Ch 8 Flashcards
The EP-C is responsible for developing exercise prescriptions for healthy clients and those with medically controlled diseases who are cleared by their physician for independent exercise.
• Individuals with a chronic condition can experience health-fitness benefits such as reduced disease symptoms, reduced medication reliance, and restoration of mental wellbeing.
• This chapter reviews disease pathology, exercise considerations and contraindications, and the process for developing a proper F.I.T.T. plan for those with chronic conditions.
_________ Disease
• (CAD) is one of the most prevalent types of cardiovascular disease and accounts for the most cardiovascular deaths.
• Atherosclerosis is a process where ______ develop causing the artery wall to thicken while reducing _____ diameter.
• Fatty streak formation starts a repeating cycle of ______ in the artery, during which lumen diameter is progressively reduced until either a partial or complete impairment of blood flow occurs
___________ is an imbalance between myocardial oxygen demand and supply.
– ______: results from increased demand from heart
– ______: more severe; often seen in a ______
• The symptoms of stable ischemia lessen as the ______ of the heart decrease, or when ______eases or ceases.
• Individuals with unstable ischemia need to seek medical treatment immediately.
Hypertension (HTN)
• HTN is characterized as a ______in either systolic (>140 mm Hg) or diastolic (>90 mm Hg) blood pressure.
• Primary HTN accounts for _______% of all cases, has no established pathology, and thus is considered _________.
• Secondary HTN, which accounts for very few cases, is associated with identifiable causes such as renal disease, _____, drug induced side effects, sleep apnea, _____ disorders, and many others.
• Left untreated, HTN can cause stroke, _____ heart failure, _____ kidney failure and blindness.
.coronary artery, fatty streaks, lumen
Repair and remodeling, myocardial ischemia,
Stable, unstable, Resting state, oxygen demands
Exercise , persistent elevation, 90-95, idiopathic
Stress, neurologic, chronic 2X
Peripheral Artery Disease (PAD)
• PAD is characterized by occlusion of vessels of the upper and lower limbs as a result of ______.
– Resulting ______ can cause pain and easy fatigability
• Most common symptom is ______, a cramping, aching sensation affecting calf muscles especially during weight-bearing exercise.
• PAD severity is graded on a 4-point scale in which 0=asymptomatic and 4=_____loss in the limbs.
• PAD severity is based on the______ index (ABI)
Peripheral Artery Disease (cont’d)
• ABI is a ratio of systolic blood pressure (SBP) measurements taken in a _____ position at ____at the level of the ankle and the brachial artery.
• ABI = ankle SBP/brachial SBP
– ABI values >____ are considered normal
– ABI value ___ mg dL−1) and LDL-C (>___mg dL−1), are associated with increased risk of atherosclerosis and CAD.
• Small LDL particles are more _____ compared with the large particles.
.atherosclerosis, ischemia,
intermittent claudication , tissue, ankle-brachial
Supine, rest, .90, 200, 130, artherogenic
Obesity and Metabolic Syndrome
• Obesity, associated with a BMI > 30kg/m2, is associated with co-morbidities including ______.
• Metabolic syndrome is a cluster of metabolic risk factors including ______, hypertension, central adiposity, and _____.
• Mortality rates caused by CVD are substantially higher in those having the metabolic syndrome.
Pulmonary Diseases: COPD
• COPD is an umbrella term used for a collection of pulmonary diseases, including chronic bronchitis, emphysema, and asthma.
• Emphysema is the permanent enlargement of airspaces along with necrosis of alveolar walls causing an accumulation of air in the lung tissue.
• Chronic bronchitis is characterized by chronic, pulmonary inflammation, damage to the bronchial lining, and airflow obstruction.
• Asthma consists of both inflammation and increased smooth muscle constriction in the lungs in response to various triggers.
Role of Exercise in CVD
• Regular exercise can:
– Decrease coronary inflammatory markers
– Decrease stress and damage on the coronary arteries
– Reduce the risk of clotting and a second MI through decreases in blood platelet adhesiveness, fibrinogen levels, blood viscosity
– Alleviate claudication, improve pain-free walking time and distance, and improve ABI scores
– Lower SBP and DBP by 5-7 mmHg
Role of Exercise in Metabolic Disease
• Improved insulin sensitivity
– Greater control of blood glucose levels
– A reduced medication requirement
• Lowered blood concentrations of LDL-C and increased concentrations of HDL-C.
• The role of exercise in treating obesity is most effective when used in combination with caloric restriction.
• Exercise yields improvement in the complex of risk factors associated with metabolic syndrome.
.insulin resistance and all cause mortality,
Hyperglycemia, dyslipidemia ,
Role of Exercise in Pulmonary Disease
• The scientific literature is____ as to the extent that exercise plays a role in reducing the pathologies of pulmonary diseases.
• While exercise may not cure pulmonary diseases, it does bring a noticeable increase in ______
• The overall benefit of exercise allows the pulmonary client to exercise longer at ______.
Prescription
• The guidelines presented in this chapter are principles only.
• All guidelines should be used with flexibility and careful attention to the contraindications, limitations, and goals of the individual living with a chronic disease.
• One overriding objective of the exercise prescription is to promote a physically active lifestyle.
• The EP-C uses the basic scientific process, knows the individual client’s needs, and develops and implements an appropriate exercise prescription.
F.I.T.T. Considerations: CVD
• Optimal exercise frequency is ____or more days each week.
• CVD clients usually have limited functional capacities; therefore shorter exercise episodes of 10 to 15 minutes performed ____times each day may be useful and often results in exercise being better tolerated.
• CVD clients may use ____ instead of HR monitoring if on heart-rate modifying medications.
• Exercise intensity is always prescribed below the_____threshold; however, any client experiencing ischemia should be exercising in the presence of someone with more specific training than the EP-C.
F.I.T.T. Considerations: CVD (cont.)
• High Intensity Interval Training (HIIT) can improve exercise capacity and quality of life.
• The overall exercise goal for cardiac clients is to progress to ___minutes of aerobic conditioning a day.
– Increase duration from _____minutes per session depending on exercise tolerance
• The F.I.T.T. for _____ is no different than in the general population.
– Most cardiac patients will likely start at a low level
.mixed, quality of life, higher intensities, 5
2-3, RPE, myocardial ischemic, 60, 1-5
Resistance training,
F.I.T.T. Considerations: Metabolic Disease
• The EP-C can safely work with clients with_____ type 2 diabetes.
• Exercise frequency of ____days a week is recommended.
• Exercise intensity ranges between _____% HRR and VO2 reserve and corresponds to an RPE of _____
• Exercise duration begins with a daily accumulation of ____minutes and progresses to 60 minutes of daily aerobic conditioning.
- Exercise frequency and intensity recommendations for resistance training are not different from those used for healthy sedentary individuals.
- Exercise intensity is set at ____% of 1-RM with 2-3 sets of ____repetitions.
- Exercise duration is usually set at ___ multi-joint exercises for all major muscle groups.
- Special considerations include proper footwear and foot care, wearing medical identification, having an available carbohydrate source, caution if exercising in the evening.
Disease
• In most cases these clients are unlikely to ever fully vanquish their symptoms.
– Functional capacity and exercise tolerance becomes progressively more restricted.
• The EP-C is prepared to work with a well-controlled asthma client, and should encourage him or her to perform aerobic exercise at least _____days a week.
• A useful tool to measure intensity is the ____ scale. Aim for a value in the range of ____on a scale of 0 to 10
F.I.T.T. Considerations: Pulmonary Disease (cont.)
• Exercise duration recommendations for the pulmonary client are to obtain at least ___minutes each session
• Long term goal is to move progressively towards ___minutes of continuous or intermittent physical activity and aerobic conditioning.
.well controlled, 5-7, 50-80, 12-16, 20
60-80, 8-12, 8-10, 3-5, dyspnea, 3-5
20,60
Ischemic Responses During Exercise
• In the ischemic person, maximum exercise capacity is limited by insufficient_____supply.
• If the heart is deficient of oxygen, exercise capacity is limited.
• The ischemia duration necessary to produce an infarct ____.
– Design exercise prescriptions that safely avoid the ____ threshold or the heart rate at which ____ symptoms develop.
BP Responses During Exercise
• Normally, a single exercise session causes a linear increase in systolic blood pressure with no change in diastolic blood pressure.
• In the hypertensive person, SBP changes with exercise are often ____ and can reach excessively high levels (>____mm Hg).
• Given the potential acute and chronic concerns associated with exercise and HTN, the EP-C must be aware of and follow guidelines for initiating and terminating exercise in the hypertensive client.
Special Considerations for HTN
• The hypertensive client can exercise once BP is___.
• In the presence of severe HTN (>___/___mm Hg), exercise is only engaged after initiating drug therapy.
• If resting SBP is >____ mm Hg, or resting DBP >___ mm Hg, even with meds, exercise is contraindicated.
• During exercise if SBP becomes >___ mm Hg or DBP >___mm Hg, exercise is stopped.
• _____can attenuate HR response, and necessitate the need to use RPE or “beats above resting” for exercise intensity monitoring.
Special Considerations for PAD
• A ______, as well as time or distance to the onset of symptoms, can be used to monitor exercise.
• The client may benefit from work-rest intervals to provide relief from onset of severe claudication during exercise.
• Weight-bearing activity should be the primary type of exercise prescribed, though non-weightbearing can be used for warm-up and cool-down.
• A ___environment may aggravate symptoms of claudication. A longer warm-up is recommended.
Special Considerations: Diabetes (both types?)
• Diabetic clients need blood glucose monitoring before, during, and post exercise.
• A readily available source of carbohydrate, such as fruit juice or hard candy, should be available at all times.
• If pre- or during exercise blood glucose measurements are ___mg they can continue exersice.
.myocardial oxygen , varies, ischemic
Angina, curvilinear, 250, controlled, 180/110
200, 115, 220, 105, beta-blockers,
Claudication scale, cold, 70, 100,
Special Considerations: Diabetes (cont.)
• When pre-exercise blood glucose values are >____mg dL−1 and blood ketones are present or if blood glucose is simply >___ mg dL−1, blood glucose must be lowered before initiating exercise.
• When an active retinal ______ is present or recent laser corrective _____ for retinopathy is completed, exercise is to be avoided.
– Postponing exercise will limit the risk of triggering vitreous hemorrhage and retinal detachment.
Special Considerations: Diabetes (cont.)
• Proper foot care and foot wear is essential.
• Exercise with a partner or with supervision to reduce the
risk of problems associated with hypoglycemic events.
• Exercise is not recommended during peak insulin action because hypoglycemia may result.
• Because delayed post-exercise hypoglycemia is a known risk, late evening exercising is not recommended.
• Always carry medical identification.
Special Considerations: Obesity
• Recommendations include accumulating more than 2000 kcal/wk of energy expenditure
• To reduce joint stress and risk of musculoskeletal injury, choose non-weightbearing or low-impact modes.
• Because of likely low fitness level, progress slowly.
• Added behavioral and motivational strategies can help
adherence.
• Additional considerations include adequate warmup and cooldown, adequate hydration, and loose clothing for heat dissipation.
Disease
• Exercise training improves muscle functionality; therefore, overall exercise tolerance is improved.
• Another exercise training goal for the COPD client is dyspnea desensitization:
– A condition characterized by shortness of breath that often limits exercise
• Early in the exercise program, the COPD client will need constant monitoring until they are able to learn pulmonary triggering symptoms.
• Many COPD clients will need constant O2 sat monitoring in order to maintain blood oxygen saturation >90%
Special Considerations: Pulmonary Disease (cont.)
• Fast-acting inhalers are kept close to hand at all times especially while exercising.
.250, 300, hemorrhage, surgery,
Special Considerations: Pulmonary Disease (cont.)
• A client with CRPD is treated in a similar fashion as a COPD client because they have similar exercise limitations and considerations.
• Additional considerations for patients with COPD include:
– optimal exercise training time is mid to late morning
– avoid extreme temperatures and high humidity as they can trigger symptoms and, potentially, a medical incident
Over The Counter (OTC) Medication
• The greater risk of OTC medications is drug interaction and the interactive effect that these drugs can have on many chronic conditions.
• OTC cold and flu medications often contain some form of ephedrine which has been shown to increase systemic blood pressure.
• The diabetic patient should avoid any OTCs that contain alcohol or sugar as they are likely to affect blood glucose levels.
• Conflicting evidence exists regarding the effect of NSAID’s on blood pressure; therefore, HTN clients taking NSAID’s are monitored closely.
Prescription Drugs
• The most common class of CVD drugs includes beta- blockers, calcium channel blockers (CCB), ACE inhibitors, digitalis, diuretics, and cholesterol lowering medications.
• Although beta-blockers lower heart rate and myocardial contractility, they also increase exercise capacity by decreasing coronary ischemia.
• CCBs (used for treating HTN and angina) and ACE inhibitors (used for treating HTN) both increase arterial diameter, thereby lessening blood pressure and decreasing the work by the heart.
Prescription Drugs (cont.)
• Niacin and cholesterol lowering drugs tend to have very little effect on heart rate and contractility and thus no direct impact on exercise capacity or the exercise prescription.
• Statins alone or in combination with fibric acid are often associated with unusual muscle soreness.
• Digitalis, commonly used in CHF and for certain persistent arrhythmias, increases contractility, slows rate, and mediates arrhythmias.
.
Prescription Drugs (cont.)
• Diuretics are used to control HTN and edema by triggering the kidney to excrete water, increasing resting and submaximal HR.
• Prescribing exercise for CVD, metabolic disease, or pulmonary clients requires some knowledge of common medications, particularly their effect on exercise response, exercise capacity and hemodynamics.
• The EP-C is expected to be familiar with the most commonly prescribed medications and understand how to modify an exercise prescription accordingly.
Implementing an Exercise Plan
• When developing a PA and exercise prescription for a medically cleared client, the EP-C must complete a thorough review of the client’s medical record.
– This allows for a full understanding of specific health conditions and possible exercise limitations before developing an exercise plan.
– Those individuals who have had a recent medical event should seek an organized rehabilitation setting for exercise.
• After a complete review of the client’s file, the EP-C is ready to meet and discuss all plan aspects.
Implementing an Exercise Plan (cont.)
• Educational sessions provide a vital means for developing patient understanding while enhancing the likelihood in optimizing the F.I.T.T. prescription.
• Once the exercise type or mode is selected, the EP-C gives detailed exercise instructions using demonstrations and provides safety information regarding all exercises and the use of all exercise equipment.
• Client records for exercise frequency, intensity, time, and type are developed and kept on file.
Look at recommendations for FITT
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