CVP exercise prescription

Question 1

abnormal response to exercise - HR

Answer 1

increases >30 bpm above resting HR with mild exercise

decreases below resting HR

Question 2

abnormal responses to exercise - systolic BP

Answer 2

increases > 20-30 mmHg above resting level

decreases > 10 mmHg below resting level

Question 3

abnormal responses to exercise - diastolic BP

Answer 3

> /= 10 mmHg

norm - 0-10 mmHg > rest

Question 4

abnormal responses to exercise

Answer 4

O2 drops below prescribed level

pt becomes severely SOB

RR increases to a level not tolerated by pt

ECG changes

Question 5

60% Max HR

Answer 5

4.8 METS

Question 6

80% max HR

Answer 6

6.4 METS

Question 7

1 MET

Answer 7

3.5 ml O2/kg/min

Question 8

max MET level on a GXT

Answer 8

8 METS

Question 9

target HR 60% HR

Answer 9

Max HR x 0.60

Question 10

for cardiac pts with a low functional capacity, initiate exercise programs at what level?

Answer 10

40-40% max HR

Question 11

for pulmonary pts with a low functional capacity, initiate exercise programs at what level?

Answer 11

20-40% max HR

Question 12

monitoring of intensity - duration

Answer 12

usually assessed as pts tolerance 5-15 mins

Question 13

monitoring of intensity - frequency

Answer 13

1-2x/day due to likely decreased level of conditioning

Question 14

dyspnea scale

Answer 14

1-5 assess SOB
1 = little breathlessness related to exercise
5 = severe breathlessness related to exercise

Question 15

angina scale

Answer 15

scale 1 -5
1 = slight pain perception
5 = infarction pain

Question 16

phase 1 of cardiac rehab

Answer 16

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

Question 17

phase 2 of cardiac rehab

Answer 17

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

Question 18

phase 3 cardiac rehab

Answer 18

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

Question 19

phase 4 cardiac rehab

Answer 19

a continuation of phase 3 but without supervision. the patients continue to apply what they have learned during the preceding phases

Question 20

Peripheral Artery Disease

Answer 20

pts w PAD are at greater risk of having coronary and cerebral vascular disease than those without PAD

Question 21

PAD risk factors

Answer 21

smoking, atherosclerosis, diabetes, 60+

Question 22

PAD pts with intermittent claudification

Answer 22

start with short bouts of low intensity exercise
progressed to continuous low level exercise as tolerated

Question 23

PAD pts exercise rec

Answer 23

twice a day at low intensity
progress to 3x a day increase the intensity

Question 24

PAD pts with elevated resting systolic BP exercise rec

Answer 24

begin exercise at a low target HR

40-60% for cardiac pts
20-40% for pulmonary pts

Question 25

if a pts BP won't normalize during exercise what should happen

Answer 25

termination of the exercise

Question 26

alterations in exercise prescription for older adults

Answer 26

rest HR may be elevated warm up - longer and stretching often required support for balance

Question 27

physiological differences in older adults

Answer 27

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

Question 28

what do beta blockers do

Answer 28

affect HR and incrase fatigue

Question 29

what do diuretics do

Answer 29

affect blood volume and blood flow to muscle

Question 30

exercise duration for older adults

Answer 30

use intermittent exercise to tolerance

Question 31

exercise frequency for older adults

Answer 31

incorporate a day of rest between exercise sessions inless exercise is of very low intensity and short duration performing multiple times a day

Question 32

what % is okay to increase exercise

Answer 32

never increase more than 10% during one sessoin increase duration first up to 30-40 mins before adding increases in intensity

Question 33

what happens to adolescents and young adults for exercise

Answer 33

physical activity levels decline dramatically

Question 34

ExRx for young children intensity

Answer 34

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

Question 35

ExRx young children duration

Answer 35

perfrom 2-3 sets of 8-10 different exercises ensuring major muscle groups are included

Question 36

ExRx young children frequency

Answer 36

limit strength training to 2-3x/wk and encourage other forms of PA

Question 37

exRx children risks

Answer 37

avoid thermal injury chilren have increased risk of hypothermia

Question 38

warning signs to progress slowly - CHF

Answer 38

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

Question 39

indications to terminate exercise session

Answer 39

SBP > 200-220 DBP >110 HR >80-85% of predicted maximum

Question 40

prognosis and goal setting in cardiopulm PT

Answer 40

Prognosis for Pulmonary patients is guarded because of their up and down status - easily triggered

Question 41

prognosis and goals of pulm pts

Answer 41

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

Question 42

prognosis and goals - cardiac pts

Answer 42

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