Cardiovascular and Pulmonary: Exercise Prescription Flashcards
FITT Principle
- Frequency
- Intensity
- Time
- Type
Type: Lower Extremity Cardiorespiratory Endurance
- Recommended to improve exercise tolerance
- Can be maintained at a constant velocity
Type: Upper Body Ergomotor
- Smaller muscle mass
- Lower VO2max (Than LE cardio)
Type: Upper Body Ergomotor: Vitals differences from Leg Ergometry
- Higher Heart Rate
- Lower Stroke Volume
- Higher Systolic and Diastolic Blood Pressure
Type: Early Rehab
- Exercise should be discontinuous (Interval Training)
- Frequent rest periods
- Then progress to continuous training
Type: Resistance Training
- Typically incorporated in water stages of rehab following a period of aerobic conditioning.
- Typically performed at 60-80% of a 1 or 10 RM
- Rate pressure product is used to monitor response to exercise.
Type: Resistance Training: Red Flag: Valsalva Maneuver
Carefully monitor for Valsalva Maneuver which is:
- Forced exhalation against a closed airway
Type: Resistance Training: Red Flag: Valsalva Maneuver: Causes
- Increase in BP and a reduction in stroke volume and cardiac output.
Type: Resistance Training: Red Flag: Valsalva Maneuver: Resistance exercise is contraindicated when
- Patients have uncontrolled hypertension or arrhythmias
Intensity: Heart Rate
- HRmax has close correlation to 60-80% of functional capacity or VO2max
Intensity: Heart Rate: Beta Blocker
- Affects ability for HR and BP to rise in response to exercise
Intensity: Heart Rate: Pacemaker
- Can affect the ability for HR to rise in response to an exercise if the pacemaker is fixed
Intensity: Ratings of Perceived Exertion Scale (RPE)
- May be helpful if patient is on a beta blocker when HR can not be used as a measure of intensity.
- May not be appropriate for some populations
- May not be effective for those who are not familiar with the scale
Intensity: MET’s
- 40-85% of a functional capacity achieved on ETT
Intensity: MET’s: Problems with using MET’s alone to prescribe intensity
- High intensity activities must be performed in a discontinuous pattern
- Metabolic cost of activity can be impacted by several factors making it in precise
Time
- Can range fro 10-60 min
- Moderate intensity activity usually has a time duration of 20-30 min
- Patients level of conditioning plays a critical role in determining time of activity
Frequency
- Dependent upon intensity and duration
- Low intensity+short duration=Greater frequency
Frequency: Time+Intensity
- Mod intensity=3-5 sessions per week (Greater than 5 MET’s)
- Low Intensity=Daily or multiple daily activities (Exercise less than 5 MET’s)
Progression: Modify Activity if
- HR does not meet target HR
- RPE is lower than it typically is for a given exercise (indicating that patient feels the exercise is easier than it has been)
- Patient no longer has ischemia at a given exercise intensity
Exercise: Red Flag
Consider reduction in exercise if
- Acute illness. fever, flu
- Acute injury, orthopedic complications
- Progression of cardiac disease
- Edema
- Weight gain
- Unstable angina
- Environmental stressors
ACSM GUIDELINES: Red Flag: Exercise Termination
- Diastolic BP greater than or equal to 110 mmHG
- Decrease in systolic BP of greater than 10 mmHG during exercise
- Significant ventricular or atrial dysrhythmias
- Second or third degree AV block
- Exercise Intolerance: Angina, Dyspnea
- ECG changes indicative of ischemia
Prescription: Post Percutaneous Trans-luminal angioplasty
- Initiate a walking program immediately
- Wait to exercise vigorously approx 2 weeks post PTCA to allow inflammatory process to subside
Prescription: Post Coronary Artery Bypass Graft
- Limit upper extremity exercise while sternal incision is healing.
- Avoid lifting, pushing, and pulling for four to 6 weeks post surgery
