Exercise Safety Guidelines Flashcards
Normal response
- Increased RR
- Rise in SBP
- Minimal (+/- 10) or no change in DBP
- Rise in HR
Following 5 min rest: BP w/in 10 mmHg of resting value, HR w/in 10 bpm resting value
When to stop: Cardiovascular
- SBP 200-220 w/o EKG (>250 w/ EKG)
- Sudden >10 mmHg SBP
- Failure of SBP to rise
- DBP 100-110 w/o EKG (>115 w/ EKG)
- Decrease in HR below baseline
When to stop: neurological
- Dizziness/lightheadedness
- Confusion
- Ataxia
- Shaking/tremors
When to stop: integument
- cyanosis
- pallor
- diaphoresis (excessive sweating)
- cold/clammy skin
When to stop: pain
- leg cramps
- severe claudication
- chest/arm/jaw pain
- moderate to severe angina
when to stop: respiratory
- mod-severe dyspnea (unable to say 5 words)
- abnormal breathing pattern
- drop in O2 sats >10% below baseline or <88% (does not recover w/in 5 min rest)
When to stop: endocrine/GI
- suspected hypoglycemic response
- nausea/vomiting
Cancer possible contraindications
Bone metastasis sites
Tumors in targeted strength training areas
Medication effects
MSK possible contraindications
No high intensity strength training on involved limb:
- recent fracture <6 weeks
- Unstable fracture
- osteomyelitis (bone infection)
- avascular necrosis
- wounds w/ exposed tendon or muscle
Surgical possible contraindications
Craniotomy <6 weeks
- no bending, lifting >10 lbs, valsalva
Abdominal <6 weeks
- no crunches, valsalva, lifting >10 lbs
sternal <6 weeks
- no UE high intensity, valsalva, lifting >10 lbs
Steroid use precautions
- HTN
- immunosuppression
- osteoporosis
- muscle weakness/myopathy
- thin skin, poor wound healing
Beta blocker use precautions
- Hypotension
- bradycardia
- drowsiness
Contraindications to high intensity exercise (12)
Unstable angina (pain at rest)
Decompensated heart failure (evidenced by worsening edema, fatigue, and SOB at rest)
Acute cardiac event w/in 6 weeks (MI, vtach/vfib, pacemaker placement, CABG)
Severe mitral or aortic valve stenosis
Mitral or aortic valve of any severity WITH history of syncope and w/o corrective surgery
Severe pulmonary hypertension (MAPpulm > 55 mHg)
PE w/in 6 weeks
Proliferative diabetic retinopathy
CVA w/in 6 weeks
Cerebral aneurysm of any size if untreated, or treated w/in 6 weeks
Rhabdomyolysis w/in 6 weeks
Physician ordered “no strenuous activity” restrictions
Precautions to high intensity exercise
Limb specific conditions (fracture, osteomyelitis, avasc necr, bone cancer, DVT w/in 6 weeks w/ anticoag)
Abdominal precautions or chronic condition (hernia; avoid valsalva)
Severe osteoporosis or compression fx (avoid spinal flexion and rotation)
Moderate or severe non-proliferative diabetic retinopathy (avoid valsalva; keep BP < 150/100)
Aortic aneurysm (no lifting >75 lbs, avoid valsalva, keep BP <150/100)
Submax exercise testing assumptions
A steady-state HR is obtained for each exercise work rate
A maximal HR for a given age is uniform (220-age)
Mechanical efficiency is the same for everyone (VO2 at given work rate)
Linear relationship between HR and workload
HR will vary depending on fitness level between subjects at any given workload
Signs/symptoms of obstructive lung disease
SOB
dyspnea on exertion
orthopnea
wheezing
peripheral cyanosis
digital clubbing
pursed lip breathing
malaise
chronic cough
weight loss
increased use of accessory mm.
prolonged expiratory period
Obstructive lung disease
Inability to get air out
COPD (emphysema, chronic bronchitis)
Decreased FEV1/FVC ratio (decreased amount of air that can be forcefully expired in 1 second - FEV1)
Physiologic effects of exercise and obstructive lung disease
impedes lung emptying, req more time
increased breathing leads to hyperinflation, small tidal volume
impairment of gas exchange
Positive effects of exercise and obstructive lung disease
CV reconditioning
desensitization to dyspnea
improved ventilatory efficiency
restrictive lung disease
inability to get air in
diminished lung volume
increased or normal FEV1/FVC ratio (decreased FVC - amount of air that can be forcefully exhaled in 1 min)
Extrapulmonary causes of restrictive lung disease
Neuromuscular disorders (DMD, ALS, GB, SCI)
chest wall disorders (obesity, compression fx, ankyl spondy)
pleural disorders (fibrosis, effusion)
Intrapulmonary causes of restrictive lung disease
pulmonary fibrosis
RDS
malignancy
pulmonary edema
lung resection
radiation
How to assess lung function as a PT
O2 sats
Cyanosis
Pulmonary function test (differential)
impact of exercise on cardiovascular function
increase in HR, SV, CO, SBP
with training, HR can decrease w/ same intensity
CO and SV plateau at max cardiac function (HR at max capacity)
can use relationship between HR and VO2 to predict VO2max
Angina scale
Stop at 3+ (severe, very uncomfortable)
Double product/rate pressure product
HR x SBP = RPP
fixed anginal threshold
improve HRR and SBP response to increase exercise tolerance
atrial fibrillation
uncontrolled: >100 bpm
controlled: up to 100 bpm
greater risk for throwing clots
pulse rate does not work with dysrhythmias
How to monitor heart function as a PT
HR (consider meds)
BP
RPP/double product
EKG rate and ST level (differential)
symptoms (angina, lightheadedness, Borg dyspnea scale)
