Impaired Capacity

Question 1

What decreases with age?

Answer 1

Cardiac output
Max HR
Resting and maximal stroke volume
Venous return
Blood Flow

Question 2

How does Blood Flow decrease?

Answer 2

25% increase in Left Ventricular thickness
Vessel rigidity
65 yo has 30-40% of aerobic capacity of young adult

Question 3

What increases with age?

Answer 3

Blood Pressure: both resting & exercise
Cardiac Dysrhythmias
By 75 yo, <10% of SA node cells

Question 4

Age related changes in the heart

Answer 4

Increase adipose tissue 
Increase collagen content 
Decrease muscle cells (myocytes) 
Decrease innervation/nerve conduction tissue
Decrease sympathetic modulation of HR

Question 5

What do age related in changed in the heart result in?

Answer 5

decrease excitability, decrease cardiac output, venous return and an INCREASE in dysrhythmias

Question 6

What happens with the walls of the heart become less compliant?

Answer 6

Results in decreased ejection fraction Declines in Left ventricle expansion and contractility (i.e. reduced end diastole volume)

Question 7

What happens with increased atrial size correlated to left ventricular compliance?

Answer 7

increased workload on the atria

hypertrophy of the aorta

Question 8

End Diastolic Volume

Answer 8

volume of blood in ventricles before contraction

Question 9

Preload

Answer 9

End diastolic pressure which is stretching the walls of ventricles to their greatest dimensions

Question 10

Stoke Volume

Answer 10

Volume of blood ejected from the heart per heartbeat

Question 11

Stroke Volume

Answer 11

Volume of blood ejected from the heart with each beat

Stroke volume = End diastolic volume – end systolic volume

Question 12

What does stroke volume depend on?

Answer 12

contractility
preload
afterload

Question 13

Contractility:

Answer 13

the more forceful the contraction

Question 14

Preload

Answer 14

the end of stretch of the wall of ventricle

Question 15

Afterload

Answer 15

the resistance that the ventricle must overcome to eject blood out of left ventricle

Question 16

VO2

Answer 16

A physiological measure of how much oxygen the body uses at rest or during activity

Question 17

When will VO2 increase?

Answer 17

Increases in proportion to intensity of exercise/physical activity and will plateau when maximal ability for oxygen delivery is reached, which is maximal oxygen consumption (V·O2 max).

Question 18

Aerobic Capacity

Answer 18

Ability to provide and sustain energy aerobically

Reflects the body’s ability to take up, deliver, and use oxygen.

Question 19

Oxygen Consumption (VO2):

Answer 19

Physiological measure of how much oxygen the body uses at rest or during activity. And increases in proportion to intensity of exercise/physical activity and will plateau when maximal ability for oxygen delivery is reached.

Question 20

VO2 Max:

Answer 20

Maximum amount of oxygen that can be taken in, transported and consumed by the working muscles per minute

Question 21

Factors Affecting Aerobic Activity

Answer 21

Age
Gender
Training
Physiological Make Up

Question 22

Age

Answer 22

VO2 max declines with age
After the age of 25 it decreases by 1% each year
Exercise regularly to combat these effects

Question 23

Gender

Answer 23

Men generally have higher VO2 max
Women have a VO2 max of 15-30% lower
Depends on age and other physiological factors

Question 24

Training

Answer 24

Fitness testing can determine VO2 max
Training can improve VO2 max by 10-20%
In addition, lifestyle and diet influence VO2 max

Question 25

For optimum aerobic performance we need

Answer 25

Slow twitch muscle fibers Mitochondria Myoglobin stores

Question 26

Other physiological factors that affect VO2 max

Answer 26

Size of the heart Size of the lungs Number of red blood cells

Question 27

What can affect reconditioning?

Answer 27

Illness Functional limitations Restricted activity Cognitive limitations

Question 28

Age related physiological changes

Answer 28

Reduced maximal oxygen consumption secondary to decreased cardiac performance and skeletal muscle endurance Conditions that affect functional mobility (stroke, Parkinson’s disease, osteoarthritis, bone fractures etc.)

Question 29

What is included in PT Exam?

Answer 29

``` History Systems Review Tests and Measures Evaluation, Diagnosis and Prognosis Plan of Care and Interventions ```

Question 30

History:

Answer 30

Comprehensive history of a patient with impaired aerobic capacity helps to show contributory factors and to determine appropriate interventions. Identification of risk factors for cardiovascular disease

Question 31

Signs and Symptoms highly suggestive of cardiovascular or pulmonary disease

Answer 31

``` SOB at rest or with mild exertion Pain Discomfort in the chest, neck, jaw, arms, or other areas that may result from cardiac ischemia Orthopnea Paroxysmal nocturnal dyspnea Bilateral ankle edema Palpitations Tachycardia Intermittent leg claudication Known heart murmur Undue fatigue with usual activities ```

Question 32

Tests and Measures

Answer 32

Vital Signs 6-Minute Walk Test Self-Report Measures

Question 33

Commonly Used Symptoms Scales

Answer 33

Angina Scale Dyspnea Scale Claudication Scale Rating of Perceived Exertion (RPE)

Question 34

Angina Scale

Answer 34

Mild, barely noticeable Moderate, bothersome Moderately severe, very uncomfortable Most severe or intense pain ever experienced

Question 35

Dyspnea Scale

Answer 35

Light, barely noticeable Moderate, bothersome Moderately severe, very uncomfortable Most severe or intense dyspnea ever experienced

Question 36

Claudication Scale

Answer 36

Definite discomfort or pain, but only at initial or modest levels (established, but minimal) Moderate discomfort or pain from which the patient’s attention can be diverted (e.g., by conversation) Intense pain (short of grade 4) from which the patient’s attention cannot be diverted Excruciating and unbearable pain

Question 37

Systolic BP change during activity?

Answer 37

Systolic BP reflect cardiac output and should also go up in proportion to the metabolic demand of the exercise or activity

Question 38

Diastolic BP during exercise?

Answer 38

Diastolic BP reflects total peripheral resistance, which remains relatively stable in most people during aerobic exercise

Question 39

Absolute exercise contraindications:

Answer 39

unstable angina uncontrolled cardiac dyrhythmias symptoms of hemodynamic compromise uncontrolled symptomatic heart failure acute or suspected major cardiovascular event acute systemic infection a recent significant change in resting ECG suggestive of ischemia, MI or other cardiac event

Question 40

Relative exercise contraindications:

Answer 40

``` known significant cardiac disease severe atrial hypertension tachydysrhythmia or bradydydysrhythmia electrolyte abnormalities uncontrolled metabolic disease chronic infectious disease mental or physical impairment leading to inability to exercise safely ```

Question 41

Absolute indications for terminating exercise

Answer 41

``` Drop in systolic BP or greater than 10mmHG from baseline Moderately severe angina (>2/4) increasing nervous system symptoms signs of poor perfusion subject's desire to stop technical difficulties with equipment sustained ventricular tachycardia ST elevation ```