Cardio FITTs and CPGs Flashcards
For Aerobic Exercise, what is the FITT recommendation for PAD?
- F: Minimally 3x / week ; preferably up to 5x / week
- I: Moderate Intensity (40-59 VO2 R) to the point of moderate pain (i.e., 3 out of 4 on the claudication pain scale) or from 50-80% of maximum walking speed
- T: 30-45 min (excluding rest) for a minimum of 12 weeks; may progress to 60 min
- T: Weight bearing (i.e., free or treadmill walking) intermittent exercise with seated rest when moderate pain is reached and resumption when pain is completely alleviated
For Resistance Exercise, what are the FITT recommendations for PAD?
- F: At least 2x / week performed on nonconsecutive days
- I: 60-80% 1RM
- T: 2-3 sets of 8-12 reps ; 6-8 exercises targeting major muscle groups
- T: Whole body focusing on large muscle groups; emphasis on lower limbs if time limited
With Cardiorespiratory Exercise, What is the %HRR, %HR Max and RPE for Moderate Intensity exercise?
- %HRR: 40-59%
- %HR Max: 64-76%
- RPE: Fairly light to somewhat hard (RPE 12-13)
With Cardiorespiratory Exercise, What is the %HRR, %HR Max and RPE for Vigorous Intensity exercise?
- %HRR: 60-89%
- %HR Max: 77-95%
- RPE: Somewhat hard to very hard (RPE 14-17)
What is the FITT recommendation for Aerobic (Cardiovascular Endurance) Exercise?
-
F: At least 3x / week,
-For most adults, spreading the exercise session across 3-5 days per week may be the most conductive strategy - I: Moderate Intensity (40-59 HRR) and/or Vigorous (60-89% HRR) intensity is recommended for most adults
-
T: 30-60 min per day (≥ 150 min a week) of moderate intensity; 20-60 min per day (≥ 75 min a week) of vigorous intensity exercise; or a combination of mod and vig daily to atain the targeted volumes of exercise;
-(Also 500-1000 MET-min/week) - T: Aerobic exercise performed in a continuous or intermittent manner that involves major muscle groups is recommended
Phase 1 Cardiac Rehab
What is the FITT Recommendation for Inpatient Cardiac Rehabilitation Programs?
F: 2-4 session/day for the first 3 days of the hospital stay
I: Seated or standing resting HR + 20 bpm for individuals with MI and + 30 bpm for individuals recovering from heart surgery ; Upper limit ≤120 bpm that corresponds to an RPE ≤ 13 on a scale of 6-20
T: Begin with intermittent walking bouts lasting 3-5 min as tolerated ; progressively increase duration. The rest period may be a slower walk (or complete rest) that is shorter than the duration of the exercise bout ; Attempt to achieve a 2:1 exercise/rest ratio ; Progress to 10-15 min of continuous walking
T: Walking. Other aerobic modes are useful in inpatient facilities that have accommodationss
Patients who demonstrate appropriate hemodynamic, ECG, and symptomatic responses to the self-care and ambulation evaluation can have their activity levels increased
What is the FITT Recommendation for Aerobic exercise for those in Outpatient Cardiac Rehabilitation?
F: Minimally 3 days/week; preferably up to 5 days/wk
I: With an exercise test, use 40-80% of exercise capacity using HRR, VO2R or VO2 Peak ; Without an exercise test, use seated or standing resting HR +20 bpm to +30 bpm (OR do your own Exercise test)
T: 20-60 min
T: Arm ergometer, combination of upper and lower (Dual action) extremity cycle ergometer, upright and recumbent cycle ergometer, recumbent stepper, rower, elliptical, stair climber, treadmin
What is the FITT Recommendation for Resistance exercise for those in Outpatient Cardiac Rehabilitation?
F: 2-3 non-consecutive days/wk
I: Perform 10-15 reps of each exercise without significant fatigue; 40-60% of 1RM
T: 1-3 sets ; 8-10 different exercise focused on major muscle groups
T: Select equipment that is safe and comfortable for the individual to use
(FITT recommendations)
What is the ACSM guideline for Aerobic Exercise for Individuals with Heart Failure?
F: Minimally 3 days per week; preferably up to 5 days per week
I: Start at 40 to 50% and progress to 70-80% VO2 reserve (HRR)
T: Progressively increase to 20-60min a day
T: Aerobic exercise: focusing on treadmill or free-walking and stationary cycling as capable
(FITT recommendations)
What is the ACSM guideline for Resistance Exercise for Individuals with Heart Failure?
F: 1-2 nonconsecutive days
I: Begin at 40% 1RM for Upper Body and 50% 1RM for Lower Body. Gradually increase to 70% 1RM over several weeks to months
T: 1-2 sets of 10-15 reps focusing on major muscles
T: Weight machines, dumbells, elastic bands and/or body weight can be used
MUST KNOW
In the CPG, what is Action Statement 2?
Educate on and Facilitate Components of Chronic disease management
- PTs MUST make appropriate nutrition referrals, perform medication reconciliation and provide appropriate education on preventative self-care behaviors to reduce risk of hospital readmissions
- These include:
-Daily weight measurement to identify increases greater than 2 to 3 lbs in 24 hrs or 5 lbs over 3 days
-Recognition of S/S of an exacerbation
-Action plan with Red/Yellow/Green CHF tool
-Following nutrition plan
-Medication management/medication reconciliation
MUST KNOW
In the CPG, what is Action Statement 3?
Prescribe Aerobic Exercise Training
PTs MUST prescribe aerobic exercise training for patients with Stable, NYHA class 2 to 3 HF using the following parameters:
- Time: 20-60 min
- Intensity: 50-90% of Peak VO2 or Peak work
- Frequency: 3 to 5 x a week
- Mode: Treadmill or cycle ergometer or dancing
Total energy expenditure during the program was the most important determinant of improvement in peak VO2
MUST KNOW
In the CPG, what is Action Statement 4?
Prescribe High-Intensity Interval Exercise Training in Selected Patients
PTs SHOULD prescibe high intensity interval-based exercise (HIIT) for patients with stable, NYHA Class 2 to 3 HFrEF using the following parameters:
- Time: >35 total minutes of 1 to 5 minutes of high-intensity (>90%) alternating with 1 to 5 minutes at 40% to 70% active rest intervals, with rest intervals shorter than the work intervals
- Intensity: >90 of peak VO2 or peak work.
- Frequency: 2 to 3 times per week.
- Duration: at least 8 to 12 weeks.
- Mode: treadmill or cycle ergometer
Shorter HITT sessions may allow for the greatest long-term adherence
MUST KNOW
In the CPG, what is Action Statement 5?
Prescribe Resistance Training
Physical therapists SHOULD prescribe resistance training for the upper and lower body major muscle groups for
patients with stable, NYHA Class I to III HFrEF using the
following parameters:
- Time: 45 to 60 minutes per session.
- Intensity: 60% to 80% 1RM, 2 to 3 sets per muscle group.
- Frequency: 3 times per week.
- Duration: at least 8 to 12 weeks
Resistance training can be especially effective in patients that do not tolerate continuous or interval aerobic training or other therapeutic modalities. Accommodating patient preference for mode of exercise may increase patient adherence, and thus resistance training should be offered as an option
(FITT recommendations)
What is the ACSM guideline for Aerobic Exercise for Individuals with Heart Failure?
F: Minimally 3 days per week; preferably up to 5 days per week
I: Start at 40 to 50% and progress to 70-80% VO2 reserve (HRR)
T: Progressively increase to 20-60min a day
T: Aerobic exercise: focusing on treadmill or free-walking and stationary cycling as capable
(FITT recommendations)
What is the ACSM guideline for Resistance Exercise for Individuals with Heart Failure?
F: 1-2 nonconsecutive days
I: Begin at 40% 1RM for Upper Body and 50% 1RM for Lower Body. Gradually increase to 70% 1RM over several weeks to months
T: 1-2 sets of 10-15 reps focusing on major muscles
T: Weight machines, dumbells, elastic bands and/or body weight can be used
What is NYHA Class I?
No limitation in physical activity; ordinary physical activity does
not cause fatigue, palpitations, or dyspnea
What is NYHA Class II?
Slight limitation of physical activity; comfortable at rest but
ordinary activity results in fatigue, palpitations, or dyspnea
What is NYHA Class III?
Marked limitation of physical activity; comfortable at rest but
less than ordinary activity results in fatigue, palpitations, or
dyspnea
What is NYHA Class IV?
Symptoms at rest; unable to do any physical activity without symptomology
