- doesn't require O2 - utilizes one molecule of glucose - occurs in the cytoplasm - by-product is lactic acid - yields net 2 ATP

- Uses carbs, fats and proteins - occurs in the mitochondria - by-products war H2O and CO2 - Yields net 36 ATP per glucose molecule

Final Exam Flashcards by Barb Goodhart

What are some of the barriers to optimal practice patterns?

Care based on Reimbursement instead of evidence-based
Limited incentives for high-quality transitional care (lack of ACO’s)
Fear of adverse events, penalties, or litigation
Current emphasis is on returning pts to PLOF which was already low
Lack of awareness of more effective clinical care strategies

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Anaerobic Metabolism

doesn’t require O2
utilizes one molecule of glucose
occurs in the cytoplasm
by-product is lactic acid
yields net 2 ATP

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Aerobic Metabolism

Uses carbs, fats and proteins
occurs in the mitochondria
by-products war H2O and CO2
Yields net 36 ATP per glucose molecule

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Cells that use aerobic metabolism

heart, CNS, PNS, skeletal muscle (Type I)

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Cells that use anaerobic metabolism

Connective tissue cells (bone, cartilage, RBC’s); Skeletal muscle (Type II)

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VO2 is (equations)

CO x a-v O2 difference

Volume of O2 entering lungs -volume of O2 leaving lungs

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At what % of VO2 max does aerobic threshold usually fall?

55%

Can increase w/ training and decrease with detraining

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1 MET= ________VO2

3.5mLO2/Kg*min

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______MET’s is considered moderate physical activity

3-6 MET’s

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______MET’s is considered vigorous physical activity

> 6MET’s

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What VO2/MET level is considered disabled by Social Security?

18mL/Kg*min or ~5 MET’s

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Examples of Symptom limited graded tests

Treadmill–Bruce, modified Bruce, Balke, Naughton

Can use cycle ergometer for people w/ balance disorders, obesity or WBing precuations/restricitons

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Drawback of Submax testing

Tend to udnerestimate VO2 max in untrained and overestimate in the trained

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Cardiovascular Contraindications

Recent MI (w/in 3-6 weeks)
Pulmonary embolism/infarction (<6 weeks)
DVT detected – avoid affected limb only if they are otherwise appropriate
Myocarditis, endocarditis, pericarditis
recent cerebral shunting/aneurysm coil
resting HR <50 or >100
unstable angina
severe pulmonary hypertension (mean pulmonary arterial pressure >55 mmHG)
Severe and symptomatic aortic or valvular stenosis
fistula on UE for dialysis access
uncontrolled hypertension (Resting SBP>170, DBP>100)
Decompensated CHF
absent pulses in the limbs

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Retinopathy Precautions

Avoid valsalva maneuvers.

Severe nonproliferative no SBP >170
Proliferative: exercise is contraindicated

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Cancer possible Contraindications

Bone metastasis
Tumors in strength training area
medication effects (precaution)

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MSK possible contraindications (9)

Fx in last 6 weeks
unstable fxs
osteomyelitis-no training in involved limb
Avascular necrosis - no training on involved limb
wounds with exposed tendons/muscles
compression fxs need to remain in neutral alignment
WBing restrictions
Marfan syndrome
Hernias

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Surgical precautions

All: no lifting >10lbs, no valsalva
Craniotomy<6weeks: no bending over
Abdominal<6weeks: no sit-ups/crunches
Sternal<8weeks: no UE

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Other medical conditions possible contraindications

acute infection
mono
hepatitis
AIDS

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Possible precautions w/ steroids (5)

hypertension
immunosuppression
osteoporosis
muscle weakness and myopathy
thin skin and poor wound healing

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Possible precautions w/ beta-blockers

hypotension
bradycardia
drowsiness

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Normal tidal volume

0.5L at rest

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Forced Vital Capacity (FVC)

3-5L, 80% predicted or better is normal

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Forced expiratory volume (FEV1)

2.5-4L, 80% predicted or better is normal

FEV1/FVC

>80% in healthy adults

Normal pH

7.40 (7.2-7.6)

pCO2

35-45 mmHg

pO2

80-100mmHg

Ejection Fraction

>55%

normal fasting blood glucose levels

60-100 mg/dL

Safe blood glucose levels for PT session

100-250 mg/dL

Normal RBC count

Men: 4.7-5.5x10^6 Women: 4.1-4.9x10^6

Normal WBC count

Exercise as tolerated:3,900-11,000 | Caution w/ exercise: <3,900 with fever

Normal Hb levels

Men: 14.4-16.6 Females: 12.2-14.7

Hb level precautions

<8.0 Discuss w/ MD 8-10 Decreased exercise tolerance 10-12 low impact, low intensity resistance exercise

Normal Hematocrit values

Males: 43-49% Females: 38-44%

Hematocrit precautions

30 reduced capacity for exercise begins 25-30 Markedly reduced exercise tolerance <20 No exercise

Platelet Count precautions

>20k low impact, resistance OK 10k-20k no resistance, non-impact <10k and/or temp >100.5 no exercise

Normal platelet counts

150,000-400,000

INR precautions

.9-1.1 Normal 2-3 Normal if on anticoagulation therapy >5 Evaluate mobility and assess safety for discharge planning >6 discuss w/ MD

Neurological Stopping Points

- dizziness/lightheadedness - confusion - ataxia - shaking/tremors

Integument stopping points

- cyanosis or palor | - diaphoresis or cold/clammy skin

Pain stopping points

- leg cramps or severe claudication - chest/arm/jaw pain - moderate to severe angina

Respiratory stopping points

- moderate to severe dyspnea - abnormal breathing pattern - drop in O2 stats >10% below baseline or <88%

Endocrine/GI stopping points

- Suspected hypoglycemia | - Nausea or vomiting

How do you calculate VO2 from MET's?

MET's x 3.5 = VO2

How do you calculate MABP?

DBP - 1/3(SPB-DBP)

Angina Scale and where to stop exercise

1+ Light, barely noticeable 2+ Moderate, bothersome 3+ Severe, very uncomfortable (stopping point for exercise) 4+ Most severe pain ever experienced

Borg Dyspnea Scale

0-10, 0.5 is just noticeable, 5 is severe, 7 is very severe

Ranchos Los Amigos dyspnea levels

``` Pt is able to count to 17 in 7.5-8 seconds: 0 on a single breath 1 requires 2 breaths 2 requires 3 breaths 3 requires 4 breaths 4 unable to count ```

Ventilation=?

Tidal volume x respiratory rate

Chronic bronchitis

over production of mucus causes an occlusion of airways

Emphysema

can be hereditary Alpha 1-antitrypsin deficiency or cause by smoking (most) Alveoli merge into giant air sacs so gas exchange is limited and air gets trapped in the lungs

Signs/symptoms of COPD (14)

- SOB - DOE - orthopnea (only able to breathe in upright position) - wheezing - increased RR - peripheral cyanosis - digital clubbing - pursed lip breathing - malaise - chronic cough - barrel chest - weight loss - decreased FEV1/FVC - chronic anxiety or depression

Karvonen formula for target HR

Target Heart Rate = [(max HR − resting HR) × %Intensity] + resting HR

Defining parameters of aerobic HIIT

60s all out (75-85% max HR; 14-16/20 or 6-8/10), 30-60s rest (preferably active recovery) x20 mins

PAD diagnoses based on ABI levels:

Normal=0.91+ Mild obstruction=0.70-0.90 Moderate obstruction=0.40-0.69 Severe obstruction <0.40 (may have sx at rest, at risk of amputation)

Gait speeds for red, yellow, and green flags

Red flag <=0.6 m/s yellow flag =0.6-1.0 m/s Green flag >1.0m/s

MDC for gait speed

0.1-0.2