CVP exercise prescription Flashcards
abnormal response to exercise - HR
increases >30 bpm above resting HR with mild exercise
decreases below resting HR
abnormal responses to exercise - systolic BP
increases > 20-30 mmHg above resting level
decreases > 10 mmHg below resting level
abnormal responses to exercise - diastolic BP
> /= 10 mmHg
norm - 0-10 mmHg > rest
abnormal responses to exercise
O2 drops below prescribed level
pt becomes severely SOB
RR increases to a level not tolerated by pt
ECG changes
60% Max HR
4.8 METS
80% max HR
6.4 METS
1 MET
3.5 ml O2/kg/min
max MET level on a GXT
8 METS
target HR 60% HR
Max HR x 0.60
for cardiac pts with a low functional capacity, initiate exercise programs at what level?
40-40% max HR
for pulmonary pts with a low functional capacity, initiate exercise programs at what level?
20-40% max HR
monitoring of intensity - duration
usually assessed as pts tolerance 5-15 mins
monitoring of intensity - frequency
1-2x/day due to likely decreased level of conditioning
dyspnea scale
1-5 assess SOB
1 = little breathlessness related to exercise
5 = severe breathlessness related to exercise
angina scale
scale 1 -5
1 = slight pain perception
5 = infarction pain
phase 1 of cardiac rehab
the inpatient program that begins soon after a cardiac event and finished when the patient is ready to go home from the hospital. the emphasis is on low-level exercise and education for the patient and family
phase 2 of cardiac rehab
an outpatient hospital based program that begins approx. 2 weeks after discharge from hospital. dieticians, social workers, pharmacists, physicians and other may be involved in care. this phase emphasizes monitored exercise and continued education on exercise and lifestyle management
phase 3 cardiac rehab
an ongoing community based exercise and education program supervised by cardia nurses and exercise specialists. spouses and SO may also participate in this maintenance program with a referral from a physician
phase 4 cardiac rehab
a continuation of phase 3 but without supervision. the patients continue to apply what they have learned during the preceding phases
Peripheral Artery Disease
pts w PAD are at greater risk of having coronary and cerebral vascular disease than those without PAD
PAD risk factors
smoking, atherosclerosis, diabetes, 60+
PAD pts with intermittent claudification
start with short bouts of low intensity exercise
progressed to continuous low level exercise as tolerated
PAD pts exercise rec
twice a day at low intensity
progress to 3x a day increase the intensity
PAD pts with elevated resting systolic BP exercise rec
begin exercise at a low target HR
40-60% for cardiac pts
20-40% for pulmonary pts
if a pts BP won’t normalize during exercise what should happen
termination of the exercise
alterations in exercise prescription for older adults
rest HR may be elevated
warm up - longer and stretching often required
support for balance
physiological differences in older adults
decrease in maximal oxygen consumption (VO2)
(greater differences seen in sedentary vs active)
changes in ventricular compliance
decrease in Max HR (more significant in sedentary vs active)
elevated respiration rate disproportional to exercise
increase in systolic pressure due to increased arterial stiffness (increased afterload)
decreased ability to sweat
increased infiltration of body fat
with PAD: decreased oxygen supply to muscle
what do beta blockers do
affect HR and incrase fatigue
what do diuretics do
affect blood volume and blood flow to muscle
exercise duration for older adults
use intermittent exercise to tolerance
exercise frequency for older adults
incorporate a day of rest between exercise sessions inless exercise is of very low intensity and short duration
performing multiple times a day
what % is okay to increase exercise
never increase more than 10% during one sessoin
increase duration first up to 30-40 mins before adding increases in intensity
what happens to adolescents and young adults for exercise
physical activity levels decline dramatically
ExRx for young children intensity
weight loads - 8 or more reps
heavy weights can damage developing skeletal and joint structures
avoid repetitive use of maximal amounts of wt in strength training during adolescence
ExRx young children duration
perfrom 2-3 sets of 8-10 different exercises ensuring major muscle groups are included
ExRx young children frequency
limit strength training to 2-3x/wk and encourage other forms of PA
exRx children risks
avoid thermal injury
chilren have increased risk of hypothermia
warning signs to progress slowly - CHF
Low angina threshold
Low anaerobic threshold
Resting Tachycardia (HR >100)
Excessive SOB or other S & S
Fall of SBP > 20mmHG
Slow recovery from activity
Excessive fatigue lasting > 1-2 hrs post exercise
Increase in arrhythmias during activity
Lack of HR or BP response to activity
Excessive HR or BP responses to activity
LE claudication
indications to terminate exercise session
SBP > 200-220
DBP >110
HR >80-85% of predicted maximum
prognosis and goal setting in cardiopulm PT
Prognosis for Pulmonary patients is guarded because of their up and down status - easily triggered
prognosis and goals of pulm pts
Key to achieving success with pulmonary patients is to address symptoms and activities - reduce the work of breathing
Goals for pulmonary rehabilitation are:
- Control and alleviate symptoms
- Minimize pathophysiological complications of respiratory impairment
- Train the patient to achieve optimal capacity to carry out ADLs
Patient Education
Decrease psychological symptoms -> anxiety or depression
Improve quality of life
Return the patient to gainful life and employment
Promote independence and self-reliance
Reduce exacerbations and hospitalizations = decreased morbidity and mortality
Encourage participation in recreational pursuits
Assist with Nutritional Support
prognosis and goals - cardiac pts
Cardiac Patients prognosis often more favorable as compared to pulmonary pts
Primary goal is secondary prevention with emphasis on:
Improving functional capacity
Reducing or managing symptoms angina
Improving overall skeletal muscle fitness
Improve the Quality of life
Patients with acute MI and CABG have been shown to demonstrate significant improvement in aerobic capacity following exercise conditioning
The greatest improvements found in patients with the lowest initial max VO2
