PHYS NORMS AND EX SAFETY Flashcards
CONTRA-INDICATIONS TO HIGH INTENSITY EXERCISE
-unstable angina (pain at rest)
-decompensated heart failure (worsening edema, fatigue, SOB at rest)
-acute cardiac event within 6 weeks (MI, VTACH/VFIB, PACEMAKER/DEBFIB PLACEMENT, CABG)
-MI within last 6 weeks
-PE within last 6 weeks
-severe valve stenosis (mitral or aortic) or valve stenosis with history of syncope without corrective surgery
-severe pulmonary hypertension (mean pulm arterial pressure >55 mmHg)
-proliferative or severe non-proliferative diabetic retinopathy (risk vision loss)
-CVA within last 6 weeks (esp hemorrhagic)
-cerebral aneurysm of any size, if untreated
-cerebral aneurysm of any size, if treated within 6 weeks
-rhabdomyolysis within 6 weeks
-hydrocephalus if treated with shunting
-physician ordered “no strenuous activity” restrictions
PRECAUTIONS TO HIGH INTENSITY EXERCISE
LIMB SPECIFIC; AVOID HIGH INT REHAB INVOLVING AFFECTED LIMB:
-fracture
-osteomyelitis
-avascular necrosis
-osteosarcoma
-bone metastases
-DVT within 6 weeks with anticoagulation
-abdominal precautions or chronic conditions (hernia) (avoid Valsalva) * have pts count, talk out loud, or participate in patterned breathing to avoid Valsalva
-severe OP or compression fracture (avoid spinal flexion and rotation) ** note that avoiding all activity is not good
-moderate or severe non-proliferative diabetic retinopathy (avoid valsalva and maintain BP <150/100)
-aortic aneurysm (no lifting >75 lbs, avoid valsalva, maintain BP <150/100)
Joint replacement precautions
-HIR to the affected limb immediately after surgery
-monitor pain, swelling, and incision healing to determine progression or modification
-if pain is limiting factor –> load the joints distal and proximal to the joint replacement
-can also perform HIRT in non-WB positions
WBAT precautions for HIRT
-apply HIR principles to affected limbs through closed chain activities (within patient’s tolerated limits)
Surgically stabilized fractures precautions:
ex: ORIF
-immediately apply HIR principles to open-chain exercises involving the non-affected areas of the limb
-strengthen the adjacent areas and try not to stress the actual incision
-may be able to introduce HIR principles to affected area of limb after 2 weeks
Acute or chronic pain HIRT precautions
-alternate sides or types of activity to avoid excessive pain increases; work within non-painful ranges
-try an ECCENTRIC focus
ex: stand up using their arms, then have them sit back down without their arms while focusing on quad control
-usually CONCENTRIC portion is more painful
Cognition precautions to HIRT
-modify environment
-monitor your patient’s energy levels - schedule when they are at their highest mental and physical energy levels
-simplify/minimize verbal info - 1-step commands, visually demonstrate exercises, ask patient to copy your movements
-have a back up plan –> plan for more exercises or activities than you anticipate needing during session so you can change up the task to keep your patient engaged
PA considerations moderate non-proliferative diabetic retinopathy:
-limit increases in BP
-avoid valsalva
-avoid jarring activities like boxing
-maintain BP below 150/100
PA considerations proliferative diabetic retinopathy:
-limit increases in BP
-avoid valsalva
-avoid jarring activities like boxing
-avoid high impact activities or activities that raise intra-ocular pressures: high impact aerobic dance, weightlifting, jogging, boxing, racquet sports, scuba diving, trumpet playing, rollercoasters, head-down activities
-encourage low impact activities: swimming, walking, low-impact aerobic dance, stationary cycling, endurance exercise
Possible CI’s of cancer:
-bone metastasis sites –> concern for pathological fractures
-tumors in targeted strength training area
-consider that meds could affect long bone strength
MSK CI’s
-recent fractures < 6 weeks
-unstable fxs
-osteomyelitis: no high intensity strength training on involved limb
-AVN: not on the involved limb
-wounds with exposed tendon or muscle on involved joint
-compression fxs (maintain neutral alignment of the joint)
-weight bearing restrictions with graft or fx sites (open chain, iso only)
-Marfan syndrome (CT disorder)
Possible surgical contra-indications:
CRANIOTOMY (< 6 weeks)
o No bending over
o No lifting >10 pounds
o No Valsalva
ABDOMINAL PRECAUTIONS (< 6 weeks)
o No sit-ups/crunches
o No Valsalva
o No lifting >10 lbs
STERNAL PRECAUTIONS (< 6 weeks) (ex: after CABG)
o No UE high-intensity
o No Valsalva
o No lifting >10 lbs
Medications: possible precautions
STEROIDS side effects:
-HTN
-immunosuppression
-OP
-muscle weakness and myopathy
-thin skin and poor wound healing
BETA-BLOCKERS side effects:
-hypotension
-bradycardia
-drowsiness
NORMAL RESTING HR
ADULTS: 60-100 BPM
PEDS: 76-85 BPM
NORMAL RESTING BP
WOMEN: 110/70 mm Hg
MEN: 120/80 mm Hg
NORMAL EXERCISE MAX BP
250/115 mmHg (with monitoring)
Clinical (without monitoring) below 200 SBP, below 110 DBP
NORMAL RESTING RR
Resting: 12-18
Distressed resting: RR: 20+
NORMAL RESTING BP
SBP
less than 120
AND
DBP
less than 80
ELEVATED RESTING BP
SBP
-120-129
AND
DBP
less than 80
HTN STAGE 1 BP RESTING BP
SBP:
130-139
OR
DBP:
80-89
HTN STAGE 2 BP RESTING BP
SBP:
140 OR HIGHER
OR
DBP:
90 OR HIGHER
HYPERTENSIVE CRISIS RESTING BP
SBP:
HIGHER THAN 180
AND/OR
DBP: HIGHER THAN 120
VO2 max values for different populations
Below 20 mL/min/kg - substantially impaired
Near 20 mL/min/kg- impaired
- Deconditioned middle age
adults: 30-40 - Conditioning (months): 45-55
- High level endurance
athletes: 70 - High level cross country
skiers: 80 - Sedentary young adults: 45
- Sedentary middle age adults:
35 - Post MI: 22
◦ Up ~20% with training - Severe pulmonary disease: 13
What is one MET
-a metabolic equivalent; how much oxygen is consumed per minute at rest
-3.5 ml O2 consumed/kg of body weight/min (VO2)
-also 1 kcal/kcal/hour
VACCUM: 3.5
DANCING: 6.5
JOGGING: 7.0
BICYLING: 8
RUNNING A 7 MIN MILE : 14 MET
Pulmonary function tests:
TV: 0.5 L at rest
FVC: 3-5 L
- max air you can forcibly remove from your lungs after forcibly inhaling
FEV1: 2.5-4 L
-the maximum amount of air that the subject can forcibly expel during the first second following maximal inhalation
FEV1/FVC: > 80% in healthy adults
-indicates how much air you can forcefully exhale
What happens to the hemoglobin-O2 dissociation curve during exercise?
It shifts to the right
-Hb has a decreased affinity for oxygen so that oxygen can be available in circulation for exercise
EXERCISE: increase temperature, increase co2, decrease pH, increase 2,3-DPG
-decreased hemoglobin affinity for oxygen at higher intensities of exercise
Normal ABG values:
- pH: 7.40 (7.2-7.6)
- pCO2: 35-45 mmHg
- pO2: 80-100mmHg
CLASS I NYHA classification of heart failure
MILD
No symptoms and no limitation in ordinary physical activity, ordinary PA does not cause undue fatigue, rapid/irregular heartbeat or SOB
CLASS II NYHA classification of heart failure
MILD
Slight limitation of PA
comfortable at rest, but ordinary PA results in fatigue, rapid/irreg heartbeat, or SOB
CLASS III NYHA classification of heart failure
MODERATE
marked limitation of PA, comfortable at rest, but less than ordinary activity causes fatigue, rapid/irregular heartbeat (palpitation) or SOB (dyspnea)
CLASS IV NYHA classification of heart failure
SEVERE
-unable to carry out any PA without discomfort, fatigue, irregular/rapid HR or SOB present at rest
-if any PA undertaken, discomfort rises
Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.
What is an ejection fraction and what is a normal ejection fraction value?
-Ejection fraction is measured as a percentage of the total amount of blood in your heart that is pumped out with each heartbeat
NORMAL: >55%
normal percent body fat men/women
MEN: 15-18%
WOMEN: 22-25%
BMI CLASSES AND VALUES
UNDERWEIGHT
<18.5
NORMAL
18.5-24.9
OVERWEIGHT
25-29.9
OBESITY CLASS I
30-34.9
OBESITY CLASS II
35-39.9
EXTREME OBESITY CLASS III
>40
Normal blood glucose levels, pre-diabetic, and diabetic:
NORMAL
-60-100 mg/dL
PRE-DIABETIC
-100-125 mg/dL
DIABETIC
-126+ mg/dL
Oral Glucose tolerance test levels:
NORMAL
<140 mg/dL
PRE-DIABETES
140-200 mg/dL
DIABETES
>200 mg/dL –> less ability to metabolize glucose
Blood glucose levels (mg/dL) during exercise:
<100
-run risk of hypoglycemia (DO NOT EXERCISE)
100-250
-able to exercise
> 250-300
-warrants caution
ketones in the urine
-NO EXERCISE
NORMAL RBC COUNT MEN AND WOMEN
MEN: 4.7-5.5 mm^3
WOMEN: 4.1-4.9 mm^3
WB CELLS and exercise precauations/contraindications
EXERCISE AS TOLERATED:
3900-11000 mm^3
CAUTION WITH EXERCISE
<3900 with fever mm^3
Hemoglobin and Hematocrit contra-indications
HEMOGLOBIN (mg/dL)
-NORMAL: 14.4-14.6 males, 12.2-14.7 females
<8 discuss with MD
8-10 decreased ex tolerance
10-12 low impact, low intensity resistance exercise
HEMATOCRIT (%)
-males: 43-49%
-females: 38-44%
30- reduced capacity for exercise begins
25-30- markedly reduced exercise tolerance
<20- no exercise
Platelet value possible contraindications:
150000-400000- normal
<10,000 and/or temperature >100.5 - no exercise
10000-20000- no resistance, non-impact
> 20k- low impact, resistance (keep in mind fall risk)
INR possible contra-indicatons:
**someone on coumadin (anticoagulant)
0.9-1.1: normal w/out anticoagulation
2-3: normal if on anticoagulation therapy
> 5: evaluate mobility and assess safety for discharge planning (risk of bleeding)
> 6: discuss with MD (risk of bleeding)
What does a high/low INR mean?
When the INR is higher than the recommended range, it means that your blood clots more slowly than desired (bleeding risk)
A lower INR means your blood clots more quickly than desired.
Normal Response to exercise:
-increased RR
-rise in SBP
-minimal or no change in DBP
–> change should be less than 10 mmHg
-rise in HR
–> blunted by beta blocker meds and age
-following exercise, within 5 minutes of rest
–> BP returns to within 10 mmHg
–> HR to within 10 BPM of resting value
WHEN TO STOP EXERCISE
CARDIO:
-SBP > 250 mmHg with EKG monitoring
-SBP 200-220 without EKG monitoring
-sudden drop in SBP >10 mmHg
-Failure of SBP to rise
-DBP >115 mmHg with EKG monitoring
-DBP 100-110 without EKG monitoring
-Decrease in heart rate below baseline
NEURO:
-dizziness/lightheadedness
-confusion
-ataxia
-shaking/tremors
INTEGUMENT:
-cyanosis or pallor
-diaphoresis or cold/clammy skin
PAIN:
-leg cramps or severe claudication (ms. pain due to lack of oxygen)
-chest/arm/jaw pain
-moderate to severe angina
RESP:
-moderate-severe dyspnea
-abnormal breathing
-drop in o2 sats >10% below baseline or <88% (does not recover within 5 min of rest)
ENDOCRINE/GI:
-suspected hypoglycemic response
-nausea or vomiting
