Exercise prescription Flashcards
what info do you need to review prior to prescribing exercise?
1: review of systems : MD eval or last office note
2: current medical hx
3: past medical hx
4: medications
5: symptoms:
- angina or equivalent
- dyspnea
- syncope
- orthopnea
- edema
- palpitations
- claudication
- orthopedic pain
- lightheadedness/dizziness
6: blood pressure (sitting/standing): orthostatic changes
7: risk stratification
- apparently healthy
- known disease
8: work status and physicality of work
9: recreational activities
10: risk factors
11: goals
FIT M
= volume of exercise
frequency: # of sessions
intensity: how hard
time: duration of session
mode: type of activity
*higher volume needed for pt looking to lose weight
what is the guideline for the MINIMUM frequency of exercise?
more days than you don’t
what is the guideline for the MINIMUM duration of exercise?
30 minutes
volume of exercise for cardiovascular benefit
120-200 minutes per week
10,000 steps per day
750-1200 cals/week
volume of exercise for weight loss
200-300 minutes
>12,000 steps/day
1200-2000 cal/week
intensity
Target heart rate:
- % max (from GXT or est max of 220-age)
- Karvonen
- % VO2 max (linear relationship to HR)
Rate of perceived exertion (RPE) Rating of perceived dyspnea (RPD) METS ischemic threshold oxygen saturations
mode
due to specificity of training, mode of activity is especially important in relation to patient’s goals
considerations for progressing exercise
1: RPE or RPD
2: THR
3: oxygen saturation
4: change in clinical status- symptoms, orthopedic
5: ejection fraction
6: blood pressure
7: blood glucose
8: GOALS!
resistance training
= >50% 1 rep max
MI: 5 weeks post AND 3 weeks continuous cardiopulmonary exercises
CABG: 8 weeks post AND 3 weeks of continuous cardiopulm exercise
stent: 2 weeks post
ok to start light handweights and theraband immediately
contraindications for resistance training
-symptomatic heart failure
-severe valve disease
-uncontrolled arrhythmias
-unstable symptoms
-uncontrolled hypertension:
SBP >= 160; DBP >=100
-high intensity training with active retinopathy
warm up
gradually increasing lower level active cardiopulmonary exercise
5-10 min
cool down
active lower lever activity
5-10 minutes
stretching
diabetes
- atypical symptoms or none at all
- medications: insulin vs. oral agent vs. diet controlled
- do not inject insulin into working muscle group
- monitor blood glucose
(critical: 400 (MD notified immediately); >100 to exercise) - timing of last meal
- amount and combo of foods
- exercise IS insulin
- neuropathy (balance!!)
- retinopathy (caution with resistance training)
- maximize calorie burn
- foot care
obesity
-maximize calorie burn
-aware of changes in orthopedic status
-mode of exercise (NWB vs WB)
-change up routine to keep the body burning fuel inefficiently
-dietary changes
-remember volume of exercise
(decreased intensity-> more frequency and longer duration)
*can they fit on machines?
want to maximize caloric burn
pulmonary
- postural and breathing training
- oxygen saturations with exercise
- supplemental oxygen use
- resistance training especially to increase upper extremity strength
heart failure/low ejection fraction
- monitor for fluid retention
- increased HR
- prone to increased fatigue, slower progression
- prone to increased ventricular ectopy (may have ICD (implantable defibrillator))
pacemakers
HR response to exercise via:
- UE movement
- heel strike
- respiratory rate
Rarely see fixed rate settings
demand pacing=may see some intrinsic beats, if HR too low pacer will kick in or if too high pacer will slow rate
arthritis
- mode of activity primary thought
- stretching and flexibility
- balance issues
- adjustment based on daily changes in pain
***common for rotator cuff injuries with severe cardiac-open heart surgery patients
anxiety/fear/depression
- build self confidence
- empower patient to believe in themselves
- you have to be confident and anticipate their needs
- reinforcement of progression from first week
- interval training
**need to know when it is appropriate to push them!
peripheral vascular disease
- treadmill training!
- walk to moderate claudication, rest and restart in 5-8 min intervals
- remember some risk factors as heart disease
