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Cardiopulmonary > exercise prescription > Flashcards

exercise prescription Flashcards

1
Q

what re the normal ranges for cardiac patients at rest

A

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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2
Q

what is abnormal response of heart rate due to exercise

A

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

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3
Q

what is abnormal change in systolic BP seen in exercising

A

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

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4
Q

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

A

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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5
Q

what is abnormal response to diastolic BP seen throughout exercise

A

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

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6
Q

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

A

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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7
Q

how do you calculate max heart rate?

A

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

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8
Q

exercise prescriptions intensities should be determined using what?

A

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

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9
Q

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

A

40%-60% of max heart rate

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10
Q

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

A

20% - 40% of max heart rate

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11
Q

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

A

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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12
Q

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

A

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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13
Q

review the brainscape for 4 phases of cardiac rehab

A
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14
Q

what does PAD put patients more in risk of developing

A

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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15
Q

how should you prescribe exercise to patients with PAD?

A

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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16
Q

what should an exercise prescription look like for older adults

A

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

active vs sedentary
free of disease vs multiple dx

17
Q

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

A

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

18
Q

what are the physiological differences of older adults

A

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

19
Q

what are other possible phyisiological factors effecting older adults

A

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

20
Q

what mode and intensity should you use for older adult patients

A

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

21
Q

what should the duration and intensity be for older adults?

A

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

22
Q

what should a cool down look like for older adults

A

Cool down
Incorporate a good cool down stretching program

Research supports weight training for older adults

23
Q

what re some social and style considerations for older adult patients

A

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

24
Q

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

A

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

25
Q

what should you encourage your young child patient to do?

A

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

26
Q

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

A

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

27
Q

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

A

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

28
Q

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

A

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

29
Q

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

A

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

30
Q

why would you terminate an exercise session

A

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

31
Q

how is prognosis stated and adjusted for in cardiopulmonary patients

A

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

32
Q

what is the key to success in pulmonary patients

A

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

33
Q

what are the goals for pulmonary rehabilitation?

A

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

34
Q

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

A

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

35
Q

what are more medical goals for pulmonary patients

A

Reduce exacerbations and hospitalizations = decreased morbidity and mortality

Encourage participation in recreational pursuits

Assist with Nutritional Support

36
Q

what is the prognosis in cardiac patients look like?

A

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

37
Q

what is the primary goal for cardiac patients

A

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

38
Q

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

A

significant improvement in aerobic capacity following exercise conditioning

39
Q

when is the greatest improvements found for cardiac patients?

A

lowest initial max VO2

Cardiopulmonary (6 decks)

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