak
B. moderate
C. strong
D. very strong
D
A patient rehabilitating from cardiac surgery is monitored using an arterial line. The primary purpose of an arterial line is to
A. measure right arterial pressure
B. measure heart rate and oxygen saturation of the blood
C. measure pulmonary arlery pressure
D. measure systemic blood pressure
D
A patient who has received a heart transplant is undergoing cardiac rehabilitation with a physical therapist. Which of the following descriptions BEST represents the cardiovascular effects that occur when this person begins exercising?
- No initial change in heart rate followed by a gradual increase after several minutes
. - Immediate increase in heart rate that gradually stabilizes after several minutes.
- No inftial change in heart rate followed by a gradual decrease after several minutes.
- Immediate decrease in heart rate that gradually stabilizes after several minutes.
- This is the correct answer. After a heart transplant, there is no longer any sympathetic innervation to the heart, blunting the effect of exercise on heart rate. After several minutes of activity, the heart will then respond to circulating catecholamines and increase gradually.
After your assessment, you design an exercise program to address the following muscle groups: quadriceps, deltoids, biceps and wrist extensors. According to proper fundamental exercise prescription, exercises should be given in what order?
a. Front raises, squats, hammer curls, wrist curls.
b. Squats, wrist curls, front raises, hammer curls.
c. Squats, shoulder press, hammer curls, wrist curls.
d. Wrist curls, hammer curls, shoulder press, squats.
C
The largest muscle group is Quadriceps - Deltoids - Biceps - Wrist extensors. Therefore, the correct sequence is - Squats, shoulder press, hammer curls, wrist curls
Your patient has been working on your patient program for 6 weeks. When he returns to see you, he is complaining that he is fatiguing more quickly than he used to. He states that he requires more time to recover from strenuous exercise than he used to. You discuss his training parameters with him and conclude that he has not been giving himself adequate rest between sessions. He has also been progressing his weights too rapidly and has not been maintaining an adequate diet or fluid intake. You determine the increased time to recover from exercise is due to:
a. Injury
b. Acute muscle soreness
c. Delayed onset muscle soreness
d. Overtraining
D
• Acute Muscle Soreness - Incorrect
Develops during or directly after strenuous exercise is performed to the point of muscle exhaustion.
• Delayed Onset Muscle Soreness - Incorrect
After vigorous and unaccustomed resistance training or any form of muscular overexertion, DOMS, which is noticeable in the muscle belly, may occur. It begins to develop 12-24 hours after the cessation of exercise.
• Overtraining - Correct
A decline in physical performance in healthy individuals participating in high intensity, high volume-strength or endurance training programs.
It is now 1.5 weeks after surgery. Due to pain, your patient has been unable increase activity and is likely suffering physiological changes associated with immobilization. Which of the following statements is false regarding functional consequences of immobilization and reduced activity?
a. Decreased total blood and plasma volume.
b. Increased blood lipids related to heart disease.
c. Decreased basal heart rate.
d. Closure of small airways in dependent regions of lungs leading to lung collapse.
C
The next stage of your research involves testing different muscles in isolation. What type of exercise would be best?
a. Closed chain exercise
b. Open chain exercise
c. Eccentric exercises
d. None of the above
B
Open chain exercises involve the distal segment moving in space. Muscle activation occurs predominantly in the prime mover and is isolated to muscles of the moving joint.
Your patient successfully received a heart transplant 6 weeks ago. You have been instructed to start a monitored exercise program. Which of the following would you not recommend as a mode of monitoring his vitals at this stage of recovery?
a. Rate of perceived exertion
B. Heart rate
c. Blood pressure
d. Electrocardiogram
B
• The heart has been de-innervated and no longer receives stimulation from the autonomic nervous system to respond quickly to exercise.
• During exercise, the heart rate will respond very slowly to chemical changes in the blood.
Therefore, this is not an effective way to monitor exertion.
