Intervention 2- Exercise Prescription

Question 1

Components of aerobic exercise

Answer 1

FITT principle: frequency, intensity, time, type

Question 2

cardiorespiratory endurance activities

Answer 2

• walking, jogging, or cycling recommended to improve exercise tolerance
• can be maintained at a constant velocity
• very low interindividual variability

Question 3

dynamic arm exercise

Answer 3

• 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

Question 4

other aerobic activities

Answer 4

• swimming, cross-country skiing
• less frequently used due to high inter individual variability
• energy expenditure related to skill level

Question 5

who should dancing, basketball, racquetball, and other competitive activities not be used for?

Answer 5

high risk, symptomatic and low fit individuals

Question 6

early rehabilitation

Answer 6

• 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

Question 7

warm up and cool down

Answer 7

• 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

Question 8

resistive exercise

Answer 8

• 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

Question 9

what does valsalva cause

Answer 9

dramatic increase in BP and a reduction in SV and CO

Question 10

Resistive training is contraindicated for….

Answer 10

patients with uncontrolled hypertension or arrhythmias

Question 11

relaxation training

Answer 11

• 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

Question 12

how is intensity prescribed

Answer 12

• 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

Question 13

If you dont have a GXT, how do you prescribe exercise intensity based on HR?

Answer 13

208- (0.7xage) then take 70%-85%
- this closely corresponds to 60-80% of functional capacity or VO2max

Question 14

when is estimated HR max used for exercise prescription?

Answer 14

Where submax ETT has been given

Question 15

What can more closely approximate the relationship between HR and VO2max?

Answer 15

• heart rate range/reserve (aka Karvonen’s formula)
• but has increased variability in patients on medications

Question 16

what do beta blockers do during exercise

Answer 16

affect ability of HR and BP to rise normally in response to exercise

Question 17

pacemaker affect of exercise

Answer 17

can affect ability of HR to rise in response to an exercise stress if it is fixed

Question 18

other factors affecting HR and BP response to exercise

Answer 18

environmental extremes, heavy arm work, isometric exercise, and valsalva

Question 19

2 problems with using RPE alone to prescribe exercise intensity

Answer 19

1. individuals with psychological problems
2. unfamiliarity with RPE scale may affect selection of ratings

Question 20

average conditioning time for moderate intensity exercise

Answer 20

20-30 mins

Question 21

when thinking about time, severely compromised individuals may benefit from..

Answer 21

multiple short duration exercise sessions spaced throughout the day

Question 22

what does frequency of an activity depend on?

Answer 22

intensity and duration

Question 23

average frequency

Answer 23

3-5 sessions/week for exercise at moderate intensities and duration

Question 24

modify exercise prescription if..

Answer 24

1. HR is lower than target HR for given exercise intensity
2. RPE is lower for a given exercise
3. symptoms of ischemia do not appear at a given exercise intensity

Question 25

rate of progression depends on…

Answer 25

age, health status, functional capacity, personal goals, preferences

Question 26

as training progresses, what should you progress first?

Answer 26

duration is increased first, then intensity

Question 27

consider reduction in exercise/activity with:

Answer 27

1. acute illness, fever, flu
2. acute injury, orthopedic complications
3. progression of cardiac disease: edema, weight gain, unstable angina
4. overindulgence
5. environmental stressors

Question 28

adverse responses to inpatient exercise leading to exercise termination

Answer 28

1. diastolic BP >/= 110 mmHG
2. decrease in systolic BP >10mmHG during exercise
3. significant ventricular or atrial dysrhythmias with or without associated sxs
4. second or third degree heart block
5. sxs of exercise intolerance, including angina, marked dyspnea, and ECG changes suggestive of ischemia

Question 29

exercise prescription for post-PTCA

Answer 29

1. wait to exercise vigorously approximately 2 weeks s/p to allow inflammatory process to subside
2. walking program can be initiated immediately
3. use s/p GXT to prescribe exercise

Question 30

exercise prescription for post-CABG

Answer 30

1. limit upper extremity exercise while sternal incision is healing
2. avoid lifting, pushing, pulling for 4-6 weeks s/p

Question 31

16 contraindications for inpatient and outpatient cardiac rehabilitation

Answer 31

1. unstable angina
2. resting SBP >200 or DBP >110
3. orthostatic BP drop >20 mmHg with symptoms
4. critical aortic stenosis
5. acute systemic illness or fever
6. uncontrolled atrial or ventricular arrhythmia
7. uncontrolled sinus tachycardia
8. uncompensated CHF
9. 3rd degree AV block w/o pacemaker
10. pericarditis or myocarditis
11. recent embolism
12. thromboplebitis
13. resting ST segment depression or elevation (>2mm)
14. uncontrolled diabetes
15. severe orthopedic conditions that prohibit exercise
16. other metabolic conditions such as acute thyroiditis, hypo/hyperkalemia or hypovolemia