Ch 18 F&D - Primary Prevention, Risk Reduction, Deconditioning Flashcards
prehabilitation
exercise dose that will maintain the patient’s conditioning level and prevent deterioration
prehabilitation parameters
- intensity more important than frequency (better to complete high intensity exercise less frequently than low intensity exercise more often/frequently)
- quality over quantity
- more research for exercise prescription to prevent negative side effects of recumbency/bed rest
appropriate dosing needed to prevent “life-style related conditions” has not been determined with exception of:
ischemic heart disease can be prevented & “optimal” cardiovascular health can be achieved through moderate volume of regular physical activity at an intensity of 6 METs
what best represents the human condition
upright and mobile
what is the difference btw bed rest and deconditioning
deconditioning = cumulative affect; result of a person being sedentary and having restricted mobility (can be secondary to bedrest)
bedrest definition
physician written order that says they cannot get out of bed
physiological effects of bed rest
- CV and pulmonary deterioration occurs more quickly than MS deterioration
- Takes longer to recover from effects of bedrest than for the impairments of bedrest originally occur
- worse in older adults than younger adults
- active older adult has better physiological reserve to accommodate for illness/bedrest
- Restricted mobility is associated with clinical depression
- Additional considerations in Table 18-2 (p. 252)
mobilization and exercise ENHANCE mucociliary transport and airway clearance resulting in:
improved pulmonary function (top of hierarchy)
changes in body position assist in airway clearance to minimize pooling and stagnation of bronchial secretions resulting in:
decreased risk of atelectasis
effects of bedrest on the CV system
- Loss of fluid-volume and pressure regulating mechanism
- Decrease in plasma volume
- Diuresis
- Increased hematocrit
- Increased risk for deep vein thrombosis (DVT) – this is PREVENTABLE!
effects of bedrest on the pulmonary system
- *Increased work of breathing; secondary effect of decrease lung volumes:
- dec. Functional Residual Capacity (worse in supine; improved in sitting)
- dec. Residual Volume
- dec. Forced Expiratory Volume
effects of bedrest on the MS system
- Muscle Atrophy leading to weakness, dec coordination, impaired balance
- Excessive strain on ligaments and joints (when they start to move again) leading to joint contracture
- Disuse osteoporosis (once bone loss occurs it is irreversible, so inc fx risk)
- Limited alternatives to lying in bed result in poor postural alignment, stiffness, soreness
effects of bed rest of other systems
- Orthostatic hypotension
- Inc risk for skin lesions and decubitus ulcers
- Inc renal load leading to dysrhythmia, muscle wasting, weakness, neuropathy, glucose intolerance, and reduced bone density
- dec activity of the sympathetic nervous system
- dec electrical activity in brain
- Emotional/behavioral changes
- dec reaction times
- sleep disturbance
- impaired psychomotor performance
- dec insulin sensitivity
- dec lymphatic flow and impaired immune system response
- depression
alternatives to bedrest
- creatively-designed furniture that supports normal physiological functioning. (i.e. stretcher chair, kinetic bed)
- Avoid passive positioning whenever possible!
- Active standing > passive standing
- Upright sitting > passive standing
indications for bedrest
- Minimize effects of gravity to promote healing following trauma or orthopedic surgery
- Minimize the effects of edema; can be achieved more specifically though
- *Mobilizing patients and permitting bathroom privileges has been reported to be less stressful than having to use a bedpan
- *disadvantages are better documented than benefits
acute effects of mobilization and exercise on cardiopulmonary system
- *increased airway diameter in addition to the following increases:
- Minute alveolar ventilation
- Alveolar ventilation
- Tidal Volume
- Respiratory Rate
- Air flow rates
- Cardiac Output
- Stroke volume
- Heart rate
- Blood pressure
- Rate pressure product (HR + Systolic BP)
- hemodynamic benefits are greater in an upright position
For those with impaired venous return and myocardial contractility begin with…
moderate-intensity recumbent cycling
In those with stroke and other clotting disorders ______ levels of activity are associated with _______ in platelet activity.
moderate; minimal increases
**No evidence to support this as a risk factor in this population
role of resistance training
- prevent mechanical ventilation or aid in weaning from it (respiratory m.)
- Prevents m. atrophy
- improved aerobic exercise responses in healthy older adults
- *Should be included in cardiac and pulmonary rehabilitation programs
before beginning resistance training use caution and screen for…
- *caution in those with ischemic heart disease due to increased arterial wall stiffness
- *Screen for risk factors before prescription of abdominal exercises due to intrathoracic pressure increases and SV decreases
acute effects of mobilization and exercise on endocrine system
- stimulation
- Increased sympathetic nerve stimulation; improves processing of sympathetic neurotransmitters
- increase catecholamines, including anti-inflammatory effects
acute effects of mobilization and exercise on CNS
- Arousal due to activation of the reticular activating system
- Parasympathetic inhibition coupled with sympathetic activation to assist with systemic responses to exercise
acute effects of mobilization and exercise on metabolic system
- Improved sensitivity to insulin
- Increased growth hormone synthesis
acute effects of mobilization and exercise on immune system
- Improves WBC production
- Dose-dependence unknown; know aerobic ex = better, but don’t know what threshold marks what amount will shift to worse than better for the immune system (what is the magic duration #/time?)
- Prolonged exhaustive exercise is associated with compromised immunity
