Exercise Prescription Flashcards
What are the two BACPR referral pathways?
Outpatient rehabilitation and primary care/GPs.
What is the importance of adhering to BACPR approved standards?
Cannot be overstated.
Who can benefit from long-term (Phase IV) community-based exercise prescription?
- Individuals post myocardial infarction
- Individuals post percutaneous coronary intervention
- Individuals with stable chronic heart failure
- Individuals post coronary artery bypass graft surgery
- Individuals with stable angina
- Individuals post valve replacements
- Individuals with permanent pacemaker
- Individuals with implanted cardioverter defibrillator
- Individuals post cardiac transplant.
Fill in the blank: The opportunity for inclusion of _______ of individuals with coronary heart disease may also be considered.
spouses/partners and family members.
What must extra participants receive before starting their exercise?
Appropriate and relevant screening, assessment, and guidance.
What must be done if exclusion criteria occur after the exercise program has commenced?
The client must be referred back to and evaluated by an appropriate health, rehabilitation or medical practitioner
This applies to signs and symptoms or contraindications to exercise occurring on any occasion.
What should clients understand regarding contraindications to exercise?
Clients should come to know these contraindicating factors and not perform exercise until they are resolved
This helps in developing skills and knowledge for future independent activity.
What is a risk for participants who find it difficult to monitor their exertion levels?
Increased risk of an exertion-related cardiac event
Such participants should receive additional guidance on monitoring exertion levels.
List three absolute contraindications to exercise.
- Unstable angina
- Unstable or acute heart failure
- Unstable diabetes
These contraindications require evaluation before resuming exercise.
What must happen in the case of febrile illness regarding exercise resumption?
The client must wait for the fever/illness to be completely resolved and return to normal health
A health practitioner may also need to confirm resolution in serious cases.
What is an example of a sign or symptom that indicates a need for medical evaluation before exercise?
New angina diagnosed within the previous month
Any change in the pattern of established angina also requires evaluation.
What condition is indicated by fluid retention, evidenced by excessive breathlessness and rapid weight gain?
Heart failure
Swollen ankles and pitting edema are also indicators.
What should be monitored if medication has been reviewed or changed within the previous month?
Control of blood glucose levels
Incidences of hyperglycemia and repeated hypoglycemic episodes should also be monitored.
What heart rate condition indicates a potential problem during exercise?
Resting high heart rate or inappropriate rapid rise in heart rate during exercise that does not stabilize on rest
This requires further evaluation.
True or False: Hypertension usually has clear signs or symptoms.
False
Hypertension is often asymptomatic and detected only through blood pressure monitoring.
What symptoms might indicate a need for medical evaluation related to exercise?
- Light-headedness
- Dizziness
- Fainting when changing positions
- Feeling unwell or feverish
These symptoms can indicate instability or other health issues.
What is the clinical stability criterion for exercise programming?
Clinically stable means no change in symptoms or significant change in medication during the preceding month.
What is the target heart rate range for moderate intensity activities?
40-70% HRR or RPE Borg scale 11-14 or 2-4 (CR10 scale)
What commitment should clients ideally show in a long-term exercise setting?
Commitment to monitor and regulate the intensity of their activity.
What should be provided for individuals unable to sustain moderate intensity activities?
A clear risk stratification for lower functioning patients.
What is required from BACPR instructors when assessing referred clients?
A standard screening and assessment must still be carried out.
What is a crucial step if clients develop symptoms listed in Box 9.3?
They may need to be referred back to their primary care team / GP.
What should be discussed with clients regarding new symptoms?
Discuss to exclude ‘innocent’ explanations like non-adherence to the home programme.
What should be documented if clients are not complying with their medication?
Document the non-compliance and refer back to their GP.
What can non-compliance to key medications increase the risk of?
Exertion-related cardiac events.
Fill in the blank: Deteriorating exercise performance despite apparent compliance may require referral back to the _______.
GP
What are some reasons for referring a client back to their GP? (List at least two)
- Deteriorating exercise performance
- Worsening of angina or development of unstable angina
True or False: A referral from an outpatient rehabilitation program absolves BACPR instructors from performing an assessment.
False
What should be documented in the post-rehabilitation documentation by BACPR Instructors?
The assessment of a referred client’s ability to exercise safely.
What symptom might indicate a need for referral back to a GP in clients?
Excessive breathlessness despite apparent compliance with prescribed medication.
What is the primary responsibility of the primary care team regarding a patient’s long-term goals?
Supporting smoking cessation, weight control, healthy eating patterns, and physical activity levels
The primary care team also monitors indicators like cholesterol levels and hypertension.
What should the aims and objectives of a long-term exercise programme do?
Complement the role of the primary care team
Effective programmes reflect partnerships between various bodies, including public health and local leisure providers.
Define the principle of overload in exercise programming.
Overloading the body challenges it beyond its current capacity to create the necessary stimulus for adaptation.
What does progression refer to in exercise programming?
Continuation of overload, requiring further overload after the initial stimulus to create necessary adaptation.
What is meant by ‘Progressive Overload’?
The coupling of progression and overload in exercise training.
List the recommended exercise training aims.
- Provide regular supervised exercise sessions
- Establish individualised exercise prescription
- Offer advice and support for lifestyle changes
- Encourage independence and self-motivation
- Review participants’ progress regularly
What is the consequence of performing exercise at the same intensity for the same duration repeatedly?
No fitness improvements will be seen.
How should overload be created in exercise programming?
By increasing intensity, frequency, or duration of training
Only one variable should be increased at a time.
What should happen if progression in exercise programming is too slow?
Improvements will be unlikely and hard to perceive.
What can occur if progression is applied too fast in exercise programming?
Injury or illness may occur.
Fill in the blank: If no _______ is applied, no further fitness improvements will be seen.
progression
Provide an example of gradual progression in exercise.
Increasing resistance from 1 set to 2 sets or increasing CV intensity from 60% HRR to 65% HRR.
What does individualisation in exercise programming mean?
Programs need to be designed to account for individual differences.
What is specificity in the context of exercise training?
The body will only adapt according to the exact type of overload placed upon it.
What happens to fitness levels after one to two weeks of detraining?
Fitness will be noticeably reduced.
What is the term for losing adaptations due to stopping training?
Detraining.
Why is recovery time important in a training program?
Without recovery, fitness adaptations will not take place.
What does exercise programming need to be centered around?
The patient’s goals.
How long can it take to lose training adaptations completely with no activity?
A few months.
What should be lowered if a patient has missed several weeks of rehabilitation?
Exercise intensity.
What is an example of how to modify exercise programming?
Increase or reduce intensity or duration if required.
What can overtraining result in?
Long-term decreases in performance and impaired ability to train.
True or False: Training programs should follow a one-size-fits-all approach.
False.
What factors should influence the initial and subsequent progression of the exercise prescription?
- Patient’s fitness level
- Exercise experience
- Comorbidities
- Risk stratification
- Goals
What does adaptability in exercise programming refer to?
The ability to modify the program as needed.
What is a recommended practice regarding resistance training (RT) frequency?
RT should not be performed on consecutive days.
Fill in the blank: The training period provides the stimulus for development; the _______ allows the adaptations to take place.
recovery period.
What are the main components of fitness to consider in programme design?
Aerobic and resistance training
Balance and flexibility should also be considered.
What should be considered for motor skills development and fall prevention?
Balance and flexibility
These are important for aiding motor skills.
What is the typical structure of long-term exercise programmes in the UK?
Specialist groups, usually studio or gym-based/home-based circuit training
Many programmes limit the time clients may stay in these groups.
What is an exit strategy in the context of specialist exercise groups?
A plan developed by management to transition clients to independent or mainstream activities
This is done in consultation with local coordinators and primary care teams.
What should BACPR exercise instructors avoid to promote client independence?
Perpetuating a sense of dependence
Instructors should encourage self-help and long-term lifestyle changes.
What is the recommended duration for a warm-up before aerobic exercise?
A minimum of 15 minutes
Warm-up should include pulse-raising, mobility, and stretching.
What are the key mechanisms triggered during pulse-raising activities?
Increased coronary blood flow, raised ischaemic threshold, and reduced risk of angina and arrhythmias
These mechanisms are essential for matching myocardial demands.
What should you do before starting an exercise session?
Advise the person in charge of any changes in symptoms, medication, test results, joint problems, or general health
This includes new or worsening chest pain, breathlessness, etc.
What should you report during an exercise session?
Any angina, chest discomfort, dizziness, joint problems, or feelings of being unwell
This ensures safety during exercise.
What should be brought to the exercise class if prescribed?
GTN (glyceryl trinitrate)
Even if it is not used regularly, it is important to have it on hand.
Fill in the blank: The coronary arteries vasodilate as a result of increased _______.
metabolic activity
This is due to various metabolic by-products.
What are endothelial vasodilators that contribute to increased coronary blood flow?
Nitric oxide
These help dilate coronary arteries.
True or False: Sympathetic activity contributes to vasodilation of coronary arteries.
True
However, this effect is to a lesser degree compared to metabolic activity.
What is the key point regarding coronary arteries during exercise?
Coronary arteries are dilated, and the risk of ischaemia is reduced
This is critical for safe exercise.
What is advisable for the older average age group during range of motion exercises?
A relatively gradual progression of range of motion exercises is advisable.
What activities should be combined to maintain elevated cardiac output during warm-up?
Pulse (metabolism) raising and mobility activities.
For clients with impaired motor skills, what type of activities may be necessary?
Activities that intersperse flexibility/mobility activities with light intensity aerobic activities.
What types of stretches should be included in the warm-up?
Either slow full-range moving stretches or short duration static stretches.
What are the benefits of including stretches in the warm-up?
- Ensure participants explore their full natural range of movement
- Encourage good balance and alignment
- Help identify tight or sore muscles prior to exercise
- Practise positions for maintaining or developing flexibility.
What should be performed with upper body stretches during the warm-up?
Upper body stretches should be performed with the feet moving.
What should be interspersed with lower body stretches?
Dynamic movements designed to maintain an elevated heart rate.
What is the target heart rate range by the end of the warm-up period?
Within 20 bpm below the lower end of their target training heart rate.
What is a recommendation regarding the use of music during warm-up?
Instructors should develop the skill of teaching warm-up without using music.
Why is it suggested to limit the use of music during warm-up?
- Music can over-motivate participants
- It prevents self-pacing
- Competing for attention with the instructor’s voice can hinder information absorption.
What should be included prior to starting the conditioning component?
A ‘re-warm’ consisting of simple pulse-raising movements (2-3 minutes).
What is one of the main objectives of exercise in cardiac rehabilitation?
To improve fitness by employing the principles of training.
What do the FITT principles stand for in aerobic training?
- Frequency
- Intensity
- Time
- Type
What does continuous training involve?
Uninterrupted activity, usually performed at a constant sub-maximal intensity.
What is an example of continuous training?
Going for a 2-mile walk at a relatively constant speed of 3 mph.
What does interval training entail?
Bouts of relatively more intense work interspersed with bouts of lighter activity or Active Recovery.
What is the recommended frequency for aerobic exercise training?
At least 3 times per week.
What is the suggested intensity range for aerobic exercise?
40-70% HRR, RPE 11-14 or CR10 2-4.
What is the recommended duration for aerobic exercise?
20-60 minutes.
What type of activities should be used in aerobic exercise?
Activities that use large muscle groups in a rhythmic manner.
What does Active Recovery (AR) involve?
Performing short-term lighter intensity activities in-between bouts of targeted conditioning exercises
What are the two key factors that determine the length of the AR period?
- Intensity and duration of the preceding bout of targeted conditioning exercise
- Fitness level of the client
What is one example of how intervals of targeted conditioning and AR can be performed?
Running on a treadmill for 5 minutes at 70% HRR followed by 1 minute of AR walking at 40-50% HRR
What is another example of combining targeted conditioning with AR?
1 minute of step-ups at a targeted RPE of 14 followed by AR 1 minute of biceps curls with a light weight or no weight
What practical consideration should be taken during upper body AR?
Feet need to be kept moving or toes wriggling
What is the target intensity range for aerobic exercises?
40-70% VO,max/METs max or 40-70% HRR or RPE 11-14
What is the duration of the recommended warm-up?
15 minutes
What is one advantage of the interval approach to exercise?
A greater total volume of aerobic exercise may be achieved than with continuous exercise
Why is the interval approach beneficial for clients with low fitness levels?
It provides a greater stimulus for physiological adaptation
What is the eventual goal of exercise based on the FITT principle?
To achieve continuous aerobic exercise
What must BACPR instructors demonstrate in their program design?
The ability to design a programme flexible enough to accommodate clients benefiting from both interval and continuous approaches
What is the recommended total cardiovascular work duration?
20-30 minutes plus MSE and/or AR
What is the duration of the cool-down in the exercise programming?
45-60 minutes
Fill in the blank: The interval approach is advantageous for achieving a greater total volume of aerobic exercise than _______.
[continuous exercise]
What is High Intensity Interval Training (HIIT)?
A mode of exercise training that alternates between short bouts of high and low intensity exercise.
What intensity is often considered ‘high intensity exercise’?
> 85% peak power output or VO2max.
Is HIIT a safe method of exercise for patients with stable CAD and Chronic Heart Failure?
Yes.
How does HIIT compare to moderate intensity continuous exercise training in improving peak aerobic fitness?
HIIT can improve peak aerobic fitness to a greater extent.
What are the attrition and adherence rates of HIIT compared to moderate intensity continuous exercise training?
They appear to be similar.
What is the recommendation for using HIIT in exercise programming?
HIIT should be recommended when similar protocols for exercise testing and prescription are available.
List some supervised activities that improve fitness in individuals with heart disease.
- Circuit training
- Gym-based exercises (bicycles, steppers, treadmills, rowing machines)
- Walking/jogging programmes
- Exercise to music classes (step and line dancing)
List some unsupervised activities that can improve fitness.
- Walking/jogging
- Cycling
- Swimming
- Individual gym programme
- Home-based equipment (stationary cycles, rowing machines, steps, mini-trampoline)
What is the minimum duration for a cool-down period?
10 minutes.
Why is it inadvisable to intersperse lying down exercises with aerobic exercise?
Increased myocardial workload and risk of arrhythmias.
What is a risk of returning to an upright position after lying down?
Increased risk of orthostatic hypotension.
What age-related factor increases the risk of hypotension in older adults post-exercise?
Age-related slowing of baroreceptor responsiveness.
What effect do high levels of circulating catecholamines have post-exercise?
They increase the risk of arrhythmias.
What is the key point regarding an extended cool-down period?
Reduces risk of arrhythmias and hypotension.
What is Design A in aerobic training programmes?
Example of a non-equipment circuit
Includes exercises that do not require any equipment.
List the CV Stations in Design A.
- CV Station A: Half Star
- CV Station B: Hamstring curl
- CV Station C: Knee raises
- CV Station D: Backward Lunges
- CV Station E: Shuttle walk
Each station represents a different aerobic exercise.
What exercises are included in Design A?
- Bicep curls
- Wall press ups or tricep kick backs
- Seated low row
- Upright row
- Chest press
These exercises target various muscle groups and can be performed without equipment.
What is Design D in aerobic training programmes?
Aerobic endurance training programme in a home-based setting
Focuses on exercises that can be done at home without specialized equipment.
What is the focus of Design E?
Independent walking programme
Emphasizes walking as a primary form of aerobic exercise.
What type of recovery area is mentioned in Design A?
Active Recovery Area (weights, resistance bands & chairs for seated row)
Used for recovery between exercises in the circuit.
Fill in the blank: Design B utilizes _______.
[equipment]
Refers to the use of equipment in aerobic training.
True or False: Design C includes a gym setting for aerobic endurance training.
True
Design C is specifically tailored for a gym environment.
What do the uppercase letters ‘ABCDE’ represent in the circuit format?
Aerobic (CV) stations
What do the lowercase letters ‘abcde’ represent in the circuit format?
AR (aerobic resistance) stations
How long is each interval of aerobic activity during the class?
1 minute
What is the recommended number of repetitions to be completed at AR stations?
10-15 repetitions
What should participants do if they complete their repetitions before the time is called?
March on the spot
Which exercise is noted as being unable to be performed bilaterally?
Triceps kick back
What alternative exercises can participants perform if there is insufficient time for triceps kickbacks?
- Push-ups against a wall
- Triceps dips using a chair against a wall
What is a key consideration for incorporating equipment in the circuit?
There may be more people at a station than equipment available
What should an instructor continuously do to ensure proper technique?
Monitor participants and correct poor technique
What should participants note during each bout of CV work?
Their rating of perceived exertion (RPE)
What is the total CV time for Level 1 participants?
12 minutes
What is the total AR time for Level 1 participants?
12 minutes
What is the CV to AR ratio for Level 2 participants?
1 CV:1 AR ratio
At which levels do the majority of participants perform?
- Level 2
- Level 3
- Level 4
What is the biggest progression in the amount of aerobic exercise performed?
Between Levels 1 & 2 and Levels 4 & 5
What is the recommended number of sets and repetitions for participants at levels other than Level 5?
At least 1 set of 10-15 repetitions
Why is it important for new clients to be familiarized with the circuit format?
To avoid confusion
Fill in the blank: Participants must remember how many consecutive CV stations they are expected to perform before going into the _______.
AR area
True or False: Participants at Level 5 are expected to perform their resistance training in the same session as CV.
False
What type of environment does the circuit design create among participants?
A sociable programme
What is the total CV time for Level 5 participants?
24 minutes
What is the layout format of the circuit described?
Alternates 6 aerobic (CV) stations and 6 AR stations
How long does each participant complete the aerobic exercise at the odd-numbered stations?
1 minute
What is the purpose of reducing the time spent in active recovery?
To progress to more continuous aerobic exercise
What is the role of the walk/jog around the perimeter?
To supplement the aerobic training
What is used as active recovery (AR) between the stations?
Walking up and down between the stations
What does Borg’s RPE scale provide at every station?
Visible reference for exertion levels
What is the duration of the stations in the circuit design?
1 minute with the option to reduce AR to 30 seconds
What instruction does the instructor give at the start of each minute?
Calls ‘Change’
What should those at the even-numbered stations do after 30 seconds?
Walk
How many times is the circuit completed?
Twice
What intensity should the walk be completed at?
The intensity of the CV stations
Fill in the blank: The circuit includes _____ aerobic stations and _____ AR stations.
6 aerobic stations and 6 AR stations
True or False: The aerobic stations are numbered with odd numbers.
True
List the first three aerobic stations in the circuit.
- Stationary Bicycle
- Lateral Raises
- Side step
List the first three AR stations in the circuit.
- Seated Low Row
- Tricep Dip/Kickback
- Upright Row
What is the total CV time for Level 1 in Design B?
12 minutes
What additional time is added for Level 2 in Design B?
30 seconds additional CV work
What is the total AR time for Level 3 in Design B?
24 minutes
How can additional graduations of progression be achieved?
By missing out every other AR station and replacing it with aerobic training through walking or jogging
What is the recommended duration for aerobic stations if numbers/equipment allow for all participants to start on an aerobic station?
2 minutes at odd numbers and 1 minute at even numbers
What is an alternative mode of AR for participants with orthopaedic limitations?
Walking
What is the layout structure of the circuit in Design B?
CV stations on one side and AR on the other
What should the instructor call halfway through the minute for Level 1 participants?
‘Walk’
What can be done if calling the time after 30 seconds proves difficult?
Ask a second instructor to call after 30 seconds
How can the circuit of alternating CV and AR stations be arranged for easier movement?
As a ‘clock’ style circular circuit
What is one way to progress aerobic exercises without equipment?
Increase range of movement and/or add an appropriate arm movement
For the Half star / side tap exercise, how can it be progressed?
Increase range of movement and/or add an arm movement
How can the hamstring curl exercise be progressed?
Increase range of motion and/or add an arm movement
What progression can be made for knee raises?
Increase height of knee and/or add an arm movement
What is a way to progress the backward lunge exercise?
Increase range of motion and/or add an arm movement
What are the progression steps for the shuttle walk/jog?
- Walk
- Fast walk
- Walk in one direction and jog back
- Gentle jog in both directions
- Run
What is the purpose of increasing range of motion or adding arm movement in side stepping?
To enhance the effectiveness of the exercise.
How can squats be progressed?
By increasing range of motion and/or speed.
What should be considered when incorporating squats into a circuit?
The ability of the participant and how the exercise is performed.
What does performing 1 squat represent for someone who struggles to rise from a chair?
1 repetition maximum.
What muscle groups are challenged by performing 10-15 repetitions of squats?
- Quadriceps
- Hamstrings
- Gluteus maximus
What is the effect of performing squats rhythmically for a prolonged period?
It provides a stimulus to increased aerobic fitness.
Why is using squats as a recovery from an aerobic station generally inappropriate?
It engages the same muscle groups as the preceding aerobic exercise.
What must be adapted if squats are included as an aerobic exercise?
The depth and rate of the squat.
What is generally recommended for setting the rate of exercise in aerobic stations?
Set the rate and alter the resistance to elicit a heart rate response within the THRR.
What is the recommended stepping speed for increasing step height?
Between 18 and 24 cycles per minute.
What is the target revolutions per minute for a stationary cycle?
Between 50 to 55 revolutions per minute.
What is the target stroke rate for a rower?
Between 25 to 30 strokes per minute.
What is the recommended resistance and revolutions per minute for a stepping machine/cross trainer?
Increase resistance maintaining 50-60 revolutions per minute.
Describe the cycle for the astride step exercise.
1 foot up onto the step, 2nd foot up onto the step, 1st foot down onto the floor, 2nd foot down onto the floor.
What can be added to the astride step for added impact?
Stepping down from the step and jumping back up.
What should be increased in rebounder/mini trampette exercises?
Range of movement of legs and arms.
What is the progression for the upright row exercise?
Increase resistance using dumbbells, resistance bands, or body bar.
What equipment can be used to increase resistance in lateral raises?
Dumbbells or resistance bands.
What exercise involves increasing resistance using resistance bands and is performed seated?
Seated low row.
How can resistance be increased for the chest press exercise?
Using resistance bands.
What can be used to increase resistance for biceps curls?
Dumbbells, resistance bands, or body bar.
What alternative can be used to triceps kickbacks for increased resistance?
Triceps dips.
What is the starting position for a wall press-up to increase difficulty?
Feet further away from the wall.
What can be done to progress the effect on the pectoral muscle in wall press-ups?
Move hands further apart.
What does AET stand for in the context of training?
Aerobic Endurance Training
What is the initial total cardiovascular (CV) time achieved by the client in the example?
16 minutes
What was the average RPE for cardiovascular (CV) training in the early rehab phase?
13
What intensity target is set for cardiovascular (CV) training?
60-70% HRR / RPE 13-14
What is the total time for the warm-up in the training program?
15 minutes
How long should the graduated warm-up on treadmill/bike last?
6 minutes
What is the RPE target for the initial warm-up phase?
<11
How long is the cooldown phase in the training program?
10 minutes
What is the frequency of the training sessions recommended?
2-3 times per week
In Level 1, what is the duration of total CV in interval bouts?
4 minutes
What is the active recovery (AR) duration between intervals in Level 1?
1 minute
What is the total CV time in Level 2?
20 minutes
In Level 3, how long is each total CV interval bout?
6 minutes
What is the duration of AR between bouts in Level 3?
30 seconds
What is the unique feature of Level 4 training?
6 minutes CV at 65% THR with no AR
What principle should the resistance content follow according to the program?
FITT principle
What should be done after total CV work before the cooldown?
Add some resistance content
Fill in the blank: The final 10-minute graduated cool-down would end the session and include _______ stretches.
maintenance / developmental
True or False: The resistance training program must be completed on a different day from the aerobic endurance training.
False
What is the target RPE for the warm-up in the aerobic endurance training programme?
9-10
How long is the total CV time in the example programme?
20 mins
What is the average RPE for CV during Early Rehab?
13
What is the intensity target for CV in terms of HRR?
60-70% HRR
What are the two types of exercises included in the home-based programme?
- CV (Cardiovascular)
- AR (Resistance)
What is the duration of the cool down in the exercise programme?
10 mins
Fill in the blank: The individual home-based programme adopts an _______ approach leading to continuous CV.
interval
What exercise corresponds to CV1 in the programme?
Walk forward/backwards
What exercise corresponds to AR1 in the programme?
Upright row with hand weights or water bottles
How many times is the circuit completed in the home-based programme?
Twice
What is the average RPE for AR during the programme?
11
What is the recommended resistance approach for AR in Level 2?
Resistance is increased as appropriate
What is the total AR time in Level 1 of the programme?
10 mins
In Level 3, what is the total CV time?
26 mins
True or False: The resistance training should be completed on a different day from the CV work.
False
What principle should the resistance content follow?
FITT principle
What is the total time for Level 5 of CV exercises?
28 mins
What type of movements are included in the AR exercises?
- Resistance exercises with hand weights or water bottles
- Bodyweight exercises
Fill in the blank: The final 10-minute graduated cool down would then end the _______.
session
What is the purpose of the ‘graduated pulse lowering’ mentioned in the programme?
To gradually decrease heart rate after exercise
What is the recommended warm-up duration for the walking programme?
1 minute each of alternate heel lifts, side steps, heel digs, tap backs, side taps, followed by 10 minutes of leisurely walking
What is the target RPE (Rate of Perceived Exertion) for the leisurely walking pace?
9-11
What is the duration of the main workout in the walking programme?
20-30 minutes
What is the target RPE for brisk walking during the main workout?
12-14
What is the progression level for 2 minutes of brisk walking?
Level 1
How many minutes of brisk walking are prescribed in Level 6 of the progression?
30 minutes
What is the cool-down duration after the walking programme?
10 minutes
Which muscles should be stretched during the cool-down?
Calves, quads, and hamstrings
What are some methods to increase the intensity of walking?
- Increasing stride length
- Adding an incline
- Larger arm swing
- Carrying a bag in each hand
- Wearing a rucksack with weight
What are contraindications for resistance training?
Ischaemia on activities < 5 METS
What should be considered for safety in resistance training?
- Recovery from bypass surgery
- Exercise technique
- Muscle balance
- Breathing pattern (avoid Valsalva manoeuvre)
- Appropriate training for exercise professionals
What is the recommended warm-up duration for resistance training?
15 minutes
What specific techniques can be included in the warm-up for resistance training?
- Warm-up set of 10-15 repetitions at a light load
- Specific joint mobilization exercises
What do the FITT principles for resistance training emphasize?
Inclusion of all major muscle groups to avoid muscle imbalances
What is the importance of including all major muscle groups in resistance training?
To avoid muscle imbalances which may lead to postural changes and muscle weakness
Fill in the blank: The warm-up for resistance training may include a warm-up set of _______ at a light load.
10-15 repetitions
What should be considered when starting a resistance training program for a client?
Start on the low end of the FITT table, such as 1 set per exercise and lower load/RPE
Gradually increase sets and load as the client becomes fitter and stronger
What are the modes of resistance training?
- Body weight
- Free weights
- Fixed resistance machines
- Portable equipment (e.g., resistance bands, kettlebells)
Modes are flexible depending on availability
What is the recommended frequency for resistance training?
2-3 times per week on non-consecutive days
This frequency helps in recovery and muscle adaptation
What is the recommended repetition range for resistance training exercises?
10-15 repetitions of each exercise without significant fatigue
RPE should be 11-13 on a 6-20 scale or 40%-60% of 1RM
What is the recommended number of sets and exercises for resistance training?
1-3 sets; 8-10 different exercises focused on major muscle groups
This structure promotes balanced muscle development
What should be selected for resistance training?
Equipment that is safe and comfortable for the individual to use
Safety and comfort are crucial for compliance and effectiveness
What is the duration of the cool-down after resistance training?
The cool-down should last 10 minutes
It should follow the same structure as for aerobic training
Does muscle stretching after exercise influence exercise-induced muscle damage (DOMS)?
No, muscle stretching performed after exercise does not influence DOMS levels
However, repeated bouts of stretching during the days following exercise may reduce muscle stiffness
What should be done prior to commencing resistance exercises after aerobic training?
A 5-minute cool-down is required before commencing the resistance exercises
This helps avoid issues such as hypotension, arrhythmias, and ischaemia
Can resistance training programs be standalone?
Yes, resistance training programs can be standalone or completed at the end of an aerobic exercise training program
They can be designed for gym or home settings
What is the structure of an individualised resistance training (RT) programme?
1-3 sets of 10-15 reps covering 8-10 major muscle groups.
What is the target RPE after 10 reps in a resistance training programme?
12-13
What is the recommended duration for the concentric and eccentric phases per repetition?
1-2 seconds concentric, 3 seconds eccentric
What should be done if a participant can perform 15 reps in a resistance training exercise?
Increase volume by increasing resistance and progressively increase the number of sets.
What is the total warm-up duration recommended before resistance training?
15 minutes
What activities are included in the warm-up for resistance training?
10 mins graduated pulse raiser on bike, plus mobilisation progressively increasing ROM and 10-15 reps of lighter weights preceding each exercise.
List four exercises included in the resistance training programme.
- Chest press
- Leg press
- Triceps extension
- Hip abduction
How many sets and reps are recommended for the deadlift with kettlebell?
1 set of 10-15 reps
What is the RPE for the first set of the lateral raise exercise?
12
How many reps and sets are recommended for biceps curl at RPE 12-13?
1 set of 10-15 reps
What is the cool-down duration recommended after resistance training?
10 minutes
What activities are included in the cool-down for resistance training?
Graduated pulse lowering movements and final maintenance or developmental stretches.
Fill in the blank: If a participant can perform 15 reps, they should _______.
increase volume by increasing resistance
True or False: The resistance training programme includes exercises for all major muscle groups.
True
What is the recommended RPE for 2 sets in the resistance training programme?
12-13
What is the progression level for resistance training from 1 set to 3 sets?
Increase from 1 set of 10-15 reps at RPE 12 to 3 sets of 10-15 reps at RPE 13.
List two exercises that require 2 sets of 10-15 reps at RPE 12-13.
- Lat pull down
- Lateral raise
What are the key components of a resistance training programme warm-up?
- Graduated pulse raiser
- Mobilisation increasing ROM
- Lighter weights preceding exercises
What is the focus of an individual Home Resistance training (RT) programme?
An individualised plan based on client’s need and goals.
What is the recommended number of sets and reps for major muscle groups in a home RT programme?
1-3 sets of 10-15 reps.
What is the target Rate of Perceived Exertion (RPE) after 10 reps?
12-13.
What should the tempo be for each repetition during the exercise?
1-2 second concentric, 3 second eccentric.
What should a participant do if they can perform 15 reps?
Increase volume by increasing resistance or number of sets.
What is the recommended warm-up duration for a home RT programme?
Total 15 minutes.
What activities are included in the warm-up?
- 10 mins graduated pulse raising movements
- Mobilisation progressively increasing ROM
- 10-15 reps of lighter weights preceding each exercise.
What is the RPE for the Wall press or Chest Press exercise?
RPE 13.
What is the RPE for the Sit to stand or Squats exercise?
RPE 12.
What equipment can be used for Triceps extension in the home RT programme?
Hand weights or filled water bottles.
What is the RPE for the Hip Abduction exercise?
RPE 12.
What is the RPE for the Lateral raise exercise?
RPE 12.
What is the RPE for the Bent over row exercise?
RPE 12.
What is the RPE for the Biceps curl exercise?
RPE 12.
What is the RPE for the Upright row exercise?
RPE 12.
What is the recommended cool-down duration for a home RT programme?
10 mins.
What should the cool-down consist of?
- Graduated pulse lowering movements
- Final maintenance/developmental stretches.
Fill in the blank: If a participant can perform 15 reps, they should _______.
[increase volume by increasing resistance or number of sets]
Why is incorporating balance exercises important for clients?
To reduce the risk of falls and improve confidence and function.
What is a basic example of a balance exercise?
Stepping on a trampette while holding the handrail.
What are the FITT principles for flexibility training?
- Frequency: 2-3 days per week, daily being most effective
- Intensity: To the point of feeling tightness or slight discomfort
- Time: 10-30 seconds hold, 4 repetitions of each exercise
- Type: Static and dynamic stretching focused on major joints and lower back.
What is adaptive shortening?
Muscles becoming less flexible due to age, inactivity, or poor posture.
Why are PNF stretches generally not appropriate for patients with coronary heart disease?
The isometric contraction involved leads to increased blood pressure.
What is the recommended exercise frequency for individuals with coronary heart disease who have graduated from Phase III programmes?
At least three times per week.
What is the target duration for exercise sessions for these individuals?
20-60 minutes.
What percentage of HRmax is recommended for exercise intensity in this population?
60-80% of HRmax.
What should be recorded on the information sheet when a patient transfers to the exercise programme?
The training heart rate or rating of perceived exertion established during Phase III.
What signs and symptoms should be monitored to determine appropriate response to exercise?
- Excessive breathlessness
- Loss of quality of movement
- Skin colour
- Sweat rate.
What is considered the ‘gold standard’ for determining target heart rate?
Performing a graded and maximal exercise test.
What is the estimated heart rate threshold for exercise based on %HRR?
Between 40% and 70% of heart rate reserve.
Fill in the blank: Developmental stretches should be introduced for muscles that are subject to _______.
adaptive shortening.
What is the formula used to estimate maximum heart rate for individuals over 45 years?
206 - (0.7 x age)
What is the formula used to estimate maximum heart rate for individuals under 45 years?
220 - age
What is the error range for estimated maximum heart rate?
As much as 20 bpm above or below the estimate
If a 70-year-old man has an estimated HRmax of 157 bpm, what could his actual maximum heart rate be?
As low as 146 bpm or as high as 168 bpm
True or False: Individuals on B-blockers may have increased resting and maximum heart rates.
False
What is the typical expected reduction in maximum heart rate for patients on B-blockers or Ivabradine?
20-30 bpm
How is the Target Heart Rate (THR) established according to BACPR?
Using the heart rate reserve (HRR) method
What does the heart rate reserve (HRR) method take into account?
The difference between maximum heart rate (HRmax) and resting heart rate (RHR)
What is the typical range for anaerobic ventilatory lactate threshold?
40-70% HRR
How do less active individuals compare to more active individuals regarding the anaerobic threshold?
Less active individuals will be at the lower end of the threshold range
Fill in the blank: HRR = HRmax - _______.
RHR
How do you calculate the 40% HRR?
(HRR x 0.4) + RHR
How do you calculate the 70% HRR?
(HRR x 0.7) + RHR
What is the age-adjusted HRmax formula for a 65-year-old individual?
206 - (0.7 x 65) = 160 bpm
What is the THRR for a 65-year-old with a resting heart rate of 75 bpm?
109 - 135 bpm
Calculate HRmax for a 70-year-old on beta blockers.
206 - (0.7 x 70) - 30 = 127 bpm
What is the THRR for a 70-year-old with an RHR of 65 bpm on beta blockers?
90 - 108 bpm
Calculate HRmax for a 44-year-old individual.
220 - 44 = 176 bpm
What is the THRR for a 44-year-old with an RHR of 75 bpm?
115 - 146 bpm
How do you calculate HRmax?
HRmax = 220 - age
What is the HRmax for a 44-year-old on beta blockers?
HRmax = 176 - 30 = 146
What is the formula for calculating HRR?
HRR = HRmax - Resting HR
What is the HRR for a 44-year-old with a resting HR of 60?
HRR = 146 - 60 = 86
How do you calculate training intensity at 40% HRR?
(HRR x 0.4) + RHR = 40% HRR
What is the 40% training intensity for a HRR of 86 and resting HR of 60?
40%: (86 x 0.4 = 34) + 60 = 94 bpm
How do you calculate training intensity at 70% HRR?
(HRR x 0.7) + RHR = 70% HRR
What is the 70% training intensity for a HRR of 86 and resting HR of 60?
70%: (86 x 0.7 = 60) + 60 = 120 bpm
What is the THHR range for the given example?
THHR = 94 - 120 bpm
What does RPE stand for in exercise programming?
Rating of Perceived Exertion
Who devised the RPE scales?
Professor Gunnar Borg
What is the RPE (6-20) scale primarily developed for?
Whole body aerobic exercise
What does the CR10 scale focus on?
Differentiated or localised sensations of strain, exertion, or pain
True or False: The scales are valid and reproducible indicators of exercise intensity.
True
What invalidates the use of RPE scales?
Altering the scales or not following instructions
What should clients understand about RPE?
They should grasp the concept of sensing exercise responses
Fill in the blank: The intensity at which a client works should be initially determined by _______.
[heart rate or MET level]
What should clients be exposed to in order to understand RPE scales?
Differing levels of intensity
What should clients consider when using the RPE scale?
Both the verbal descriptor and the numerical value
What should clients do during aerobic exercise when using RPE?
Pool all sensations to give one rating
What is a key point to confirm to clients regarding RPE?
There is no right or wrong answer; it is based on their perception
What is a situation where clients may not reflect their sensations accurately?
When they have a preconceived idea about exertion level
Why should RPE scales be visible during activities?
To ensure accurate ratings of effort
What does RPE stand for?
Rating of Perceived Exertion
How does the reliability of RPE relate to exercise intensity?
It relates to the client’s ability to repeat the same exercise intensity at a given RPE on different days.
How can RPE be accurately measured?
By measuring RPE on the same circuit station or piece of equipment at a given heart rate or MET level on two or more occasions within a few days.
What is one way to establish the validity of RPE?
By getting the patient to provide an RPE for different levels of work rate during exercises.
True or False: A client who underestimates their RPE can be identified easily.
True
What RPE should participants report by the end of the warm-up period on the CR10 scale?
No higher than 3
Fill in the blank: A rating of 12-13 on the 6-20 scale corresponds to approximately ______ of heart rate reserve or VO2max.
60%
What does 1 MET represent in terms of oxygen consumption?
3.5 millilitres of oxygen per kilogram of body weight per minute
If an activity uses 14.0 ml kg min, how many METs is that?
4 METs
Why is knowledge of MET values important?
It helps to prescribe or exclude activities according to their known MET values.
What should be done if a client is at the top end of their training heart rate range when walking at 4 mph?
Activities like skipping or freestyle swimming should be excluded.
What type of activities permit little variation in individual execution?
Walking and cycling
What are some examples of ‘free-moving’ activities?
- Dancing
- Skipping
- Rebounding on a mini-trampoline
How can activities be modified to maintain a narrowly defined training heart rate range?
By altering speed or height and rate in activities like walking, jogging, or bench stepping.
What is the significance of monitoring intensity in exercise?
It helps to ensure clients are exercising within safe and effective intensity ranges.
What RPE rating corresponds to 85% of heart rate reserve or VO2max?
16 on the RPE scale
What does VO2max represent?
Maximal oxygen uptake
VO2max is a measure of the maximum amount of oxygen that an individual can utilize during intense exercise.
What is the significance of METs max?
Maximal metabolic equivalents
METs max indicate the highest level of energy expenditure during physical activity.
Define HRRmax.
Maximal heart rate reserve
HRRmax is the difference between maximal heart rate and resting heart rate.
What percentage of HRmax corresponds to the rating of perceived exertion (RPE) of 19?
100% HRmax
This indicates maximal exertion as per the Borg RPE scale.
What is the Borg RPE scale range?
6-20
The Borg RPE scale is a subjective measure of perceived exertion during physical activity.
What perceived exertion descriptor corresponds to an RPE of 11?
Light
This descriptor indicates a low level of exertion.
Fill in the blank: %HRmax equivalents to %VO2max or %HRRmax will only hold true for individuals aged _______.
35 to 50 years
This age range is critical for the accuracy of these equivalencies.
What is the Borg RPE CR10 scale range?
0-10
The CR10 scale is a simplified version of the RPE scale for ease of use.
What is the perceived exertion descriptor for an RPE of 15?
Hard
This indicates a high level of exertion during exercise.
List the descriptors for the Borg RPE scale from very light to maximal exertion.
- Very light
- Light
- Somewhat hard
- Hard
- Maximal
These descriptors help categorize levels of perceived exertion.
What heart rate range is specified for the resting HR in the context of %HRmax equivalency?
65 to 75 bpm
This resting heart rate range is important for accurate exercise programming.
What RPE corresponds to a perceived exertion level of 13-14?
Somewhat hard
This indicates a moderate level of exertion.
What is the RPE for a perceived exertion descriptor of ‘somewhat hard’?
12-13
This level reflects a moderate challenge during exercise.
What is the range for perceived exertion descriptor ‘hard’ on the Borg RPE scale?
15-16
This indicates a significantly challenging level of exercise.
What Borg RPE value corresponds to ‘very light’ exertion?
9
This indicates minimal physical exertion.
What was reported as the number one fitness trend by the ACSM worldwide survey?
Wearable technology
This trend has surpassed previous trends such as online and virtual training.
What percentage of the UK population uses a smartphone?
83%
This data is from the ONS, 2019.
What has contributed to the increased popularity of self-monitoring health-related behavior?
Availability and affordability of devices
Over the past decade, these factors have made tracking health-related behaviors easier.
What are common methods of self-monitoring with technology?
Using an app on a smartphone or a body-sensor device
These methods allow users to track their health-related behaviors effectively.
What is a significant benefit of ‘on-body’ devices?
They are likely to be with the user throughout the day
This increases the likelihood of consistent monitoring.
How do smartphones promote health?
Through features like GPS, Wi-Fi, pedometers, and accelerometers
These features create a technological environment conducive to physical activity interventions.
What is essential for effective self-monitoring?
Comprehensive support and exercise guidance
This helps individuals adhere to the prescribed exercise regimen.
What should be considered when deciding on a self-monitoring device?
Device differences, affordability, and digital inclusivity
These factors influence the appropriateness of a device for an individual.
What type of activity monitoring devices have been primarily developed?
Devices to measure aerobic activity
There is less focus on strength and resistance activity monitoring.
What opportunity do wearable activity trackers provide?
Increase physical activity through continuous monitoring
They can be particularly effective for individuals in the cardiac population.
True or False: Maintenance with the use of trackers is always sustained.
False
Ongoing support and motivation may still be required for long-term behavior change.
Fill in the blank: The practice of tracking health-related behavior is becoming increasingly popular, particularly in _______.
Physical activity
This trend is notable due to the rise of self-monitoring technologies.
What is the importance of regular exercise and physical activity after discharge from a Core/Phase III cardiovascular prevention and rehabilitation programme?
It is important as a lifelong healthy lifestyle behaviour.
What are the benefits of attending supervised group or one-to-one sessions after discharge?
They provide support and guidance for maintaining exercise.
What is one of the criteria for assessing suitability to exercise in a community setting?
Being clinically stable.
What does being clinically stable mean?
No change in symptoms or significant change in medication in the preceding month.
What is the required intensity level for activities in a community setting?
40%-70% HRR or RPE Borg scales 11-14 or 2-4.
What is required from patients regarding self-monitoring?
Showing a commitment to self-monitor and regulate the intensity of their activity.
How long may patients stay with a qualified BACPR Specialist Exercise Instructor?
Approximately 12 weeks.
What information does the transfer form include?
BACPR Protocol for Transition from Core/Phase III to Long Term Exercise/Phase IV.
What should be documented on the transfer form?
The patient’s verbal consent, cardiovascular rehab professional’s name, and signature.
What are some reasons not to refer a patient to long-term exercise?
- Awaiting urgent or emergency cardiology treatment
- Absolute exercise contraindication
Name two absolute exercise contraindications.
- Ongoing unstable angina
- Active endocarditis
What must the BACPR Specialist Exercise Instructor do with the transfer form?
Read the form and prescribe a safe and effective exercise prescription.
What should happen if there has been a new cardiovascular event reported since completing the transfer form?
The exercise prescription will not be carried out.
What is needed for communication between core and long-term exercise programmes?
A clear two-way communication pathway with a named contact and contact details.
Fill in the blank: The patient’s personalized goals should be included in the _______.
transfer form.
What should the secondary prevention plan include?
Other risk factors.
What must be documented regarding complications after a cardiovascular event?
Subsequent complications and/or interventions.
True or False: Patients with decompensated heart failure can be referred for long-term exercise.
False.
What is the role of the BACPR Specialist Exercise Instructor in the transition process?
To prescribe a safe and effective exercise prescription based on the transfer form.
What document is completed for referral in Core/Phase III Cardiac Rehabilitation?
BACPR Transfer Form (T)
How long is the BACPR Transfer Form (T) valid after discharge?
3 months
What is the first step in an Immediate Transfer process?
Email TF to local BACPR Specialist Exercise Instructor
Who prescribes and supervises the initial assessment and exercise sessions in BACPR Long-Term Exercise?
BACPR Specialist Exercise Instructor
What should be checked if more than 3 months have elapsed since the TF was completed?
If the patient still meets referral criteria
What is the referral to Primary Care warranted for?
Identified criteria such as deteriorating exercise performance or worsening angina
What symptoms indicate a need for referral to Primary Care?
- Deteriorating exercise performance
- Worsening of angina
- Worsening of other symptoms (e.g., suspected arrhythmias)
What is the referral process if a patient has a further cardiac event?
Referral to Core / Phase III for assessment
What may patients be suitable for transfer if they have undergone?
Functional assessment and personalised risk factor management
Fill in the blank: The BACPR Transfer Form (T) must be emailed to the local _______.
BACPR Specialist Exercise Instructor
True or False: Patients must complete a full Core CR exercise programme to be eligible for transfer.
False
What does MET stand for?
Metabolic Equivalent of Task
MET is a unit that estimates the amount of oxygen consumed during physical activities.
What is the MET value for bathing?
2.0
This indicates the energy cost in terms of oxygen consumption for the activity.
List three household activities with their MET values.
- Dressing/undressing: 2.5
- Ironing: 2.5
- Using a vacuum cleaner: 2.5-4.0
What is the MET value for general cycling?
4.0-9.0+
The MET value varies depending on the intensity of cycling.
Fill in the blank: One MET equals ______.
oxygen consumption at rest which is about 3.5 millilitres of oxygen per kilogram of body weight per minute.
What activity has a MET value of 9.0?
Swimming
This indicates a high level of energy expenditure during the activity.
True or False: Walking at 4 mph has a MET value of 4.0.
True
What is the MET value range for shoveling snow?
4.0-9.0+
List two leisure activities with their MET values.
- Tennis: 5.5
- Squash: 9.0
What does a MET value of 2.5 indicate?
Oxygen consumption at 2.5 times the resting rate.
What is the MET value for social dancing?
4.0-5.0
Fill in the blank: An individual exercising at 2 METs is consuming oxygen at ______.
twice the resting rate.
What is the MET value for mowing with a power mower?
4.0-9.0+
List three activities categorized as leisure activities.
- Golf (carrying clubs)
- Aerobic dancing
- Swimming
What is the MET value for walking at 3.5 mph?
3.5
True or False: Raking has a MET value of 3.0-4.5.
True
What is the MET value for skipping at 120-140 skips per minute?
6.0-9.0
What MET value indicates a very high level of physical activity?
> 8.0-12.0+
What is one criterion for suitability to transfer from Phase III to Phase IV?
Clinically stable, meaning there has been no change in symptoms or significant change in medication during the preceding month
This indicates that the patient has maintained a consistent health status, which is crucial for progression.
What intensity range of activities must an individual be able to sustain to qualify for transfer?
Moderate intensity within the target range of 40-70% HRR or at an RPE Borg scale of 11-14 or 2-4
HRR stands for Heart Rate Reserve, and RPE stands for Rate of Perceived Exertion.
What is the importance of Physical Activity Advice?
Reassure about safety and benefits
This helps to alleviate concerns and encourages participation in physical activity.
What is a suggested starting point for exercise programs?
Start @ home on waking program
This allows for a comfortable and familiar environment to begin physical activity.
What is included in the Structured Exercise Component?
Comprehensive assessment & induction
This ensures participants are aware of their exercise plan and its implications.
What does SHARE changes refer to in an exercise program?
It’s a contract
This emphasizes the commitment between the participant and the program.
What should be identified before starting an exercise program?
Identify any contraindications to exercise
Examples include tachycardia and musculoskeletal conditions.
What is the purpose of on-going screening at the start of each session?
To ensure safety and appropriateness of the exercise
This helps monitor any changes in the participant’s health status.
Fill in the blank: A comprehensive assessment & induction is part of the _______ exercise component.
[Structured]
What does risk stratification involve?
Risk stratification involves the following:
* Current clinical / cardiac status
* Investigations / results
* Lipid profile, blood glucose and HbA1c levels BMI
* Medication - compliance?
* Psychological status - anxiety? - agrophobia?
* Functional capacity assessment eg Exercise Tolerance Tests
* Calculation of TRAINING Heart Rate
* Physical limitations eg hip replacement
* Personal goals - what do they like & want.
* Habitual activity
* Habits to twin with new regimes to make them stick
These elements help in assessing an individual’s risk for cardiac events.
What is included in the lipid profile during risk stratification?
The lipid profile includes cholesterol levels and triglycerides.
It is essential for assessing cardiovascular risk.
Fill in the blank: Medication _______ is a factor in risk stratification.
compliance
What psychological statuses are considered in risk stratification?
Anxiety and agoraphobia
These can impact a patient’s ability to engage in physical activity.
What is a functional capacity assessment?
It evaluates a person’s ability to perform physical activities, often using Exercise Tolerance Tests.
This assessment helps determine safe exercise levels.
True or False: Personal goals are not considered in risk stratification.
False
What is the purpose of calculating TRAINING Heart Rate?
To determine the appropriate intensity of exercise for training.
This helps ensure safety and effectiveness in exercise programs.
What are examples of physical limitations considered in risk stratification?
Hip replacement and other similar conditions.
These limitations affect exercise options and safety.
Fill in the blank: Habitual activity is assessed to understand a patient’s _______.
baseline activity level
What does BACPR stand for?
British Association for Cardiovascular Prevention and Rehabilitation
This organization provides guidelines for cardiac rehabilitation.
What is the significance of education in the context of risk stratification?
Education is vital for informing patients about their conditions and promoting adherence to rehabilitation programs.
It helps empower patients in managing their health.
What does ISWT stand for?
Incremental Shuttle Walk test
What does 6MWT stand for?
6 minute walk test
What does CST stand for?
Chester Step test
What is the name of the exercise test that involves cycling?
Incremental cycle ergometry
What measurements are taken during submaximal tests?
HR, RPE, time to completion, stage/level attained
HR stands for heart rate, and RPE stands for rating of perceived exertion.
What are the uses of submaximal tests?
- Set exercise prescription
- Predict aerobic capacity
- Assess changes over time - outcome measure
Submaximal tests provide valuable insights into an individual’s fitness level and progress.
True or False: The results of submaximal tests are used in risk stratification.
False
Submaximal test results are not utilized for risk stratification.
What does the ‘F’ in the FITT principle stand for?
Frequency
Refers to how often exercise is performed.
What is the recommended frequency for exercise according to the FITT principle?
3+ times weekly
Example: 2 classes and 1 home circuit.
What does the ‘I’ in the FITT principle represent?
Intensity
Refers to the level of effort put into the exercise.
What factors determine exercise intensity?
Assessment findings, HRR, VO2max, METmax
These metrics help to gauge the exercise intensity.
What is the recommended intensity range for exercise in the FITT principle?
40-70% HRRmax
HRRmax refers to maximum heart rate reserve.
How is perceived exertion measured in the FITT principle?
Using the Borg scale
RPE 2-4 (CR 0-10) and RPE 11-14.
What does the ‘T’ in the FITT principle stand for?
Time
Refers to the duration of the exercise session.
What is the recommended duration for the conditioning phase of exercise?
20-30 minutes
This duration is in addition to warm-up and cool-down.
What does the second ‘T’ in the FITT principle represent?
Type
Refers to the kind of exercise performed.
What is recommended for the type of exercise in the FITT principle?
Aerobic activities
Such as walking, running, cycling, or circuit training.
What is the primary message of the BACPR education guidelines?
‘Keep active’ message
Encourages regular physical activity beyond structured exercise.
What type of recommendations are included in the BACPR guidelines?
Strength-related recommendations
These complement aerobic exercise guidelines.
What is the overall aim for exercise prescription?
3 times per week
What is the purpose of the warm-up phase in exercise prescription?
Vessel dilation
How long should the warm-up phase last?
15 minutes
What heart rate should the warm-up phase aim to be within?
20 beats of training HR
How long should the conditioning phase last?
20-30 minutes
What is the primary focus of the conditioning phase?
CV endurance
What percentage of HRR max should the conditioning phase target?
40 - 70% HRR max
What is the recommended duration for the cool down phase?
10 minutes
What heart rate range should the cool down phase aim for?
Within 10 beats of pre-exercise HR
What type of incidents may occur during the cool down phase?
Cardiac arrhythmia
What are some modes through which exercise prescription can be achieved?
- Structured class
- Structured 1 to 1
- Structured home programme
- Structured physical activities
What percentage of UK programmes were group based pre-covid?
80%
This statistic highlights the prevalence of group-based programmes in the UK fitness landscape before the pandemic.
What types of designs were used in UK programmes pre-covid?
Circuit or gym designs
These designs focus on structured, sequential activities that promote fitness.
What are the key components mentioned in the Conditioning Component?
- Monitoring
- Progression
- Safety
These components are essential for effective fitness programming.
What is the recommended frequency for strength training and resistance exercise?
2 - 3 times per week
No more than every other day
What percentage of 1 Rep Max should be used for initial strength training?
40-60% of 1 Rep Max
Initially starting lower if unaccustomed
What is the progression goal for the percentage of 1 Rep Max after good technique is achieved?
Up to 80% of 1 Rep Max
Once good technique / no adverse symptoms are present
What is the minimum number of sets and repetitions to start with in strength training?
1 - 3 sets minimum of initially 10 - 15 reps
With no significant fatigue
How should strength training be progressed for strength?
Increase weight/reduce reps down to 10 (8 minimum)
This is part of the progression strategy
How should strength training be progressed for endurance?
Increase weight but maintain 15 - 20 reps
This is part of the progression strategy
How many different muscle groups should be targeted in a strength training session?
8 to 10 different muscle groups
This ensures a comprehensive training approach
What is the purpose of home exercise in supervised exercise sessions?
To support the supervised exercise sessions
Home exercise is designed to enhance the effectiveness of supervised training.
What is a home exercise record?
A record to track home exercise activities
This record helps in monitoring progress and adherence to the exercise plan.
What does the daily walking refer to in physical activity guidelines?
A recommended form of physical activity
Daily walking is often suggested to meet physical activity requirements.
What is one criterion for transferring from Phase III to Phase IV?
Clinically stable, meaning there has been no change in symptoms or significant change in medication during the preceding month
This stability is crucial for ensuring safety during increased activity levels.
What is the target heart rate range for sustaining moderate intensity activities?
40 - 70% HRR
HRR stands for Heart Rate Reserve, which is the difference between resting and maximum heart rate.
What is the RPG Borg scale range indicating moderate intensity?
11-14 or 2-4
The Borg scale is a subjective measure of perceived exertion.
What commitment should individuals ideally show before transferring to Phase IV?
Commitment to monitor and regulate the intensity of their activity
This commitment ensures individuals can safely engage in higher levels of physical activity.
What is Risk Stratification?
The process of determining the level of risk of a patient having a further cardiac event whilst exercising
Risk Stratification is crucial for tailoring exercise programs for patients.
What criteria are used in Risk Stratification?
- cardiac history
- current cardiac status
These criteria help assess the individual’s risk level during exercise.
What are the three Risk Status categories?
- High
- Moderate
- Low
Each category indicates the level of risk associated with exercise for the patient.
True or False: Risk Stratification and risk factors are the same.
False
Risk factors are used to predict the likelihood of disease progression, not exercise risk.
Fill in the blank: Risk Stratification is used to determine the level of risk of a patient having a further cardiac event whilst _______.
[exercising]
This emphasizes the context in which Risk Stratification is applied.
What does risk stratification determine?
Clients’ individual risk of further cardiac events during exercise
This includes assessing factors that affect the likelihood of adverse events during physical activity.
What is the recommended patient-to-staff ratio during exercise?
1:3 staff to patient ratio
This ratio helps ensure adequate supervision and monitoring during exercise.
What aspects are influenced by risk stratification?
- Exercise prescription
- Exercise intensity
- Level of monitoring & supervision
These factors are tailored to the individual based on their risk profile.
What does risk stratification help identify regarding clients?
- Who needs more attention
- Who is more at risk when exercising
- Who should we worry about more than others
This identification is crucial for prioritizing care and resources.
What approach does risk stratification facilitate?
An individual approach rather than ‘one size fits all’
This allows for personalized exercise plans based on specific risk factors.
What are the complications associated with exercise following myocardial infarction or revascularisation?
Complications include heart failure and post-event ischaemia or angina.
What is the definition of poor Left Ventricular Function (LVF)?
V EF <35% indicates poor LVF (or severely impaired).
What does a V EF of 35-49% indicate?
Moderate Left Ventricular Failure (or mildly impaired).
What is residual ischaemia?
Ongoing angina symptoms or silent ischaemia indicated by ST V down on ECG during exercise or in recovery if known.
What type of arrhythmias are of concern in risk stratification?
Ventricular arrhythmias (NOT atrial).
What history is significant for ventricular arrhythmias?
History of complex ventricular arrhythmias, implanted ICD, or survivor of cardiac arrest.
What is the significance of maximal functional capacity in METS?
Maximal Functional Capacity less than 7 METS indicates risk levels.
What risk levels are associated with <5 METs and <3 METs?
<5 METs indicates moderate risk and <3 METs indicates high risk.
What does clinically significant depression on medication indicate in risk stratification?
It is a factor in risk assessment for exercise.
What are the criteria that increase risk when exercising?
Complicated Event, Reduced Left Ventricular Function, Residual Ischaemia Symptoms, Serious Arrhythmias, Other
These criteria are used to assess risk during exercise for individuals with cardiac conditions.
What constitutes a complicated event in risk stratification?
Heart failure, Post event/procedure ischaemia/angina
These events indicate significant cardiac issues that can elevate risk during exercise.
What is considered poor left ventricular function (LVF)?
EF <35%
An ejection fraction (EF) below 35% indicates severely impaired function of the left ventricle.
What is the range for moderate left ventricular function (LVF)?
EF 35-49%
This range indicates a moderate level of impairment in left ventricular function.
What are residual ischaemia symptoms during exercise?
Angina, Light-headedness, Dyspnoea, Silent Ischaemia
These symptoms can occur at low workloads and indicate underlying cardiac issues.
What are serious arrhythmias that increase risk?
History of complex ventricular arrhythmias, Implanted ICD, History of cardiac arrest
These factors significantly raise the risk of complications during exercise.
What is the significance of maximal functional capacity in risk stratification?
Less than 7 METS indicates increased risk
METS (Metabolic Equivalent of Task) is a measure of exercise capacity and lower values suggest higher risk.
What does clinically significant depression on medication indicate in risk stratification?
Increased risk
Mental health conditions can affect exercise tolerance and safety.
What is the risk classification if all criteria are marked ‘N’?
Low risk
This classification applies when none of the risk factors are present.
What is the risk classification if any criteria are marked ‘Y’ but no high-risk factors are present?
Moderate risk
This indicates some risk factors are present but not at a level that categorizes as high risk.
What indicates high risk in the BACPR risk stratification tool?
Any ONE of the high-risk criteria marked ‘Y’
This includes factors such as angina at < 5 METS or significant ST segment changes.
What level of ST segment depression is associated with high risk?
≥ 2mm ST segment depression
Significant ST segment changes during exercise testing are critical indicators of risk.
What METS value indicates high risk associated with angina?
< 5 METS
This indicates very limited exercise capacity and higher likelihood of cardiac events.
True or False: A history of cardiac arrest is a low-risk factor.
False
A history of cardiac arrest significantly increases the risk during exercise.
What is the primary reason heart failure increases risk during exercise?
The ventricles are unable to maintain a good cardiac output.
This leads to inadequate blood supply to the body during physical activity.
How does ischaemia/angina immediately post event/procedure affect exercise risk?
Ischaemia can be a precursor to arrhythmias and indicates reduced blood supply to the myocardium.
This is critical for assessing safety during exercise.
What does impairment in LV function indicate regarding cardiac output?
The myocardium is struggling to maintain cardiac output.
The amount of impairment determines the level of risk.
What should be monitored during exercise for individuals with heart failure?
Symptoms and RPE (Rate of Perceived Exertion).
This helps assess how they are coping with intensity.
What action should be taken if exercise intensity is too high for a patient?
Reduce workload.
Monitoring symptoms and heart rate response is crucial.
What is the EF percentage range indicating poor left ventricular function?
EF <35% indicates poor LVF (severely impaired).
This level of dysfunction poses a higher risk during exercise.
What EF range indicates moderate left ventricular function?
EF 35-49% indicates moderate LVF (moderately impaired).
This requires careful monitoring during exercise.
What ongoing symptoms should be monitored during exercise?
Chest pain, light-headedness, dyspnoea at low workload.
These symptoms can indicate worsening cardiac conditions.
How should increases in exercise duration and intensity be approached for patients with heart failure?
Increase should be gradual.
This minimizes risk of exacerbating symptoms.
What does ongoing angina symptoms suggest about a patient’s condition?
There is some residual disease (ischaemia) which may be controlled with medication.
Ongoing monitoring is necessary to ensure stability.
What monitoring is required for patients with known silent ischaemia during exercise?
Monitor ST segments on ECG during exercise or in recovery.
Silent ischaemia is common in diabetics.
What symptom should be watched for at low workloads as a sign of angina?
Breathlessness.
It can indicate underlying cardiac issues.
What can increase risk and implications for prescription, monitoring, and management?
Criteria related to complex ventricular arrhythmia history
Includes history at rest or during exercise
What types of arrhythmias might someone be at risk for?
Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)
These are types of potentially life-threatening arrhythmias
What device might be implanted in a patient with a history of arrhythmias?
Implanted Cardioverter Defibrillator (ICD)
This device monitors and can correct arrhythmias
What should be monitored in patients with complex ventricular arrhythmia?
Heart Rate (HR) response and symptoms such as palpitations and dizziness
Patients should report ICD activation for follow-up
What is a significant history that increases risk in patients?
History of cardiac arrest
This indicates a previous critical cardiac event
What is the maximal functional capacity threshold that indicates increased risk?
Less than 7 METS
METS refer to Metabolic Equivalent Tasks, a measure of exercise capacity
How does decreased fitness affect risk?
Increases risk of events
Lower fitness levels correlate with higher health risks
What intensity should be maintained during exercise testing?
Below that achieved in functional test
This helps to mitigate risk during exercise
What can certain medications cause in patients with arrhythmias?
Arrhythmias
Some medications may have side effects that exacerbate arrhythmias
What action should be taken if a patient reports palpitations?
Refer back to GP and keep intensity down
Ensures proper medical evaluation and adjustment of exercise intensity
What mental health condition is mentioned that can be treated with medications?
Clinically significant depression
This condition can be managed with antidepressants
What is a key consideration regarding patient satisfaction in care planning for people with CHD?
Feel satisfied with their care?
Patient satisfaction is critical in assessing the quality of care provided.
What aspect of healthcare professionals (HCP) is important in care and support planning?
HCP: respected and valued?
Respect and value from HCPs can significantly impact patient engagement and adherence.
What is necessary for effective care planning in relation to patient information?
Had relevant information?
Providing relevant information helps patients make informed decisions about their care.
What is a critical factor in ensuring patients feel involved in their care?
Feel listened to/involved?
Active listening from healthcare providers fosters a collaborative care environment.
What does consistent care refer to in the context of care for people with CHD?
Get consistent/joined up care?
Consistency in care enhances patient understanding and adherence to treatment plans.
What behavior is expected from patients regarding their treatment adherence?
Do what they are told?
Following medical advice is crucial for achieving desired health outcomes.
What is a specific expectation regarding medication for patients?
Take tablets as prescribed?
Adherence to prescribed medication regimens is essential for effective management of CHD.
What is an important outcome measure for patients with CHD?
Outcomes as good as they could be?
Evaluating health outcomes is vital to assess the effectiveness of care and support provided.
What is the individual’s perspective in the context of behavior change?
It emphasizes the personal viewpoint and experiences of individuals undergoing behavior change.
This perspective is crucial for understanding how individuals interact with health services and manage their own care.
When was the Year of Care initiated?
August 2016.
The Year of Care initiative focuses on providing personalized care and improving patient outcomes.
How many hours does a professional spend with the NHS in a year?
4 hours.
This highlights the limited time professionals have for direct consultations compared to patients’ self-care efforts.
What is the total number of hours an individual spends on self-care or management in a year?
8756 hours.
This figure underscores the significant amount of time individuals invest in managing their own health.
Fill in the blank: The professional spends _______ hours with NHS in a year.
4 hours.
Fill in the blank: An individual spends _______ hours on self-care or management in a year.
8756 hours.
What percentage of people drop out of rehabilitation programmes within the first 6 months?
50%
What do effective BACPR Exercise Instructors need to do?
Support individuals throughout the process of change
What should BACPR Exercise Instructors understand?
Factors involved in behaviour change and maintenance
What can happen if behaviour change is approached incorrectly?
Push back from the individual
Indicates resistance or refusal to change when methods are not suitable.
What certification does the instructor hold?
BACPR Exercise Instructor Training certificate
Revalidation is required every 3 years.
What should instructors provide evidence of?
Continuing professional development
What basic life-support procedures should instructors be trained in?
Automated external defibrillator (AED)
What is the recommended floor space required for aerobic exercise per patient?
20-25 sq. ft (1.8-2.3 sq. m)
What is the required floor space per individual using equipment?
6 sq. ft (0.6 sq. m)
What should be documented regarding medical emergencies during exercise sessions?
Written emergency procedure
What is the recommended temperature range for the exercise room?
18 to 23C (65-72F)
Too cold = vasoconstriction
Too hot = heart working harder
What should be the humidity level in the exercise area?
65%
What should be accessible during exercise sessions?
A telephone
Who should be advised of the long-term exercise session times?
Paramedics
What should be available throughout the exercise session?
Drinking water
What determines the instructor/client ratio in group sessions?
Profile of class members and risk stratification
What should no client be allowed to do during the session?
Move or handle equipment other than during their personal exercise programme
What should staff ensure clients are before they leave?
Asymptomatic and within 10 bpm of pre-exercise heart rate
What should be circulated among all referrers?
Client referral criteria
What type of funding options are available for clients?
- Self-fund sessions on a pay-as-you-go basis
- NHS/local council part or full funding
- Fundraising by patient support groups
What must be assured regarding client records?
Confidentiality
What should incidents be?
Recorded
What should be allowed during the initial assessment?
One-to-one consultation
What must be used prior to each session?
Pre-class checklist stating conditions for participation
What should be offered regarding session access?
Fixed number of sessions or ongoing access
What should be documented for client transfer?
Agreed and documented pathways
What should be available for clients seeking advice?
Opportunity for re-entry to supervised programme or to seek advice from a BACPR instructor
Name two types of links that should be established.
- Local Phase III CPRP coordinators
- Local GP practices
What should be included in the links established?
- Other Phase IV sessions
- Local NHS trust
- Smoking cessation clinics
- Walking groups
- Local authority leisure providers
- Private health clubs
- Physical activity specialists
What are the Priority Patient Groups as defined by NACR?
- Acute cardiac event
- Awaiting or post revascularisation
- Stable heart failure
These groups are prioritized for specific healthcare interventions.
Which additional patient groups may be included beyond the Priority Patient Groups?
- Post ICD insertion
- Stable angina
- Post valve surgery
- Post heart transplantation
These groups may also require attention in cardiac care.
What is the main focus of Exercise Programming 2024?
To facilitate exercise programming for patients with specific cardiac conditions.
The programming aims to enhance recovery and health outcomes.
True or False: Stable heart failure is considered a Priority Patient Group.
True
It is one of the three main groups prioritized by NACR.
Fill in the blank: The acronym ‘NACR’ stands for _______.
[National Audit of Cardiac Rehabilitation]
NACR focuses on improving cardiac rehabilitation services.
What are contraindications to exercise in a Phase IV setting?
- Unstable angina
- Unstable or acute heart failure
- Unstable diabetes
- New or uncontrolled arrhythmias
- Resting or uncontrolled tachycardia >100bpm
- Resting SBP >180mmHg or resting DBP >100mmHg
- Symptomatic hypotension
- Febrile illness
These conditions indicate that exercise may pose significant risk to the individual.
