Physiologic Norms and Exercise Safety

Question 1

List contraindications for high intensity exercise

Answer 1

• unstable angina
• decompensated heart failure
• acute cardiac event (CABG, MI, vtach/vfib, pacemaker/defibrillator placement) within 6 weeks
• PE within 6 weeks
• CVA within 6 weeks
• cerebral aneurysm of any size, if untreated
• cerebral aneurysm of any size, if treated, within 6 weeks
• rhabdomyolysis within 6 weeks
• severe mitral or aortic valve stenosis
• mitral or aortic valve stenosis of any severity WITH hx of syncope and WITHOUT corrective surgery
• severe pulmonary hypertension (mean pulmonary arterial pressure of >55mmHg)
  -proliferative diabetic retinopathy
• physician-ordered “no strenuous activity” restrictions

Question 2

List precautions for high intensity exercise

Answer 2

• limb specific conditions (avoid high-intensity rehab involving affected limb): fracture (recent within 6 weeks, or unstable fractures), osteomyelitis, avascular necrosis, osteosarcoma or bone metastases, DVT within 6 weeks with anticoagulation
• abdominal precautions or chronic conditions –> avoid valsalva (e.g., hernia)
• severe osteoporosis or compression fracture –> avoid spinal flexion/rotation, want neutral alignment of joint
• moderate or severe non-proliferative diabetic retinopathy –> avoid valsalva and maintain BP <150/100
• aortic aneurysm –> no lifting >75lbs, avoid valsalva, and maintain BP <150/100
• other post-operative activity restrictions/precautions

Question 3

Possible side effects of steroids

Answer 3

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

Question 4

Possible side effects of beta-blockers

Answer 4

• hypotension
• bradycardia
• drowsiness

Question 5

Resting heart rate norms (adult and pediatrics)

Answer 5

adults: 60-100 bpm
pediatrics: 75-85 bpm

Question 6

Resting BP norms (male and female)

Answer 6

female: 110/70 mmHg
male: 120/80 mmHg

Question 7

Recommended max BP while exercising

Answer 7

• 250/115 mmHg with monitoring
• 200/100 or 220/110 mmHg clinically

Question 8

Resting respiratory rate norm versus distressed

Answer 8

12-18 norm, distressed if 20+

Question 9

VO2 max norms for various populations

Answer 9

• deconditioned middle age adults: 30-40
• conditioned middle age adults: 45-55
• high level endurance athletes: 70
• high level cross country skiiers: 80
• sedentary young adults: 45
• sedentary middle age adults: 35
• post MI: 22
• severe pulmonary disease: 13

Question 10

1 MET = ___ VO2?

Answer 10

1 MET = 3.5 ml O2 consumed/kg of body weight/min (VO2)

Question 11

Fasting blood glucose levels (normal, pre-diabetic, and diabetic)

Answer 11

normal: 60-100 mg/dL
pre-diabetic: 100-125 mg/dL
diabetic: 126+ mg/dL

Question 12

Exercise risk with non-fasting blood glucose levels

Answer 12

• if <100 mg/dL –> possible risk of hypoglycemia (symptoms include being anxious and confused)
• pre-exercise level of 100-150 mg/dL –> able to exercise
  -if >250-300 mg/dL –> warrants caution
• ketones in urine –> no exercise

Question 13

RBC norms (male, female)

Answer 13

male: 4.7-5.5
female: 4.1-4.9

Question 14

Hemoglobin norms (male, female)

Answer 14

male: 14.4-16.6 gm/dL
female: 12.2-14.7 gm/dL

Question 15

Abnormal hemoglobin values for exercise

Answer 15

<8.0: discuss with MD
8-10: decreased exercise tolerance d/t important role of hemoglobin on oxygen transport
10-12: low impact, low intensity resistance exercise okay

Question 16

Hematocrit norms (male, female)

Answer 16

male: 43-49 %
female: 38-44 %

Question 17

Abnormal hematocrit values for exercise

Answer 17

30: reduced exercise capacity begins at this value
25-30: markedly reduced exercise tolerance
<20: no exercise

Question 18

Platelet values and implications

Answer 18

Normal: 150,000-400,000
>20,000: low impact/resistance
10,000-20,000: no impact/resistance
<10,000 and/or temperature >100.5*: no exercise

Question 19

INR values and implications

Answer 19

0.9-1.1 seconds: normal
2-3: normal if on anticoagulation therapy
>5: evaluate mobility and assess safety for discharge planning
>6: discuss with MD

Question 20

What is a normal response to exercise (RR, SBP, DBP, HR)?

Answer 20

• RR increases, SBP increases, and DBP has no/minimal change (i.e., rise or fall of <10mmHg), HR increases (can be blunted by beta-blockers or age)
• within 5 minutes of rest, BPO should return to within 10mmHg and HR should return to within 10bpm of resting values

Question 21

When to stop exercise according to vitals?

Answer 21

• SBP >250mmHg with EKG monitoring
• SBP >200-220mmHg without EKG monitoring
• sudden drop in SBP >10mmHg (which may indicative of a sudden bleed)
• failure of SBP to rise
• DBP >115mmHg with EKG monitoring
• DBP >100-110 without EKG monitoring
• decrease in HR below baseline

Question 22

Other signs (neurological, integument, pain, respiratory, endocrine/gastrointestinal) to stop exercise?

Answer 22

• neurological: dizziness/lightheadedness, confusion, ataxia, shaking/tremors
• integument: cyanosis or pallor, diaphoresis or cold/clammy skin
• pain: legs cramps or severe claudication, chest/arm/jaw pain, moderate to severe angina
• respiratory: moderate to severe dyspnea (unable to say 5 words), abnormal breathing pattern (wheezing, wet, stridor = inspiratory wheezing), drop in O2 sats >10% below baseline or <88% that does not recover within 5 minutes
• endocrine/GI: suspected hypoglycemic response, nausea/vomiting