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CI2 > Exercise Prescription for CR & PR (Part 1) > Flashcards

Exercise Prescription for CR & PR (Part 1) Flashcards

1
Q

Why do we assess exercise capacity?

A
  • Level of functional impairment & activity limitation
  • Limiting factors of exercise capacity
  • Guide exercise prescription
  • Identify O2 desaturation & need for supplemental O2
  • Evaluate effectiveness of rehab
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2
Q

What are the goals of exercise in PR & CR?

A
  • Improve exercise capacity & functional ability
  • Decrease symptoms
  • Empower self-mnitoring, management of symptoms & confidence to exercise
  • Find a safe & effective dose of exercise
  • Return to work or functional independence
  • Improve QOL
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3
Q

What is the overall benefit of exercise?

A

Increase CR fitness, decrease risk factors & symptoms

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4
Q

What is the main contributor to an increase in CR fitness in cardiac & pulmonary patients?

A

Peripheral adaptations (muscle)

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5
Q

How would you address a high risk patient in a group exercise class?

A
  • Decrease intensity
  • Monitor closely
  • Increase staff
  • Group high risk patients together
  • Decrease class size
  • Ensure equipment is nearby (crash cart, O2 etc)
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6
Q

What are some of the other CIs of exercise?

A
  • Uncontrolled/poorly controlled asthma
  • Unstable/uncontrolled COPD
  • Unstable cancer/blood disorders
  • Uncontrolled diabetes
  • Osteoporosis/high fracture risk
  • Unexplained symptoms that could cause risk of injury or exacerbation
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7
Q

What are the safety considerations in CVD patients?

A
  • Exclude high-risk patients from vigorous activity
  • Screen high-risk patients prior to exercise
  • Stop exercise & promptly evaluate/refer if any symptoms (chest pain, dizziness, arm/jaw pain, severe SOB, irregular HR, excessive fatigue)
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8
Q

What are the exercise considerations for clinicians in COPD?

A
  • Stratify patients according to need for medical support
  • Work closely with PR teams
  • Encourage patients to discuss daily exercise plans with their doctor
  • Reassure patients that mild SOB is normal
  • Ensure they do a warm-up & cool-down
  • Aerobic training for major muscle groups of lower limb
  • Incorporate endurance & strength training for upper limbs
  • Consider interval training
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9
Q

What are the exercise considerations for patients in COPD?

A
  • If SOB, aim to slow down rather than stop
  • If persistent severe SOB, stop & rest or take a reliever inhaler
  • Always notify someone if exercising in a group/gym
  • Stop exercise if feeling nausea, dizziness, headache, pain in chest/neck/jaw
  • Start rehab early
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10
Q

What are the exercise considerations in CVD?

A
  • High intensity = higher risk
  • Warm-up/cool-down
  • ICDs have 10-30s delay between arrhythmia & shock
  • Avoid dehydration
  • Stroke patients 3 times more likely to fall/suffer hip fractures
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11
Q

What is the BGL CI for diabetes?

A

BGL outside 6-10mmol

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12
Q

What are the precautions for hyper/hypoglycaemia?

A
  • Check BGLs 2 x before & after exercise
  • Keep carb sources handy
  • Exercise 1-2 hrs after meal & >1 hr after insulin injection
  • Don’t exercise if BGL > 13-15mmol
  • If <6mmol take carb source
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13
Q

What is a precaution for exercise in kidney disease?

A

High BP can aggravate disease progression

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14
Q

What are the precautions for exercise in peripheral neuropathy?

A
  • Avoid high intensity exercise
  • Problems managing temperature control
  • Safe area with weights
  • Grip may be impaired so be careful with weights
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15
Q

What is the most important exercise advice for T2 diabetes?

A

Check feet before and after exercise & at least twice daily

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16
Q

What does a PA history consist of?

A
  • Current PA/exercise
  • PA levels before/since exacerbation
  • Intention to do PA/exercise (stage of change)
  • Past PA/exercise & preferences
  • Current symptoms & past medical history
17
Q

What are the stages of change?

A
  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance (>6 months)
  • Relapse
18
Q

What is the principle for exercise prescription?

A

FITTVE:

  • Frequency
  • Intensity
  • Time
  • Type
  • Volume
  • Progression
19
Q

What is the normal prescription for CR & PR?

A
  • Twice a week
  • Low-mod intensity
  • 1 hour
  • 4-12 weeks (8-12 weeks heart failure)
  • Individually tailored
20
Q

What should the warm-up include?

A
  • 10-15 mins
  • Low-impac, dynamic movements
  • Large muscle groups
  • AROM all major joints
  • Gradually increase size & ROMs
  • RPE 3
21
Q

What is the recommended intensity for aerobic exercise?

A
  • Moderate (40-60%) to vigorous (60-90%)

- Light (30-40%) to moderate in deconditioned adults

22
Q

What are the prescription guidelines for aerobic exercise for PR & CR patients?

A 
F: 3-5 days per week
I: 40-80% intensity, 80% 6MWT, 4-6 Borg
T: 20-60 mins
T: Rhythmic large muscle group activities
V: Interval, continuous
P: No standard format
23
Q

What is a good exercise strategy for reducing SOB in pulmonary patients?

A

Fixing the shoulder girdle, e.g. walking aid, stationary bike

24
Q

What are the prescription guidelines for aerobic exercise for PR & CR patients?

A

F: 2-3 days/weel
I: 3-5 Borg, 30-40% upper body, 50-60% lower body
T: 48hrs between sessions
T: Various equipment
V: 10-15 reps, 1-3 sets
P: Increase resistance/weight, reps, decease rest

25
Q

What are muscle strength & total muscle cross-sectional area independent predictors of?

A

Exercise tolerance, clinical prognosis & long-term survival in patients with HF

26
Q

What does the evidence show regarding resistance training?

A
  • Pulmonary: Focus on upper limbs due to SOBOE
  • COPD: IMT may increase exercise tolerance
  • Strength training improves strength, no evidence for other outcomes
27
Q

What falls risk factors are also present in respiratory & cardiac patients?

A
  • Reduced lower limb muscle strength
  • Decreased daily PA
  • Reduced standing balance capacity
28
Q

What muscles should be the focus for flexibility training in respiratory & cardiac patients?

A
  • Spine (esp thoracic)
  • Pecs
  • AROM exercise for cervical/thoracic spine & shoulders
29
Q

What should the cool-down consist of?

A
  • 10 mins
  • Decrease intensity
  • Passive stretching
  • Patient observation >30 mins post exercise recommended
30
Q

What does evidence show regarding the PA & sedentary behaviour in people with CHD?

A

On average

  • Mod-vig intensity PA 18 mins/day
  • On non-CR days, 11 mins/day
  • Sedentary behaviour 9hrs/day
31
Q

What reassessment tools should be used for CR & PR patins?

A
  • Manual muscle testing (strength)
  • 6MWT
  • ISWT
  • Balance (TUG, Berg balance)
32
Q

What is the minimum important distance for the 6MWT?

A
  • 25m for patients with CHD

- 36m for patients with chronic HF

33
Q

What are the 5 As of intervention?

A
  • Ask: Current/past PA
  • Assess: Stages of change, PMH
  • Advise: Depending on stages of change
  • Assist
  • Arrange: Follow-up
34
Q

What is intervention advice based on?

A
  • History (including intentions & co-morbidities)
  • Motivational interviewing
  • Be realistic (relapse is common, some activities are better than others)
  • Reassurance (SOB is good)
  • Use “PA” instead of “sport” or “exercise”
35
Q

What are the key messages that should be given as part of patient advice?

A
  • Sit less, move more, enjoy exercise
  • Avoid long period of sitting
  • Make walking & PA part of daily life
  • Find opportunities (e.g. stairs)
  • Use a different floor at work when you need the toilet
  • Aim to do more activity
  • Patients can be active even with severe disease/illness
36
Q

What can “assist” include?

A
  • Education (23.5 hrs video)
  • Written/visual summary
  • Youtube videos
  • NHS choices
  • Apps/initiatives
  • Classes, facilities, groups
  • Charity websites
37
Q

When should follow-ups be arranged?

A
  • 3, 6, 12 months

- Multiple follow ups = more likely to remain active

CI2 (17 decks)

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