Exercise Prescription for Cardiovascular

Question 1

What is the ideal method for determining exercise prescription in cardiovascular disease patients?

Answer 1

A symptom-limited graded exercise test (GXT) is ideal for determining individualized exercise prescription based on hemodynamic responses:

• % HRR = The difference between your maximum heart rate and your resting heart rate.
• % VO2 max = The the maximum rate at which the body can consume oxygen during physical activity.
• % VO2 reserve = The percentage of the difference between a person’s maximum and resting VO2.

Question 2

What is functional capacity and how is it measured?

Answer 2

• Functional capacity is the heart’s ability to deliver oxygen to tissues
• Measured in metabolic equivalents (METs).
• An increase of 1 MET in functional capacity can reduce all-cause mortality by up to 30%.

Question 3

What is the recommended exercise intensity for cardiovascular patients?

Answer 3

- Target exercise intensity should be 40-80% of

• HRR
• VO2
• VO2 reserve

- With an RPE between 12-16 (moderate to hard) on the Borg scale.

Question 4

When should exercise be terminated in cardiovascular patients?

Answer 4

Terminate exercise if:

• Systolic blood pressure (SBP) exceeds 250 mmHg
• Diastolic blood pressure (DBP) exceeds 115 mmHg
• A decrease in SBP >10 mmHg.

Question 5

What precautions should be taken for diabetic patients during exercise?

Answer 5

• Initial exercise intensity should be cautious due to the risk of hypoglycemia.
• Patients with blood sugars < 70 mg/dL should be given a 15g carbohydrate snack and rechecked after 15 min.

Question 6

What is the progression strategy for cardiovascular patients?

Answer 6

• Progress intensity responsibly, as higher intensities yield greater improvements in functional capacity.
• High-intensity interval training (HIIT) may be beneficial but requires a negative ECG on GXT.

Question 7

What are the exercise considerations for chronic heart failure (CHF) patients?

Answer 7

• CHF patients are at high risk for exercise-related events and require close monitoring.
• They should exercise below ICD thresholds, and any worsening of exercise tolerance or ischemia should prompt re-evaluation.

Question 8

What are the exercise prescription guidelines for peripheral artery disease (PAD)?

Answer 8

Initial Prescription:

• Have patients walk at a speed/grade until reaching 3-4 on the claudication scale, rest until pain subsides, and repeat.

Goal:

• Progression aims for sustained walking of 30-50 minutes at 3.0 mph.

Question 9

How is exercise prescription determined for coronary artery disease (CAD) patients?

Answer 9

• A GXT is essential to determine anginal thresholds and ST-segment displacement.
• Documentation of resting HR, treadmill speed/grade, session time, and RPE.

Question 10

What are the general guidelines for documenting exercise sessions in cardiovascular rehab?

Answer 10

• resting HR
• HR changes
• treadmill speed/grade
• session time
• RPE changes
• onset of symptoms like angina or dyspnea