exercise prescription Flashcards by chaeley boykin

what re the normal ranges for cardiac patients at rest

HR: 60-100 beats/min
Systolic: <120 mmHG
Diastolic: <80 mmHG
Respiratory rate 12-20 beats per minute
Oxygen saturation: >95% on room air

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what is abnormal response of heart rate due to exercise

increases >30 Bpm above the resting heart rate with mild exercise
decreases below resting heart rate

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what is abnormal change in systolic BP seen in exercising

increases >20-30 mmHg above resting
decreases >10 mmHg bellow resting

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what are the other abnormal responses to exercise you may experience in a patient

spo2 level drops under prescribed level
patient becomes severely SOB
RR increases to a level not tolerated by a patient
ECG changes

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what is abnormal response to diastolic BP seen throughout exercise

normal: 0-10 mmHg higher from resting heart rate
abnormal more than a 10mmHg increase

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what are the calculations of mets to heart rate percent max?

60% max heart rate: 4.8 mets
80% max heart rate: 6.4 mets
met = 3.5 ml 02/kg/min

mets: max met level on a gxt is 8 mets.

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how do you calculate max heart rate?

max heart rate= 220-age
target HR is 60% of hr= max heart rate x .6

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exercise prescriptions intensities should be determined using what?

Must be of sufficient intensity to evoke a training effect determined by measuring and monitoring hemodynamic response

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cardiac patients with low functional compact should Strat around what percent of their max heart rate

40%-60% of max heart rate

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respiratory patients with low functional capacity should start at what percent of max heart rate

20% - 40% of max heart rate

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what are the normal responses to activity and exercises intensities for patients in acute care?

intestines and responses to activity can vary
duration is set to what the patient can handle - typically 5-15 minutes

frequency is normally 1-2x/day due to being reconditioned

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what two scales can be used to monitor inpatient distress while performing exercises

dyspnea scale=
1-5 asses SOB
1 = little breathless related to exercise
5= severe breathlessness related to exercise

angina scale=
1-5
1= slight pain perception
5= infraction pain

use egg, Hr watches, telemetry

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review the brainscape for 4 phases of cardiac rehab

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what does PAD put patients more in risk of developing

patients with severe pad are more at risk for developing coronary and cerebral vascular disease

risk factors include smoking, arteriosclerosis, diabetes and >60 yo

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how should you prescribe exercise to patients with PAD?

patients with intermittent classification should start with small bouts of low intensity exercise
progress to continuous exercise at a low intensity

durration:
twice a day at a low intensity
progress to 3 times a day and increase the intensity

start exercise for a low target HR
40-60% max heart rate for cardiac patients
20-40% for respiratory patients

failure of the BP to normalize= terminate the exercise session

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what should an exercise prescription look like for older adults

65+ years of age
- take into consideration physiological age vs chronological age

active vs sedentary
free of disease vs multiple dx

what are alterations to an exercise perscription you can make for older adults

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

what are the physiological differences of older adults

Decrease in maximal oxygen consumption (VO2)
Greater differences seen in sedentary vs. active

Changes in ventricular compliance

Decrease in maximal heart rate
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 are other possible phyisiological factors effecting older adults

osteoarthritis
visual issues
increased bp
might be on bp medications
beta bloker
diuretic

musculoskeletal limitations
posture and alignment
decreased flexibility and strength

other diangonis:
storke
hip fratures
memory
hearing impairment

what mode and intensity should you use for older adult patients

Mode:
Choose mode that accommodates for musculoskeletal dysfunction or other dysfunction
Unload joints when necessary
If balance problems: use stationary bike
Vary the exercise

intensity
Intensity:
Initiate with
lower intensity

Use of Karvonen
Formula = increased
Specificity of calculation

what should the duration and intensity be for older adults?

Duration:
Use intermittent exercise to tolerance

Frequency:
Incorporate a day of rest between exercise sessions unless the exercise is of very low intensity and short duration
performing multiple times per day

Progress exercise slowly
Never increase more than 10% during one session
Increase duration first, up to 30-40 minutes, before adding increases in intensity

duration increases first then intesity

what should a cool down look like for older adults

Cool down
Incorporate a good cool down stretching program

Research supports weight training for older adults

what re some social and style considerations for older adult patients

recommend good walking shoes with support and shock absorption
group activities or identify an exercise buddy
monitor for musculoskeletal breakdown or joint flair ups
monitor for changes in mental status

what are the exercise considerations in younger children on time they actually exercise?

Young children tend to choose short bursts of intense energy exercise rather than sustained activities

Adolescent and young adult
physical activity levels decline dramatically

Survey data: 21% of American youths aged 12 to 21 years meet the guidelines for 60 minutes of exercise per day
girls less active than boys as they grow older

what should you encourage your young child patient to do?

Encourage participation in a variety of activities that exercise all major large muscle groups weight bearing exercises optimize basic skills development weight management aerobic fitness bone mineral content

what does an exercise plan look like for an young child in fits principles:

Intensity: Weight loads: 8 or more repetitions to be completed heavy weights can damage developing skeletal and joint structures Avoid repetitive use of maximal amounts of weight in strength training during adolescence Duration: Perform 2 to 3 sets of 8 to 10 different exercises ensuring that all major muscle groups are included in early stages of training Frequency Limit strength training sessions to 2-3 times per week and encourage participate in other forms of physical activity

what are the safety considerations to be mindful of when working with a young child

children are anatomically, physiologically and psychologically mature children may experience a higher incidence go overuse injuries or damage the epiphyseal growth plates will excessive exercise

what are external factors we must be mindful of when working with patients that are children

Avoid thermal injury Children thermoregulate effectively in normal to moderate conditions Reduced ability to adapt to temperature extremes Children show less heat dissipation than adults Due to a lower sweat rate Greater heat production per kilogram of body weight Children also acclimate to heat more slowly than adults Children have increased risk of hypothermia high surface area-to-body mass ratio accelerates heat loss

what are the warning signs to progress slowly with a patient with 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

why would you terminate an exercise session

Cyanosis or severe pallor change Loss of sustained vigor or palpable pulses SBP > 200-220 DBP >110 HR >80-85% of predicted maximum Significant arrhythmia Onset of S3 Development of pulmonary rales

how is prognosis stated and adjusted for in cardiopulmonary patients

Prognosis for Pulmonary patients is guarded because of their up and down status easily triggered Prognosis is determined by their ability to achieve the outcomes and minimize exacerbations

what is the key to success in pulmonary patients

Key to achieving success with pulmonary patients is to address symptoms and activities  reduce the work of breathing Pulmonary rehabilitation intervention has been considered maintenance activity = third-party payers often limit the benefits

what are the goals for pulmonary rehabilitation?

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

what are some overall life goals that is important to keep in mind for pulmonary patients

Decrease psychological symptoms  anxiety or depression Improve quality of life Return the patient to gainful life and employment Promote independence and self-reliance

what are more medical goals for pulmonary patients

Reduce exacerbations and hospitalizations = decreased morbidity and mortality Encourage participation in recreational pursuits Assist with Nutritional Support

what is the prognosis in cardiac patients look like?

Cardiac Patients prognosis often more favorable as compared to pulmonary pts One time event that has some resolution Prognosis ranges from complete recovery, to surgical intervention or pharmacological management

what is the primary goal for cardiac patients

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 MI and CABG have been able to show a improvement in what?

significant improvement in aerobic capacity following exercise conditioning

when is the greatest improvements found for cardiac patients?

lowest initial max VO2