PTA Flashcards
1
Q
What are the different forms of Asthma?
A
- Allergic
- Non-allergic (exercise induced etc)
- Late onset asthma (in adult life)
- With fixed air flow limitation (due to airway remodelling)
- With obesity
2
Q
How many people in NL suffer from Asthma?
A
1.8 million
3
Q
Is Asthma more prevalent in men or women?
A
Women
4
Q
What does IgE in Asthma stand for?
A
Immunoglobulin E
(an antibody generated by the immune system in response to a harmless stimulus)
5
Q
What happens during the first contact with an allergen in Asthma?
A
- IgE production by eusoniphil leucocytes starts
- IgE attaches to mast cell
→ No symptoms
6
Q
What happens during the second contact with an allergen in Asthma?
A
- Allergen binds to IgE molecules (which are now attached to mast cell)
- Mast cell gets activated/degranulated
- Histamine is released → causes allergic reaction
7
Q
What are the characteristics of a non-allergic asthmatic reaction?
A
- Non-specific stimulus like effort, smoke, dust, fog, cold, viral infection, stress is present
- Degranulation of mast cell and release of histamine without involvement of IgE
8
Q
Exercise-induced bronchoconstriction is the case in?
A
Exercise induced asthma
9
Q
What can absence of wheezing in asthma patients indicate?
A
Exacerbation! Silent chest
10
Q
How can asthma best be treated?
A
Minimising future risk of:
- Exacerbation
- Fixed airflow limitation
- Side-effects of medication
11
Q
- Immediately decreased risk of cardiorespiratory problems by 50%
- Decrease of cholesterol after 1 week
- Decrease of blood pressure by 10mmHg
- Decrease of pulse by 10-25 bpm
- Decreased risk of infection
- Decrease in adrenaline production
These are benefits of eliminating which risk factor?
A
Smoking
12
Q
The risk for cardiac pathology equals non-smokers when?
A
2-3 years after quitting smoking
13
Q
Cholesterol decrease of 10% lowers the risk of cardiac pathology by?
A
20%
14
Q
Total cholesterol should be?
A
190mg/dL or 5mmol/L or below
15
Q
LDL should be?
A
150mg/dL or 3,9mmol/L or below
16
Q
HDL should be?
A
At least 45mg/dL or 1mmol/L
17
Q
What are benefits of a normal blood pressure?
A
- Decreased risk of cardiovascular pathology
- Decreased risk of kidney problems
- Decreased risk of stroke
- Decreased load on the heart
18
Q
Goals of cardiac rehab are?
A
→ Prevention / treatment of pulmonary complications
→ Treatment of risk factors
→ Improve and maintain exercise capacity
→ Improve quality of life
19
Q
What are the phases of cardiac rehab?
A
- Preoperative phase
- Phase 1 or clinical phase
- Phase 2 or rehabilitation phase
- Phase 3 or post-rehabilitation phase
20
Q
When does the preoperative phase of cardiac rehab start?
A
4 weeks before surgery
21
Q
What is the frequency and duration of sessions in the preoperative phase of cardiac rehab?
A
7 days per week
20min per session
22
Q
What aspects are trained in the preoperative phase of cardiac rehab?
A
- Inspiratory muscle training (IMT) with threshold device
- Breathing exercises
- Airway clearance techniques
23
Q
Which patients have to do the preoperative phase of cardiac rehab?
A
Open heart surgery patients
(coronary artery bypass grafting CABG and/or valve replacement)
→ with increased risk of developing pulmonary complications post-operative
24
Q
When does phase 1/clinical phase of cardiac rehab start?
A
Immediately after acute cardiac event
25
What are the main compartments of phase 1/clinical phase of cardiac rehab?
- In acute phase → relative rest with pulmonary physiotherapy
- Afterwards mobilisation phase at the hospital
- Dynamic mobilisation as early as possible
- Gradual build up and inclusion of ADLs like walking and stair climbing
26
When can you progress to phase 2/rehabilitation phase of cardiac rehab?
→ Patient is able to execute the intended ADLs (also with assistance)
→ Moderate exertion (3-4 MET) is possible
→ Patient has some knowledge of the heart disease
→ Patient is able to cope with condition and can increase ADL capacity
27
Where does phase 2/rehabilitation phase of cardiac rehab take place?
Almost always out-patient
28
What are the main components of phase 2/rehabilitation phase of cardiac rehab?
→ Practice functional skills
→ Develop enjoyment of exercise
→ Improve aerobic endurance
→ Improve strength and strength endurance
29
How often should strength training and endurance training be applied in phase 2/rehabilitation phase of cardiac rehab?
2-3 times per week EACH
30
What are the main characteristics of phase 3/post-rehabilitation phase of cardiac rehab?
- Carried out outside of institutional health care
- Focus on maintaining active life style initiated in phase 2
- Patient maybe advised to join exercise programme in primary care
- Check up 6-12 months after phase 2 has ended
31
Which scales can be used in cardiac patients?
Dyspnea scale
Borg scale
Angina pectoris scale
32
What are the 4 classes on the angina pectoris scale?
Class 1 - Angina only during strenuous and prolonged physical activity
Class 2 - Slight limitation, with angina only during vigorous physical activity
Class 3 - Moderate limitation, angina symptoms in ADLs
Class 4 - Severe limitation, inability to perform any activity without angina or angina at rest
33
What is the range of the dyspnea scale?
0-10
0 = nothing at all
10 = maximal
34
What are main characteristics of atherosclerosis?
- Not the same as arteriosclerosis
- Accumulation of fat-like substances, CT and calcium on inner wall (endothelium) of artery → Atheroma
- Accumulation of LDL → low-density lipoprotein, HDL can reduce this (high-density lipoprotein
35
How does atherosclerosis develop?
→ Nitric oxide (NO) is synthesised to protect endothelium against accumulation of fat
→ Increased consumption of bad saturated fat increases oxidative stress and inhibits protective function of NO
→ Plaque accumulates
36
What can be typical consequences of atherosclerosis?
Thrombosis
Infarction
Aneurysm
Pulmonary Embolism
37
What are typical symptoms of an infarction?
→ Tight and pressing pain in the centre of the chest
→ Possible radiation to arm, neck, jaw, back or stomach
→ Sweating, nausea, vomiting
38
What is the mechanism of pulmonary embolism?
- Thrombus/embolus gets trapped in small vessel
- Repetitive embolisms lead to reduction in pulmonary vascular bed
- Pulmonary hypertension develops
39
What are typical symptoms of pulmonary embolism?
→ Shortness of breath (dyspnoea)
→ Pain with sighing and coughing
→ In combination with emphysema → pulmonary infarction
40
Dilated veins due to valve disfunction
→ Blood flows back
What is the clinical term for this?
Varicose Veins
41
What are typical symptoms of varicose veins?
→ Visible tangle of barrels
→ Brown discolouration of skin
→ Swelling of lower leg/ankle (especially after long periods of standing)
→ Lying reduces pressure and swelling
→ Not painful but uncomfortable
42
How high is the percentage of muscle mass in the body weight of elderly?
25%
43
What does the TFI (Tilburg Frailty Index) assess?
- Identify fragility at early age → earlier help
- Physical, psychological and social health
- Mapping fragility
→ Increase quality and effectiveness of health care
44
When does functional ageing often start?
65 years
45
How many hours a day are elderly >70 usually sedentary?
10h per day
46
What are the 5 geriatric giants?
→ Falls
→ Incontinence
→ Confusion
→ Impaired homeostasis
→ Iatrogenic disorders (e.g. polypharmacia)
47
6% loss of muscle mass and 16% loss of strength in elderly are the result of?
10 days of bed rest
48
What is the definition of polypharmacy?
Use of at least 5 different drugs for different conditions over long period of time
49
Which tool can be used to assess delirium in elderly?
Use DOS-scale (Delirium Observation Screening)
50
What is the top injury after a fall in elderly?
hip fracture (17%)
51
Tinetti Test
Short Physical Performance Battery (SPPB)
Timed Up and Go Test (TUG)
De Morton Mobility Index (DEMMI)
Handgrip Strength Test
Berg Balance Scale
6 Minute Walk Test
What can these clinimetric tools be used for?
Assessment of functional capacity of elderly
52
Which point range indicates high risk of falling in the Tinetti Test?
≤ 18 points
53
What does the DEMMI assess?
Mobility and balance in bed, sitting, standing, walking and in dynamic motions
54
What does the Short Physical Performance Battery (SPPB) test?
gait speed, sitting to standing and balance
55
65% of Class 4 heart failure patients die within?
12 months
56
50% of Class 2-3 heart failure patients die within?
5 years
57
What is the general principle of heart failure?
- Inability to pump the blood through the body properly
- Usually because heart has become too weak or stiff
58
- **Myocardial infarction**
- **High blood pressure**
- **Heart diseases** (rhythm disorder, valve disorder, poor blood flow, cardiomyopathy)
- Coronary artery disease
- Diabetes mellitus
- Atherosclerosis → Cause for heart attack
- Valve inefficiency → Blood flows back
What can all of these pathologies cause?
Heart failure
59
What causes shortness of breath in heart failure patients?
- Fluid/oedema in the lungs
- Arteries in the lungs are under high pressure and fluid gets into the lung tissue
60
- Shortness of breath
- Fluid/oedema in the lungs
- Arteries in the lungs are under high pressure and fluid gets into the lung tissue
- Fatigue
- Oedema (ankles)
- Forgetful
- Poor concentration
- Cold hands
- Poor sleep
- Having to urinate more often during night (build up of fluid in the body)
- Attacks of shortness of breath and coughing when lying flat
- Slow recovery after physical effort
These are typical symptoms of?
Heart failure
61
Why is sudden weight gain important to check in heart patients?
Holding of fluid/water in the body -> can indicate heart failure
62
What are red flags in heart failure patients?
- Serious cognitive problems
- Weight gain of > 3kg within a few days, wether or not accompanied by dyspnea at rest
63
- No limitations in any activities
- No symptoms in ordinary activities
- VO2max > 20ml/kg/min
- MET > 6
- Watt (intensity) > 100
Which heart failure classification according to NYHA is that?
Class 1
64
- Slight limitations in physical activities
- Comfortable at rest
- Symptoms during moderate physical activity
- VO2max 15-20ml/kg/min
- MET 4-6
- Watt (intensity) 60-100
Which heart failure classification according to NYHA is that?
Class 2
65
- Marked limitation of physical activity
- Minor activities result in symptoms
- VO2max 10-15ml/kg/min
- MET 3-4
- Watt (intensity) 30-60
Which heart failure classification according to NYHA is that?
Class 3
66
- Severe limitation of physical activity
- Symptoms at rest
- VO2max < 10ml/kg/min
- MET < 3
- Watt (intensity) < 30
Which heart failure classification according to NYHA is that?
Class 4
67
What MET score is walking?
3
68
What MET score is watching TV?
1.5
69
What MET score is cycling at 12kmh?
5
70
What are the main therapy goals of heart failure treatment?
→ Maintain condition as good as possible
→ Loose weight (decrease cardiac load)
→ Minimise salt ingestion
→ Restriction of fluid (< 2l per day)
→ Stop smoking
→ Limit alcohol consumption
71
Which heart failure medication is taken to reduce the pre-load of the heart?
Diuretics like Furosemide, Hydrochlorthiazide
72
Which heart failure medication is taken to reduce the after-load of the heart?
ACE-inhibitors, vasodilators
73
Which medication is used for heart failure patients to increase heart contraction force?
Digitalis -> Digoxin
74
First endurance or interval training in heart failure patients?
First Interval then endurance
75
What are the endurance session parameters for heart failure patients with VO2max below 17.5ml?
2x 15min sessions per day
76
How is interval training for heart failure patients build up?
→ 4 x 4min of 80-90% of VO2peak
→ Active recovery 3min of 40-50% of VO2peak in between sets
77
At what frequency should inspiratory muscle training (IMT) be used in heart failure patients?
- 15-20min
- 3-4 times a week
- 8-12 weeks consecutively
78
Which heart failure patients should use IMT as an adjunct?
For class II-III with PImax < 70% of predicted value or ventilatory limitations
79
How is the 1RM in heart failure patients determined?
calculate 10RM
80
What are the normal strength training parameters for heart failure patients?
- Gradual increase from 40% to 65% of 1RM
- Train large muscle groups
→ 2-3 times a week, 2-3 sets, 10-15reps
81
How long does the pre-training period for strength training in heart failure patients take and what are the parameters?
2 week pre-training period
→ 2-3 sets, 10 reps, < 30% of 1RM
82
→ Venipuncture
→ Limb constriction
→ Limb elevation
→ Heat/cold application or surrounding
→Air travel and use of compression garments when travelling by air
Is there weak or strong evidence that the above provoke or treat lymphoedema?
Weak evidence
83
What are good ways to prevent lymph oedema according to research?
→ Maintaining a normal body weight, normal BMI
→ Participation in supervised exercise programme
84
What are the 3 types of oedema?
→ Venous oedema
→ Lip-oedema
→ Lymphoedema
85
→ Painful, swollen feelings in the legs
→ Cold feeling
→ Increasing complaints during the day
→ Tiredness
→ Foot, knee and hip complaints
These are typical symptoms of?
Lip-Oedema
86
- Large amounts of irregularly distributed fat
- Mainly hips, thighs and lower legs
- Mainly women affected
- Heredity may play a role
These are typical characteristics of?
Lip-Oedema
87
→ Heavy, restless feeling in the legs
→ Swollen ankles and legs
→ Varicose veins
→ Eczema: Brown or white skin discolouration
These are typical symptoms of?
Venous Oedema
88
- Faulty valves in veins
- Impaired return of oxygen-poor blood from legs to heart
These are typical characteristics of?
Venous Oedema
89
→ Swelling
→ Fatigue and heaviness
→ Pain
→ Limitations in movement and daily functioning
→ Skin abnormalities and infections
These are typical symptoms of?
Lymphoedema
90
- Abnormal accumulation of tissue fluid
- Malfunction of lymph system:
- Too little vessels
- Damage of lymph vessels or nodes
- Overload of lymph system
These are typical characteristics of?
Lymphoedema
91
- Clothes, jewellery and watches become too tight
- Increasing unilateral or bilateral limb circumference
- Dimple in skin after pressure
- Differences in skin thickness
These are good ways to recognise?
Oedema
92
What are risk factors for oedema?
- Inactivity
- Obesity
- Infections (erisepelas)
93
What are typical causes for oedema?
- Lymphatic system
- Blood vessels
- Fat
- Heart
- Kidneys
- Genetic factors
**→ Often a combination**
94
How much percent of yearly deaths worldwide are related to NCDs?
71%
95
How much percent of all yearly NCDs related deaths are due to high BP?
12.8%
96
What is the cut off for high BP?
140/90mmHg
97
What is a normal cholesterol level in the blood?
5.0mmol/L or 190/200mg/dL
98
Which cholesterol level increases the chances of atherosclerosis by 4 times?
> 8.0mmol/L or 300mg/dL
99
How much does co-smoking increase the risk of lung cancer or cardiovascular diseases ?
20-30%
100
What is a normal blood sugar level?
4.0-8.0mmol/L or
101
What are typical symptoms of Hypoglycaemic?
→ Sleepiness
→ Sweating
→ Pallor
→ Lack of coordination
→ Irritability
→ Hunger
102
What are typical symptoms of Hyperglycaemia?
→ Dry mouth
→ Increased thirst
→ Blurred vision
→ Weakness
→ Head ache
→ Frequent urination
103
What is the optimal body fat % for men and women?
Men <20%
Women <30%
104
What is the optimal waist size for men and women?
Men <102cm
Women <88cm
105
What is the optimal BMI?
18.5 - 24.9
106
- Increase of HR and BP
- High caloric density
- Increased risk of cancer
- Negative effects on fats and HDL
- Production of toxins in liver (acetaldehyde)
- Negatively effects BP drugs
- Bad eating habits
These are negative effects of consuming?
Alcohol
107
- Patients with heart failure
- Patients with congenital heart defect
- Patients with heart transplant
- Patients with defribrillator (ICD) or pacemaker
- Patients with arrhythmias
- Patients with atypical thoracic pain complaints (heart anxiety)
- Patients with resuscitation or cardiothoracic surgery
- Patients with left ventricular assist device (LVAD)
These are relative or normal indicators for cardiac rehab?
Relative indicators
108
- Based on coronary artery disease
- Patients with acute coronary syndrome (ACS) (including infarction AMI and unstable angina pectoris)
- Patients with stable angina pectoris
- Patients who have undergone percutaneous coronary intervention (PCI)
- Patients who have undergone coronary artery bypass grafting (CABG) or valve surgery
These are relative or normal indicators for cardiac rehab?
Normal indicators
109
Psychological stress can cause?
- Fatigue
- Pain
- Decreased motor control
- Decreased blood flow in the muscles
110
What are synonyms for sPAD (Symptomatic Peripheral Arterial Disease)?
“Intermittent Claudication”
“Window Shopping Disease”
111
How many people over 55 suffer from sPAD worldwide?
19% (200 million worldwide)
112
What is the life expectancy with sPAD?
< 10 years
113
- Narrowed arteries due to plaque (especially at branches)
- Endothelial membrane impaired
- Insufficient oxygen supply to muscles
This is the typical mechanism of which disease?
sPAD
114
- Pain in lower extremities distal to stenosis
- Walking provokes pain
- Standing and pausing reduces complaints
- Skin defects
- Colour and/or temperature differences
- Muscle weakness
- Sensory disorders
These are typical symptoms of?
sPAD
115
According to Fontaine sPAD can be categorised in?
5 classes
I - Asymptomatic
IIa - Mild claudication
IIb - Moderate to severe claudication
III - Rest pain
IV - Ulceration or gangrene
116
According to Rutherford sPAD can be categorised in?
7 classes
0 - Asymptomatic
1 - Mild claudication
2 - Moderate claudication
3 - Severe claudication
4 - Rest pain
5 - Minor tissue loss
6 - Severe tissue loss or gangrene
117
- Walking Impairment Questionnaire (WIQ)
- Cumulative Illness Rating Scale (CIRS)
- Quality of Life (EQ-5D)
- BORG-scale
- ACSM-scale
- Perceived Stress Scale (PSS)
These are typical clinimetric tools for the assessment of?
sPAD
118
What is the protocol of the graded treadmill test for sPAD?
- Speed at 2mph or 3.2kmh
- Start with altitude of 0°
- Increase altitude by 2° every 2 minutes → Until 10° is reached
- Max duration of test 30min
- Note time and distance:
→ when patient **wants to stop** (functional walking distance)
→ when patient **has to stop** (max walking distance)
- Use ACSM score
- Use as evaluative tool in treatment
119
What is the ACSM score in the assessment of sPAD?
Grade 1: Light discomfort or onset of pain on modest level (present, but minimal)
Grade 2: Moderate discomfort or pain of which the patient’s attention can be diverted (e.g. by conversation)
Grade 3: Intense pain (almost grade 4) from which the patient’s attention can’t be diverted
Grade 4: Excruciating and unbearable pain
120
What does ACSM stand for?
American College of Sports Medicine
121
What is the outcome of the ABPI/ABI - Ankle Brachial Pressure Index?
→ Dividing the systolic BP at **dorsal pedis artery** or **posterior tibial artery** (choose highest) by brachial BP
- Normal ABI: 1.0-1.4 (pressure in ankle is normally higher than in arm)
- ABI 0.9 or below? → Positive Test!!
- ABI below 0.5? → Severe PAD
→ Insufficient blood flow to heal wounds
- ABI above 1.4? → Calcification of blood vessel (diabetes or elderly people)
122
When is the ABI positive for sPAD?
0.9 or below
123
How long does the maintenance phase of sPAD rehab take?
40 weeks
124
How long does the start phase of sPAD rehab take?
4 weeks
125
How long does the self/training phase of sPAD rehab take?
8 weeks
126
How are objective limitations in sPAD reduced?
→ Maximise pain-free walking distance
- ACSM of 3-4
- Minimum 6 months → homework
- 3x per week → homework
- Each session 30min → homework
127
How are subjective limitations in sPAD reduced?
- No pain no gain
- Safe environment
- Recognise limitations ion ADLs
- Recognise and cope with cardiac limitations
→ Have fun being active!!!
128
What are the main goals of sPAD rehab?
- Improve activities and participation
- Reduce objective and subjective limitations
- Reduce risk factors of arteriosclerosis
- Education and promotion of healthy lifestyle
- Improve quality of life
129
What happens after 3-6 months according to the stepped care model?
evaluation of treatment
Continue therapy or referral to surgeon
130
What is the KomPas Tool?
Tool for shared decision making
131
What are the main tasks of claudicationet or chronisch zorgnet?
treatment and monitoring of NCDs eg intermittent claudication
132
Autogenic training / self-hypnosis for relaxation was invented by?
Johannes Schultz
133
Relaxing the body by contracting and relaxing certain muscles are the key components of which technique ?
Progressive muscle relaxation by Jacobson
134
Which amount of smokers will develop COPD?
40-50%
135
How many COPD patients used to smoke or still smoke?
75%
136
COPD is slightly more prominent in men or women?
Men
137
Which NCD will be No.3 cause of death by 2030?
COPD
138
What are the 3 main causes for bronchial obstruction in COPD?
Bronchitis
Asthmatic bronchitis
Emphysema
139
Main characteristic of bronchitis?
Hypersecretion of mucus
140
Characteristics of asthmatic bronchitis?
Decreased airway diameter due to:
- Swelling of airway walls because of inflammation
- Contraction of smooth muscle in airway walls
141
Characteristics of emphysema?
Collapse of airways due to:
- Loss of parenchyma
- Changes in intrapleural pressure
142
- Smoking
- Exacerbations (acute in onset and requires change of medication)
- Lower FEV1
- Airway responsiveness
- Comorbidities
- Body weight
- Dyspnea
- Functional exercise capacity (6MWT)
These are prognostic factors for which disease?
COPD
143
What increases the airway resistance in COPD?
Mucus plugs
Wall thickening
Oedema
144
What is parenchyma?
The essential or functional elements of an organ.
145
What is atelectasis in COPD?
- Narrowing of airways leads to hyperinflation of alveoli
- In case of total obstruction → atelectasis/collapse of the alveoli behind the obstruction
Atelectasis -> collapse of alveoli
146
What is air trapping or hyperinflation in COPD?
- A result of bronchial obstruction
- Some air stays in the airways after expiration → Thorax stays in inspiration position
- Leads to flattened diaphragm → less efficient contraction → functional weakening
-Leads to development of barrel chest
147
What is hypercapnia?
A high arterial PCO2 (> 6kPA) -> high CO2 pressure
Often in COPD patients
Insufficient expiration accumulates CO2
148
What is hypoxia?
A low arterial PO2 (< 8kPA) -> low O2 pressure
Often in COPD patients
Insufficient oxygen uptake and gas exchange
149
What is cor pulmonale?
Right heart failure due to pulmonary insufficiency
Often seen in COPD
150
How does pulmonary hypertension and eventually cor pulmonale develop?
1. Circulatory system adapts to loss of alveoli in the lungs (no ventilation → shut down of circulation)
2. Many capillaries are lost
3. Increased resistance in pulmonary arteries due to lack of vessels
4. Increased workload of right half of heart and hypertrophy of right ventricle
5. **Leads to overload and decompensation of right ventricle → right heart failure → Cor Pulmonale**
151
What is cyanosis?
Blue-ish skin due to lack of oxygenated blood supply
152
What are the GOLD stages of COPD?
Mild -> FEV1 >80% of predicted
Moderate -> FEV1 50-80% of predicted
Severe -> FEV1 30-50% of predicted
Very severe -> FEV1 <30% of predicted
!!!All stages FEV1/FVC ratio < 0.7!!!
153
What is the Hoover Sign in COPD?
→ Flattened diaphragm due to accumulation of fluid or air in intra-pleural space
→ Lower ribs are pulled inwards instead of upwards
→ Symmetric movement
154
How many COPD patient profiles are there according to the KNGF guideline?
6 profiles
155
Which COPD profiles show a mild to moderate symptom burden?
2, 3, 4, 5
156
Which COPD profile shows a high symptom burden and exacerbations with hospitalisation?
Profile 6
157
What does CCQ ≥ 1.9 and CAT ≥ 18 in COPD patients indicate?
High symptom burden
158
What does CCQ 1 to 1.8 and CAT 10 to 17 in COPD patients indicate?
Mild to moderate symptom burden
159
What does CCQ < 1.0 and CAT < 10 in COPD patients indicate?
No to low symptom burden
160
Decreased capacity in COPD patients is closer related to lung function or overall strength?
Strength
161
Which type of muscle fibres is decreasing in COPD patients?
Type 1 fibres due to decapillarisation
Decreases physical capacity
162
Why does the FRC in COPD patients increase?
- Loose lung recoil decreases
- Balance between recoil (inward) and chest (outward) changes
- More air stays behind
163
Which questionnaires can be used to determine disease stability in COPD?
CCQ and CAT
164
What are the best ways to decrease airway resistance in dyspnea?
Combination of bronchodilator and rehab has best results
165
Inspiratory muscle training is recommended for which type of patient?
patients < 70% of predicted respiratory muscle function
GOLD stages II - IV
166
What are the FITT factors for inspiratory muscle training?
- Frequency → 5x per week, 1-2x daily, min. 4 weeks
- Intensity → 30-50% of Pi,max
- Type → 30x fast and deep inhalations (in/out 1:2 or 1:3)
- Time → Approx. 5min
- Short breaks after 10 breaths are possible
167
How can the Pi, max in men and women be calculated?
142 - (1.03 x age) -> men
-43 + (0.71 x height in cm) -> women
168
How does pursed lip breathing help in COPD and/or dyspnea?
Expiration is longer
Pursed lips create internal pressure that keep the airways open
Air can be expelled from alveoli
169
Which patients might benefit from oxygen supplementation?
Drop of saturation by 4% in exercise test
170
How does the oxygen saturation / SpO2 need to be to be allowed to start exercising
Resting SpO2 has to be above 90%
171
Oxygen drops below 85% and no supplementation yet. This is an indication for what?
Contact GP
Stop exercising
172
What is the FEV1 in spirometry?
- Forced Expiratory Volume in 1 second
- Total volume of air that patient is able to forcibly exhale within 1 second
173
What is the FVC in spirometry?
- Forced Vital Capacity
- Total volume of air that can be exhaled forcibly in one breath
174
What is the MVV and how can it be calculated?
Maximal voluntary ventilation = 37.5 x FEV1
175
How can the ventilatory reserve be calculated?
MVV - VE (minute ventilation)
176
What is a normal FEV1/FVC ratio?
0.7 - 0.8
177
What does an FEV1/FVC ratio of < 0.7 indicate?
Obstruction!
Healthy elderly might have lower normal ratio -> over-diagnosing
Younger patients may have obstruction with ratio > 0.7 -> under-diagnosing
178
How long can a full exhalation in COPD patients take?
approx 15sec
179
What is the FEV6?
- Forced Expiratory Volume in 6 seconds
- Total amount of air that patient is able to exhale forcibly within 6 seconds
- In healthy people FVC and FEV6 are most often identical
180
When should interval training instead of endurance training be initiated in COPD patients?
Patient CANNOT continuously cycle in endurance test at 75% of maximal cycle load for 10 minutes consecutively
181
At what intensity should endurance training be administered in COPD patients?
60-80% of max workload
182
At what intensity should interval training be administered in COPD patients?
85-100% of max workload
183
Which Borg score should you start with in endurance therapy for COPD?
4-6
184
At which intensity do you start treadmill endurance training in COPD?
75% of 6MWT speed OR 40-60% of HRR or VO2max
185
What are the parameters of strength training in COPD patients?
2-3x per week
60-80% of 1RM
2-5 sets, 8-15 reps (at least 2min breaks)
Large muscle groups
186
Exercise therapy in COPD does not improve lung function TRUE or FALSE?
TRUE
187
What are the recommendations of the guideline concerning mucus clearance in COPD?
- Teach active breathing techniques to facilitate mucus clearance
- If unable use active aids like:
→ Positive expiratory pressure (PEP)
→ Oscillating expiratory pressure (O-PEP)
- Passive techniques like vibration or percussion are useless
188
What does stasis of mucus lead to?
→ Problems in ventilation
→ Atelectasis
→ Lung infections
189
What does hypertrophy of the mucus cells lead to?
thick and sticky mucus, blocking the airways
190
What is the 2-Phase Gas-Liquid Stream in mucus clearance?
- Shear stress between mucus and airflow in the air ways
- Low air-flow → Little friction
- High air-flow → More friction, turbulences in air flow which causes vibration
- Higher air-flow during expiration than inspiration → mucus gets moved towards mouth and is cleared
191
What are the main breathing techniques for mucus clearance?
- Active Cycle of Breathing Technique
- Stimulation of breathing movement (thorax excursion)
- Forced expiration technique
- Coughing
- Huffing
- Autogenous Drainage
192
How does the Flutter help in mucus clearance and what type of tool is it?
- Breathing through it builds pressure in lungs
→ Keeps airways open and helps air move behind mucus
- Steel ball transmits vibrations through chest wall and helps loosen mucus
- O-PEP device (Oscillating expiratory pressure)
193
Forced expiration with open glottis. What is the term for this?
Huffing
194
What are the 3 phases of autogenous drainage?
Unsticking
Collecting
Evacuating
195
Which breathing technique consists of 3 different phases?
Autogenous drainage
196
What is a different term for extension of the lungs?
Compliance
197
What is a different term for shrinking of the lungs?
Elastic recoil
198
What is the most popular definition of health literacy?
"The ability to understand and interpret the meaning of health information in written, spoken or digital form and how this motivates people to embrace or disregard actions relating to health”
199
What is functional health literacy?
- Understanding information
- Understanding and following of instructions
- Understanding of own health
200
What is communicative health literacy?
- Talk about own health
- Standing up for one self
- Asking the right questions
201
What is critical health literacy?
- Find reliable and serious information
- Make informed decisions concerning health
202
How many people that suffer from chronic disease suffer from 3 or more different ones?
27%
203
What is the i3-S Strategy?
- Innovative strategy for development of adaptations to exercise therapy related to co-morbidities
- Often therapists scale down training because of co-morbidities which makes training ineffective
- 4 steps, 3 inventory, 1 synthesis
204
What does step 1 of the i3-S strategy assess?
Inventory of relevant co-morbid diseases
205
What does step 2 of the i3-S strategy assess?
Inventory of comorbidity-related contraindications and restrictions on application of exercise therapy in index disease
206
What does step 3 of the i3-S strategy assess?
Inventory of creating adaptations to exercise therapy
207
What is step 4 of the i3-S strategy?
Synthesis of obtained information from previous steps
208
1. Rigorous assessment of health status
2. Adaptation of exercise to co-morbidity
3. Application and integration of behavioural change techniques into exercise plan
4. Clinical reasoning to support the application of exercise by health professionals
What is described here?
The 4 principles of exercising with co-morbidities
209
What is m-health?
- Mobile health
- Medical and public health practice supported by mobile devices
- E.g. smartphone, personal digital assistants (PDA), wireless trackers etc.
210
According to RTAUT model, the experience and will to use a technological device in health care as a patient is influenced by?
Personal features
Technology features
Social influence
211
According to RTAUT model, the decision use of RT is influenced by?
Objective and subjective factors
212
How many people between 60-70 suffer from diabetes?
10-12%
213
- Weight loss
- Extreme tiredness
- Increased hunger
- Excessive thirst
- Frequent urination
- Tingling and numbness
- Blurred vision
- Unhealed wounds
- Sweet urine (attracting ants)
These are typical symptoms of?
Diabetes Mellitus
214
What are typical long-term effects of diabetes?
- Retinopathy with potential blindness
- Nephropathy → renal failure
- Neuropathy → risk for ulcers, gangrene and amputation
- Charcot joints
215
- Stimulates glucose uptake into muscle tissue and adipose cells
- Inhibits hepatic glucose production
- Inhibits break down of triglycerides
- Inhibits ketogenesis
- Inhibits protein degradation
- Regulates gene transcription
- Stimulates:
- Aminoacid uptake
- Proteinsynthesis
These are characteristics of which hormone?
Insulin
216
- Hyperglycaemia → Osmotic diuresis and dehydration
- Elevated FAA levels (triglycerides in blood)
- Ketoacidosis and ketone body production
- Muscle waisting
Deficiency of which hormone leads to the above?
Insulin
217
How many cases of diabetes are type 1?
5-10%
218
How many cases of diabetes are type 2?
90-95%
219
Absolute insulin deficiency because of pancreatic ß-cell destruction in islets of Langerhans
Which type of DM is that?
Type 1
220
- Begins as insulin resistance (often in overweight patients)
- Insufficient insulin secretion in normal weight patients
- Imbalance/disturbance of insulin sensitivity and secretion
- Chronic hyperglycaemia
Which type of DM is this?
Type 2
221
When does gestational diabetes occur?
During pregnancy
222
- Uncommon
- Thirst despite drinking large amounts and urinating
- Abnormal function/levels of antidiuretic hormone (ADH) → limits urination
Which pathology is this?
Diabetes insipidis
223
Which fasting plasma glucose (FPG) level is indicative of DMT2?
→ 126mg/dL or higher (7mmol/L or higher) on 2 separate occasions
→ Measured being sober
224
Which HbA1c is normal?
4%-5.6% is normal
Glycated haemoglobin
225
Which HbA1c level is indicative for DMT2?
→ 6.5% or higher on 2 separate occasions
→ Glucose binds permanently to haemoglobin
→ Red blood cells live for 2-3months
→ Gives indication of glucose level over these past months
226
When is the oral glucose tolerance test (OGTT) indicative of DMT2?
→ 2h past OGTT blood glucose is 200mg/dL or higher
227
Fasting plasma glucose (FPG) is between 6.1mmol/L to 7 mmol/L
What does this indicate?
Pre-diabetes
228
Impaired glucose tolerance (IGT) → 2h after intake of 75mg glucose, glucose level between 7.8mmol/L to 11.1mmol/L
What does this indicate?
Pre-diabetes
229
HbA1c between 5.7% to 6.4%
What does this indicate?
Pre-diabetes
230
Who should be checked for diabetes?
- 45 years or older + overweight
- 45 years or older but not overweight → Ask GP if test is required
- Younger than 45 + overweight + risk factors for diabetes
231
What is the ABC approach in DM treatment?
**A: Diet and Exercise**
**B: Oral hypoglycaemic therapy**
**C: Insulin Therapy**
232
When should glucose lowering medication be administered in DM patients?
if it is not possible to achieve an HbA 1c of ≤ 53 mmol/mol with non-drug treatment
233
How can burned calories be calculated?
Time (h) x intensity (MET) x body weight (kg) → kcal
234
Which training intensity significantly reduces HbA1c?
HgA1c significantly reduced by training at 75% of VO2max
→ Intensity is more important then duration to lower HgA1c
235
Which VO2max should you aim for in DM treatment?
70-80%
236
Which % of 1RM should be aimed for in DM treatment?
60-80%
237
How can alcohol reduce blood glucose levels?
hypoglycaemic effect
238
How is glucose influenced by training?
- Blood glucose drops during endurance training
- Blood glucose rises briefly after last sprint
- Blood glucose increases during strength training and decreases afterwards
239
How long do glucose lowering effects last?
up to 48h
240
What is the Fick equation at rest?
Oxygen uptake (VO2) = cardiac output x (arterial oxygen content - venous mixed oxygen content)
VO2=(SV*HR)*(CaO2-CvO2)
241
What is the Fick equation at max effort?
VO_2max=(SVmax*HRmax)*(CaO_2max-CvO_2max)
242
Which value of the CPET shows as plateau in healthy people?
VO2max
→ During maximal effort/exertion
→ Training can increase that plateau
243
Which value is taken if VO2max can't be reached in patients?
Peak VO2 (PVO2) is measured and used as an estimate for VO2max
244
A normal PVO2 is influenced by which factors?
- genetic factors
- age
- sex
- body size
- quantity of muscles used
245
What is the usual resting VO2 in healthy people?
3.5ml/kg/min
246
Which macros are used to generate energy when the RER is 0.7?
carbs and fats
247
Which macros are used to generate energy when the RER is 0.8?
carbs and proteins
248
What is VE?
Minute Ventilation
- Amount of air that is inhaled and exhaled with one breath
- Expressed in l/min
249
What is the VAT and when is it usually reached in a CPET?
Ventilatory Anaerobic Threshold
- VO2 at onset of blood lactate accumulation is called lactate threshold or VAT
- Point at which minute ventilation increases disproportionately relative to VO2
→ Approx at 60-70% of VO2max
250
What happens in the metabolism once the VAT is reached?
Afterwards anaerobic metabolism occurs
→ Significant increase of lactic acid in muscles
251
Why do VE and VO2 rise linearly in the first 50-60% of VO2max (eg during CPET)?
Reflects aerobically produced CO2 in muscles
252
What is the VT1?
- Called Aerobic Threshold (AE) in sports medicine
- Called Anaerobic Threshold (AT) by Wasserman
- Slowly approaching RER of 1
- Anaerobic threshold starts to contribute a larger portion of energy
→ Increase of CO2 and lactate
- CO2 and lactate can still be metabolised as long as intensity doesn’t increase
253
What is the VT2?
- Called Anaerobic Threshold in sports medicine
- Called Respiratory Compensation Point (RCP) by Wasserman
- Aerobic and additional small amount of anaerobic metabolism don’t supply enough energy anymore
→ Body intensifies anaerobic metabolism
- Further increase in lactate and CO2 production
- Body disproportionately increases ventilation to decrease CO2 and work against metabolic acidosis
254
What is the VT3?
- Only in high-performance athletes
- Not well described yet
- Also called:
→ Respiratory compensation point
→ Panic breathing
→ Hot ventilation
255
Where can the lactate threshold be found in max exercise test?
Located near first break point
→ VT1
LT = Lactate threshold
256
Where can the maximum lactate steady state be found in max exercise test?
Located near second break point
→ VT2
MLSS = Maximum lactate steady state
257
What effects does training have on the efficiency of the cardiorespiratory system?
→ Decrease in resting heart rate → max HR stays the same
→ Increase in VO2max plateau
→ Increase of resting stroke volume and exercise stroke volume → Heart muscle hypertrophy
→ Increase of arterio-venous O2 difference
258
What equals 1 MET?
Normal resting VO2 of 3.5ml/kg/min
259
Which way is electricity traveling through the heart?
Electricity traveling through heart is downward diagonal
→ From right shoulder to left abdomen
260
Why does ECG on right arm, shoulder, wrist always show waves pointing downwards?
Electrical signal travels away from it -> From upper right to lower left
261
Why does ECG on left middle axillary region always show waves pointing upwards?
Electrical signal travels towards it -> From upper right to lower left
262
What time does 1 small box on the ECG paper show?
0.04 seconds
263
What time does 1 large box on the ECG paper show?
0.2 seconds
264
What time do 5 large boxes on the ECG paper show?
1 second
265
10 small boxes on the ECG paper are equivalent to which voltage?
1 millivolt
266
Which waves of the Sinus rhythm aren't always present?
Q and S
267
Which part of the electrical stimulation does the p-wave of the sinus rhythm show?
Atrial depolarisation
268
Which part of the electrical stimulation does the q-wave of the sinus rhythm show?
Depolarisation of septum
269
Which part of the electrical stimulation does the r-wave of the sinus rhythm show?
Depolarisation of ventricular walls
270
Which part of the electrical stimulation does the s-wave of the sinus rhythm show?
Depolarisation of Purkinje Fibres
271
Why is the r-wave the biggest wave of the sinus rhythm?
- Thick muscle and big contractions are required
- High voltage is needed
272
Which part of the electrical stimulation does the t-wave of the sinus rhythm show?
- Repolarisation of ventricular walls
- Smaller voltage than in R-wave
273
Why is the st-segment of the sinus rhythm flat in healthy patients and what does line that isn't flat indicate?
- No conduction at that time
→ Line is therefore flat
- Key indicator for myocardial ischaemia or necrosis if line goes up or down
274
How can a decreased pump function of the heart be determined?
Determine LVEF (Left ventricle ejection fraction)
275
When is the pump function of the heart decreased?
LVEF 20-25% → Only 20-25% of blood volume is effectively pumped into aorta
276
When is the pump function of the heart normal?
LVEF >55% → Normal
277
What are the norm values for the interpretation of a CPET?
- VO2peak ≥ 85% of predicted value
- Anaerobic threshold (VT1) > 40% of predicted VO2max
- HRpeak > 90% of predicted value OR HRR < 15bpm
- VEpeak < 85% maximal ventilatory capacity (MVV) or ventilatory reserve > 11l/min
- Blood pressure < 220/90mmHg
ABNORMAL VALUES INDICATE EXERCISE LIMITATION
278
What are criteria for a maximal effort during the CPET?
Client reaches one or more of the criteria below:
→ Predicted VO2peak was achieved and/or plateau in VO2?
→ Predicted Wmax and/or predicted HRmax achieved?
→ VOpeak ≥ 85% of maximal ventilatory capacity (MVV)?
→ BORG score for fatigue 9-10 on a scale of 1-10?
→ Respiratory exchange rate (RER) is > 1.15?
279
What is Gold Stage 1?
Mild airway obstruction
FEV1 > 80% of predicted value
FEV1/FVC ratio < 0.7
Approx. 28% of patients in NL
280
What is Gold Stage 2?
Moderate airway obstruction
FEV1 50-80% of predicted value
FEV1/FVC ratio < 0.7
Approx. 54% of patients in NL
281
What is Gold Stage 3?
Severe airway obstruction
FEV1 30-50% of predicted value
FEV1/FVC ratio < 0.7
Approx. 15% of patients in NL
282
What is Gold Stage 4?
Very severe airway obstruction
FEV1 < 30% of predicted value
FEV1/FVC ratio < 0.7
Approx. 3% of patients in NL
283
How can asthma be differentiated from COPD in spirometry?
In Asthma FEV1 increases by more than 12% or 200ml after use of bronchodilator
In COPD minimal change of FEV1 after use of bronchodilator
284
What are characteristics of chronic heart failure?
- Inefficiency of the heart
- Muscle becomes too weak or to stiff to pump blood sufficiently
- Stiffness often due to high blood pressure
- Does not refer to the heart stopping
285
What are characteristics of chronic heart disease?
- Several types of pathologies
- E.g. coronary artery disease
- Ischaemia and necrosis can happen leading to an infarction/heart attack
286
What are characteristics of an unstable angina pectoris?
- Due to coronary artery disease or atherosclerosis (same as stable angina)
- Chest pain is sudden and often gets worse over short period of time
287
What are characteristics of a stable angina pectoris?
- Medical term for chest pain
- Due to chronic heart disease
- Blockage or narrowing of coronary arteries causes these feelings in the centre of the chest:
→ Pressure
→ Fullness
→ Squeezing
→ Pain
288
What is the FFMI?
Fat Free Mass Index
- indicates how well the muscle development is
- used instead of BMI in muscular patients or athletes because it's more accurate
- body fat percentage is needed for calculation
289
What are norm values for the FFMI?
For men:
17-18 weak
19-20 average
21-22 good
23-24 very good
25 upper muscle limit
For women:
13-14 weak
15-16 average
17-18 good
19-20 very good
22 upper muscle limit
290
How is the BMI calculated?
bodyweight (kg) : (height (m) x height (m))
291
What is a different term for the FEV1/FVC ratio in spirometry?
Tiffeneau-Pinelli Index
292
What does the IPAQ assess?
International Physical Activity Questionnaire
Self-reported measurement of duration and intensity of physical activity over the last 7 days
The higher the score the better
293
What are signs of strong exertion /strain upon exertion in chronic heart disease patients?
* angina
* impaired pump function:
- shortness of breath disproportionate to exertion
- fatigue: abnormal fatigue disproportionate to exertion
- increased peripheral / central edema
* arrhythmias:
- high heart rate not in proportion to exertion
- irregular heartbeat, changes in known arrhythmias
* abnormal increase or decrease of blood pressure
* fainting
* dizziness
* vegetative reactions (e.g. excessive perspiring, pallor)
294
* progressive increase in heart failure symptoms;
* severe ischemia of the cardiac muscle upon exertion;
* dyspnea while speaking;
* respiratory frequency of more than 30 breaths per minute;
* heart rate at rest > 110 bpm;
* VO2max < 10 mL/kg/min;
* ventricular tachycardia upon increasing exertion;
* poorly controlled diabetes mellitus (in consultation with pa-
tient’s internal medicine specialist); * fever;
* acute systemic diseases;
* recent pulmonary embolism (< 3 months ago) causing severe
hemodynamic strain;
* thrombophlebitis;
* acute pericarditis or myocarditis;
* hemodynamically serious aortic stenosis or mitral valve steno-
sis;
* heart valve failure constituting an indication for surgical inter-
vention;
* myocardial infarction less than 3 weeks before the start of the
training;
* atrial fibrillation with rapid ventricular response at rest (> 100
bpm);
* serious cognitive problems (memory, attention and concentra-
tion);
* weight gain of > 3 kg within a few days, whether or not ac-
companied by increased dyspnea at rest.
What do these things indicate?
Contraindications for heart failure patients to participate in training programme
295
What is the percentage of ADL impairments elderly due to joint, bone and muscle degeneration?
48%!!
296
What do the following criteria indicate?
Patient age > 65
Chronic use of > 5 drugs
Presence of at leat 1 of the following risk factors:
- Impaired renal function
- Impaired cognition
- Increased risk of falling
- Impaired therapy compliance
- Not living independently
- Unplanned hospitalisations
Medication assessment (and change) of elderly in collaboration with GP
297
How many people that fall on stairs die?
60%
298
What can be said about the presence of atopy (predisposition to allergic reactions) in asthma and COPD?
Often present in asthma
Sometimes present in COPD
299
Is there a difference in FEV1 in asthma or COPD concerning daytime?
Often decreased in the morning in asthma
No change in COPD
300
What can be said about the presence of nasal symptoms like allergic rhinitis in asthma and COPD?
Very often present in asthma
Almost never present in COPD
301
What are norm values for FEV1 in males and females?
Males: 3.5L - 4.5L
Females: 2.5L - 3.25L
302
What are pack years?
- Estimates the amount of cigarettes that have been smoked in a lifetime
- 1 pack is 20 cigarettes (1 joint counts as 4 cigarettes)
- 1 pack/day for 1 year is 1 pack year
- 2 packs/day for 1 year are 2 pack years
- Lung screening should be initiated if patient has 20 pack years or more
303
What are the 5 stages of the mMRC scale for dyspnea?
0 - Little - Dyspnea only with strenuous exercise
1 - Mild - Dyspnea when hurrying or walking up a slight hill
2 - Moderate - Walks slower than people of same age because of dyspnea or has to stop for breath when walking at own pace
3 - Many/Strong - Stops for breath after walking just under 100m or after a few minutes
4 - Very much/Severe - Too dyspneic to leave house or breathless when dressing
304
What is a perceived exertion level of "very, very hard" on the Borg scale 6-20?
19
305
What is a perceived exertion level of "very hard" on the Borg scale 6-20?
17
306
What is a perceived exertion level of "hard" on the Borg scale 6-20?
15
307
What is a perceived exertion level of "somewhat hard" on the Borg scale 6-20?
13
308
What is a perceived exertion level of "fairly light" on the Borg scale 6-20?
11
309
What is a perceived exertion level of "very light" on the Borg scale 6-20?
9
310
What is a perceived exertion level of "very, very light" on the Borg scale 6-20?
7
311
What is a perceived exertion level of "no exertion at rest" on the RPE 0-10 scale?
0
312
What is a perceived exertion level of "very light" on the RPE 0-10 scale?
1
313
What is a perceived exertion level of "light" on the RPE 0-10 scale?
2-3
314
What is a perceived exertion level of "moderate, somewhat hard" on the RPE 0-10 scale?
4-5
315
What is a perceived exertion level of "high, vigorous" on the RPE 0-10 scale?
6-7
316
What is a perceived exertion level of "very hard" on the RPE 0-10 scale?
8-9
317
What is a perceived exertion level of "maximum effort, highest possible" on the RPE 0-10 scale?
10
318
How does blood pressure change/increase?
Influenced by the R-A-A System (Renin-Angiotensin-Aldosterone System)
- Lack of oxygen rich plasma in kidneys is interpreted as low BP
→ Kidneys release Renin
- Renin transforms Angiotensinogen into Angiotensin I
- Enzyme ACE (Angiotensin-Converting Enzyme) transforms Angiotensin I into Angiotensin II
- Angiotensin II travels to adrenal glands of kidneys and triggers production of Aldosterone
319
What does angiotensin II cause?
Vasoconstriction
320
What does aldosterone cause?
vasoconstriction and fluid retention
321
When there is pain at rest in sPAD the ABI is usually?
< 0.25
322
What are the 6 steps of patient education in therapy?
1. Being open
2. Understanding
3. Wanting
4. Being able
5. Doing
6. Keep doing
323
After supervised exercise therapy of 6 months which walking distance improvement can be expected in sPAD patients?
Up to 231%
324
- age > 70 years
- productive cough
- diabetes mellitus
- smoking
- COPD: FEV1 < 75%predicted or requiring medication
- BMI > 27.0 kg/m2
- Lung function: FEV1 < 80%predicted and FEV1/FVC < 70%predicted
What do these parameters indicate?
Increased risk of pulmonary complications in chronic heart disease patients after open heart surgery (according to PPC)
325
1 exploring one’s own physical limits
2 learning to cope with physical limitations
3 optimizing exercise capacity
4 applying diagnostics
5 overcoming fear of physical exertion
6 developing and maintaining a physically active lifestyle
What do these points describe?
The goals of physical therapy treatment in chronic heart failure patients
326
practicing skills and activities (to enable the patient to utilize their general or strength endurance in motor activities)
training patient’s aerobic (general) endurance
training local and strength endurance
practicing functions / activities
training to reduce risk factors
What do these points describe?
The goals of exercise programme in chronic heart disease patients
327
What is the MDC in the 6MWT for COPD patients?
54m (177ft)
328
What does a walking distance below 200m in the 6MWT in COPD patients predict?
Predictive of hospitalisation or mortality
329
What is the average walking distance in COPD patients for the 6MWT?
380m
330
What are the domains of the EQ-5D-5L?
Mobility
Self-care
Usual activities
Pain/discomfort
Anxiety/depression
Health today
331
Which tool can be used to assess self-efficacy?
General Self-Efficacy Scale
Self-reported questionnaire with a total score from 10 to 40
The higher the score the better the self-efficacy
332
Which tool can be used to assess patient health and risk factors like depression, eating, alcohol?
PHQ
Patient health questionnaire
333
What does the WIQ assess?
Walking Impairment Questionnaire
Can be used in sPAD patients
Assesses:
- Walking distance
- Walking speed
- Symptoms during walking
The lower the score the worse the impairment
334
What demmi score is a raw score of 19 points in the de Morton Mobility Index?
100 points -> best result
335
What are COPD-related red flags?
Desaturation in room air, measured with a saturation meter:
* at SpO2 < 90% at rest (after at least 10 minutes of sitting)
* at SpO2 < 85% during a physical test or exercise therapy
Peripheral oedema
Haemoptysis (coughing up blood)
Excessive sputum production compared to normal
Cyanosis and/or sleepiness during the day in combination with headache
Fever
Tachypnoea at rest
Suspicion of previously unknown co-morbidity
Exacerbation of known co-morbidity
336
When should neuromuscular electrical stimulation training (NMES) not be administered?
When patient is able to perform physical training themselves
337
How many sessions should be administered per COPD profile?
Profile 1 ➝ 0 sessions (no indication for physiotherapy/exercise therapy C/M)
Profile 2 ➝ at most 6 sessions;
Profile 3 ➝ at most 42 sessions;
Profile 4 ➝ at most 62 sessions;
Profile 5 ➝ at most 70 sessions;
Profile 6 ➝ n/a (secondary or tertiary pulmonary rehabilitation).
338
When does the ejection fraction indicate heart failure?
If ≤ 40%
