Intervention 2- Exercise Prescription Flashcards
Components of aerobic exercise
FITT principle: frequency, intensity, time, type
cardiorespiratory endurance activities
- walking, jogging, or cycling recommended to improve exercise tolerance
- can be maintained at a constant velocity
- very low interindividual variability
dynamic arm exercise
- arm ergometry
- uses a smaller muscle mass
- results in lower VO2max (60-70% lower)
- HR will be higher
- strove volume lower
- systolic and diastolic BP will be higher
other aerobic activities
- swimming, cross-country skiing
- less frequently used due to high inter individual variability
- energy expenditure related to skill level
who should dancing, basketball, racquetball, and other competitive activities not be used for?
high risk, symptomatic and low fit individuals
early rehabilitation
- activity is discontinuous (interval training) with frequent rest periods
- progress to continuous training
- interval training can also be incorporated in vigorous training to allow patient to work at higher percentage of VO2max
warm up and cool down
- gradually increase or decrease the intensity of exercise to promote circulatory and muscular adjustment to exercise
- type: low intensity cardiorespiratory endurance activity, flexibility exercise, functional mobility
- 5-10 mins
- abrupt beginning or cessation of exercise is not recommended
resistive exercise
- to improve strength and endurance in clinically stable patients
- usually prescribed in later rehab, after period of aerobic conditioning
- moderate intensities typically used
- monitor responses to resistive training using RPP
what does valsalva cause
dramatic increase in BP and a reduction in SV and CO
Resistive training is contraindicated for….
patients with uncontrolled hypertension or arrhythmias
relaxation training
- relieves generalized muscle tension and anxiety
- usually incorporated following an aerobic training session and cool-down
- assists in successful stress management and life style modification
how is intensity prescribed
- as a percentage of functional capacity revealed on GXT, within range of 40-85% depending upon initial level of fitness
- typical training intensity is 60-80% of functional capacity
- lower training intensities may necessitate an increase in training duration
- most clinicians use a combination of HR, RPE, and METs to prescribe exercise intensity
If you dont have a GXT, how do you prescribe exercise intensity based on HR?
208- (0.7xage) then take 70%-85%
- this closely corresponds to 60-80% of functional capacity or VO2max
when is estimated HR max used for exercise prescription?
Where submax ETT has been given
What can more closely approximate the relationship between HR and VO2max?
- heart rate range/reserve (aka Karvonen’s formula)
- but has increased variability in patients on medications
what do beta blockers do during exercise
affect ability of HR and BP to rise normally in response to exercise
pacemaker affect of exercise
can affect ability of HR to rise in response to an exercise stress if it is fixed
other factors affecting HR and BP response to exercise
environmental extremes, heavy arm work, isometric exercise, and valsalva
2 problems with using RPE alone to prescribe exercise intensity
- individuals with psychological problems
- unfamiliarity with RPE scale may affect selection of ratings
average conditioning time for moderate intensity exercise
20-30 mins
when thinking about time, severely compromised individuals may benefit from..
multiple short duration exercise sessions spaced throughout the day
what does frequency of an activity depend on?
intensity and duration
average frequency
3-5 sessions/week for exercise at moderate intensities and duration
modify exercise prescription if..
- HR is lower than target HR for given exercise intensity
- RPE is lower for a given exercise
- symptoms of ischemia do not appear at a given exercise intensity
rate of progression depends on…
age, health status, functional capacity, personal goals, preferences
as training progresses, what should you progress first?
duration is increased first, then intensity
consider reduction in exercise/activity with:
- acute illness, fever, flu
- acute injury, orthopedic complications
- progression of cardiac disease: edema, weight gain, unstable angina
- overindulgence
- environmental stressors
adverse responses to inpatient exercise leading to exercise termination
- diastolic BP >/= 110 mmHG
- decrease in systolic BP >10mmHG during exercise
- significant ventricular or atrial dysrhythmias with or without associated sxs
- second or third degree heart block
- sxs of exercise intolerance, including angina, marked dyspnea, and ECG changes suggestive of ischemia
exercise prescription for post-PTCA
- wait to exercise vigorously approximately 2 weeks s/p to allow inflammatory process to subside
- walking program can be initiated immediately
- use s/p GXT to prescribe exercise
exercise prescription for post-CABG
- limit upper extremity exercise while sternal incision is healing
- avoid lifting, pushing, pulling for 4-6 weeks s/p
16 contraindications for inpatient and outpatient cardiac rehabilitation
- unstable angina
- resting SBP >200 or DBP >110
- orthostatic BP drop >20 mmHg with symptoms
- critical aortic stenosis
- acute systemic illness or fever
- uncontrolled atrial or ventricular arrhythmia
- uncontrolled sinus tachycardia
- uncompensated CHF
- 3rd degree AV block w/o pacemaker
- pericarditis or myocarditis
- recent embolism
- thromboplebitis
- resting ST segment depression or elevation (>2mm)
- uncontrolled diabetes
- severe orthopedic conditions that prohibit exercise
- other metabolic conditions such as acute thyroiditis, hypo/hyperkalemia or hypovolemia
