Exercise prescription and programming

Question 1

What are the contraindications to long term phase 4 programs and what are the signs and symptoms?

Answer 1

• Unstable angina: Diagnosed/Changes in the previous month
• Unstable or acute heart failure: Fluid retention, Excessive Breathlessness, Weight gain, Swollen ankles
• Unstable diabetes: Med changes in previous month, glucose doesn’t decrease with exercise >10mmol/l pre-exercise
• Uncontrolled arrhythmia: Palpitations, dizziness, consciousness lost, Skipped beats
• Tachycardia: Resting HR >100 bpm
• Hypertension: SBP >180, DBP>100 - No symptoms
• Symptomatic hypotension: Dizziness - lying/seated to standing, or on exercise cessation
• Febrile illness - Feeling unwell/Feverish

Question 2

What criteria must be achieved for transfer to a stable Phase 4 program?

Answer 2

• Clinically stable: No change in symptoms or significant changes in medication
• Can sustain activities at moderate intensity (11-14 or 2-4 CR10 scale RPE, 40-70% HRR)
• Committed to regulate the intensity of their activity

Question 3

What are the 8 reasons a client may be referred back to their GP?

Answer 3

1) Deteriorating exercise performance despite compliance with program
2) Unstable angina despite medication compliance
3) Worsening of symptoms such as suspected arrhythmia
4) Further cardiac event
5) Uncontrolled tachycardia >100 HR
6) Resting SBP > 180
7) Resting DBP >100
8) Development of symptomatic hypotension

Question 4

What are the recommended exercise training aims?

Answer 4

• Provide regular supervised aerobic exercise
• Establish individualized exercise prescription
• Offer general advice
• Encourage independence, self-help, and self-motivation
• Review progression/regression on a regular basis

Question 5

What are the advantages and disadvantages of population of specific group sessions?

Answer 5

Advantages:
- Standardized risk stratification and screening
- Greater individualization of prescription
- Social support
- Variation in format e.g questions at the end
- Attract local funding
Disadvantages:
- May perpetuate dependence and ‘sick people’ image
- Restricts availability and class choice
- Death of group moral may affect morale
- Male dominance may discourage female participation

Question 6

What are the advantages and disadvantages of integration into a mainstream class?

Answer 6

Advantages:
- Counteracts sick people image
- Flexibility in classes
- May gain advice from healthy members
Disadvantages:
- Lack of screening
- Symptoms associated with progression may be missed
- Difficult to adapt content to individuals 
- Participants mainly female 
- Lack of social support

Question 7

What are the advantages and disadvantages of a Gym based program?

Answer 7

Advantages:
- Allows individualisation of screening and prescription
- Flexibility
- Good for independence/Self-motivation
Disadvantages:
- Lack of social support
- More expensive

Question 8

What are the FITT principles for aerobic exercise?

Answer 8

F: 3 times a week
I: 40-70% VO2 max/ HRR, RPE 11-14/2-4
T: 20-60 minutes (conditioning component)
T: Activities using large muscle groups in a rhythmical manner

Question 9

What is the first aerobic targets for athletes and the recommended progression?

Answer 9

• Perform 20 minutes of aerobic activity at 40% HRR
• Increase duration to 30 minutes
• Intensity to 70% in low-risk clients and 50-60% in moderate-risk clients
• Frequency-dependent on motivation/availability

Question 10

What 8 things should always be advised to the person in charge before and after the exercise session?

Answer 10

Before
- Change in symptoms 
- Change in medication or side effects 
- Test results - BP/Cholesterol
- New or worsening joint problems
- Feelings of being unwell 
During
- Angina, chest discomfort, dizziness
- Joint problems
- Feeling of being unwell

Question 11

In what situations must the programme be adapted?

Answer 11

• Pathologies
• Functional capacity and activity level in daily life
• Current medication
• Orthopaedic limitations
• Psychosocial limitations
• Motivation/confidence levels
• Age
• Gender
• Ethnicity

Question 12

What is the benefit of stretching and how should it be conducted?

Answer 12

Slow full range moving stretches/Short duration static (6-8 seconds)
Keep feet moving - lower body should be interspersed with dynamic movements
- Ensure participants explore full range of motion
- Encourage balance/alignment
- Identify tight/sore muscles
- Practice positions that will be held at the end of the session that aim to maintain or develop flexibility

Question 13

What should the intensity of the warm-up be

Answer 13

• HR within 20bpm below target training HR and a further 10 if they are beta blocked
• RPE 11 / 3