Exam Flashcards
Aerobic metabolism
Requires oxygen
Utilizes carbs, fats, proteins
Byproduct: water, CO2
Yields 36 ATP/glucose
Types of cells: heart, CNS, PNS, skeletal muscle (slow twitch)
Anaerobic metabolism
O2 not required
Utilizes ONLY carbohydrates
By-product: lactic acid
Occurs in cytoplasm
Yields 2 ATP/glucose
Types of cells: CT (bone, cartilage, RBC), skeletal muscle fast twitch
Anaerobic threshold
No longer able to perform work solely via aerobic
~55% VO2max (+/- training and detraining)
VO2 max
Max capacity of the body to transport and use oxygen with exercise
Factors that affect VO2
Age
Sex
Genetics (muscle fiber type)
Body composition
Endurance training
Diseases that affect oxygen transport
Name meds with exercise implications to MITIGATE FALL RISK due to INCREASED BLEEDING RISK?
Anticoagulant (a-fib)
Platelet aggregation inhibitor (PAD)
Which medication has side effects of hypotension and bradyarrhythmia?
How does this affect exercise?
Med: Metoprolol (beta blockers)
Use RPE in conjunction with HR
Which med has side effects of tachycardia, palpitation, and tremors?
This leads to exercise implication of __.
Medication: Albuterol (fast-acting bronchodilator)
Use RPE in conjunction with HR
Which medication has side effects of increased MI and CVA?
Ipratropium (anticholinergic bronchodilator)
Which medication has side effects of hypernatremia and psychiatric distress?
How does it affect exercise?
Medication: Prednisone (adrenocortical steroid)
Monitor mental health and electrolyte balance with exercise (e.g. dry mouth)
Which medication blocks enzyme needed to make cholesterol and has side effects of increased glucose/HbA1c levels, myalgia/arthralgia, and tendon rupture?
How does this impact exercise?
Medication: Atorvastatin (HMG-COA reductase inhibitor)
Monitor arthralgia/myalgia and dysglycemia
NO EFFECT ON HR/BP
Which medication is used to treat GI ulcers and GERD and has side effects of increased fracture risk?
How does this affect exercise?
Medication: Omeprazole (proton pump inhibitor)
Mitigate fall risk due to increased fracture risk
Which medication is used for anxiety and has side effects of hypotension, palpitations, ataxia?
How does this affect exercise?
Alprazolam (benzodiazepine)
Mitigate fall risk due to syncope and hypotension
Which medication is used to treat intermittent claudication and side effects of palpitations and myalgia?
How does this impact exercise?
Medication: Cilostazol (platelet aggregation inhibitor)
Mitigate fall risk due to increased bleeding risk
Assumptions of submax testing (5)
- Steady state HR obtained
- HRmax given age is uniform (220-age)
- Mechanical efficiency same for everyone
- Linear relationship between HR and workload
- HR varies depending on fitness level
Karvonen formula
THR = (HRmax-HRrest)*(%intensity) + HRrest
High intensity rehab contraindications conditions <6 weeks
RAC-Pact
Rhabdo
Acute cardiac event (MI, vtach/vfib, CABG, pacemaker placement)
CVA
PE
Cerebral aneurysm treated any size
RAC-Pact
High intensity contraindications SEVERE/PROLIFERATIVE conditions (3)
“SPR of the moment, bc you will die soon with these conditions”
Severe mitral/aortic stenosis
Severe pulmonary HTN (pulmonary map <55)
Proliferative diabetic retinopathy
High intensity contraindications miscellaneous (5)
U DUMM
Unstable angina
Decompensated HF (worsening edema, fatigue, SOB at rest)
UNTREATED cerebral aneurysm
Mitral/aortic stenosis ANY SEVERITY WITH hx of syncope and WITHOUT corrective surgery
MD-order of no strenuous activity
High intensity precautions
LAMA - soc
Limb specific conditions
Abdominal precautions (e.g. hernia)
Moderate-severe NON-PROLIFERATIVE diabetic retinopathy
Aortic aneurysm
Severe osteoporosis/compression fracture
High intensity precautions limb specific (5)
OOF-DA
Osteomyelitis
Fracture
DVT within 6 weeks with anticoag
Avascular necrosis
Osteosarcoma/bone mets
Precautions for aortic aneurysm
No lifting >75lbs
Bp <150/100
No valsalva
Precautions for mod-severe (non-proliferative) diabetic retinopathy
Maintain BP <150/100
No valsalva
Normal vitals response to exercise
RR — increase
SBP — increase, but SBP <200, DBP <110
DBP — minimal to no change (0-10)
HR — increase
Within 5 mins of rest, BP and HR should return within 10 of baseline
Concerning exercise responses
CV System
SBP >200, DBP >110
SBP fails to rise or drops >10
HR decreases
Concerning exercise responses
Integumentary system
Cyanosis
Pallor
Diaphoresis
Clammy skin
Concerning exercise responses
Neuro
Dizziness/lightheadedness
Confusion
Ataxia
Shaking/tremors
Concerning exercise responses
Pain
Leg cramps or severe claudication
Chest/arm/jaw pain
Mod-severe angina
Concerning exercise responses
Respiratory
Dyspnea <5 words (mod-severe)
Abnormal breathing
<88% O2 or 10%+ drop from baseline
Concerning exercise responses
GI
Hypoglycemic response
Nausea/vomiting
Greatest CV change due to age?
Decreased contractility of heart’s LV wall = pumping capacity reduced
High intensity resistance training in PACE
Increased SPPB and gait speed
High intensity resistance training in home health
No significant difference on gait speed compared to usual care, both showed improvement
High intensity resistance training in telerehab
Increased performance on step test
High intensity resistance training in SNF
Increased SPPB, gait speed, discharge home, and LOS
Unstable vs. chronic angina
Unstable: can happen for any reason, even at rest. Increased risk of MI
Chronic: happens regularly, induced with exercise, heavy meal and/or stress
A-fib uncontrolled vs. controlled
Uncontrolled >100 bpm
Controlled <100 bpm
A-fib = HR does not work, greater clot risk
Ventilation =
tidal volume x respiratory rate
Both increase with activity
Gait/balance signs of failure
Further level of assistance
Unintentional speed decrease
Unintentional change in how body moves in space
Gait/balance goal vs. progress
Goal: 80% OR LESS of success
If patient shows more than 80% success with gait/balance exercise, signals time to progress
Gait speed as a determinant
Leg strength
Trunk muscle endurance
Timing and coordination
Self-efficacy
Endurance exercise effect on older adult
Primarily to improve CV health, not so much for muscle endurance since they typically have more type I fibers than type II
High intensity strength exercise effect on older adult
Decrease osteoporosis
Offset age-related loss of muscle mass and strength
