Rehab Stage I - III Flashcards
What is the principle of cardiovascular rehabilitation?
To enable the patient to regain full physical, psychological and social status and to promote secondary prevention in order to optimise long-term prognosis.
What association was found regarding participation in cardiovascular rehabilitation?
Participation is associated with fewer unplanned and costly hospital readmissions.
What do clinicians endorse cardiovascular rehabilitation for?
Patients with a recent diagnosis of coronary artery disease or heart failure.
List some well-documented benefits of cardiovascular rehabilitation.
- Improved survival
- Reduced hospital admission
- Reduced angina
- Improved lipid profiles
- Reduced blood pressure
- Reduced smoking levels
- Improved functional capacity
- Improved compliance with lifestyle modifications
- Reduced anxiety and depression
- Increased confidence and well-being
- Improved return to work and leisure activities
- Improved health education of families and friends
True or False: Cardiovascular rehabilitation can lead to reduced anxiety and depression.
True
Fill in the blank: Cardiovascular rehabilitation promotes _______ to optimise long-term prognosis.
[secondary prevention]
How does cardiovascular rehabilitation affect hospital admissions?
It reduces hospital admissions.
What impact does cardiovascular rehabilitation have on smoking levels?
It reduces smoking levels.
What is one psychological benefit of cardiovascular rehabilitation?
Increased confidence and well-being.
Fill in the blank: Cardiovascular rehabilitation improves _______ with lifestyle modifications.
[compliance]
What aspect of health does cardiovascular rehabilitation improve for families and friends?
Health education.
What is a key benefit of cardiovascular rehabilitation?
Improved health education
Focuses on educating patients about managing their cardiovascular health.
Who are eligible patients for cardiovascular rehabilitation?
Patients who have had:
* An acute cardiac event (e.g. myocardial infarction)
* Revascularisation (e.g. CABG, PCI)
* Heart failure
* An implanted cardioverter defibrillator
* Peripheral arterial disease
* Stable angina
* Valve surgery
* Heart transplantation
* Congenital heart disease
* A ventricular assist device
These conditions represent a range of cardiac issues that can benefit from rehabilitation.
What patient groups are currently prioritized in cardiovascular rehabilitation programmes?
Post-myocardial infarction and post-revascularisation procedures patients
These groups are the most common participants in rehabilitation programmes.
What is the goal of cardiovascular rehabilitation practitioners regarding access to rehabilitation programmes?
To secure funding to reduce inequalities of access
This aims to include more patient groups in core rehabilitation programmes over time.
What is the focus of a multi-disciplinary approach in the first three phases of cardiovascular rehabilitation?
To ensure a variety of interventions are delivered
This includes inpatient, early discharge, and core rehabilitation.
What does the BACPR Standards and Core Components (2017) state about cardiovascular rehabilitation services?
They should be delivered by an integrated multi-disciplinary team of skilled staff
There is no consensus on which professionals should deliver cardiovascular rehabilitation.
Who typically coordinates cardiovascular rehabilitation programmes?
A specialist cardiac-trained nurse or physiotherapist
Any health professional working in the programme can also fulfill this role.
What professionals are traditionally involved in leading the exercise component of core rehab (Phase I) programmes?
Physiotherapists
Some centres now use exercise physiologists or sports scientists for this component.
What is essential for clinically complex patients in the cardiovascular rehabilitation team?
Cardiological expertise
This is crucial for patients who may need to be referred back for further assessment.
What should all team members involved in cardiovascular rehabilitation be proficient in?
Basic life support and the use of an automated external defibrillator
This is necessary for patient safety.
What does Phase I of the rehabilitation process cover?
The acute phase of illness during an inpatient stay
This phase occurs after events like acute coronary syndrome or heart surgery.
Who is eligible for Phase I inpatient cardiovascular rehabilitation?
All patients
This includes those admitted for various cardiac events.
What is the role of a specialist cardiac nurse in Phase I rehabilitation?
To coordinate and deliver various components of comprehensive cardiovascular rehabilitation
This includes integrating rehabilitation into overall medical and surgical care.
When should cardiovascular rehabilitation begin following a cardiac event?
As soon as possible
Rehabilitation should be tailored to individual patient needs.
What areas are assessed during the inpatient phase of cardiovascular rehabilitation?
Physical, psychological, and social needs
This assessment informs the rehabilitation process.
What types of information and advice are provided to patients during Phase I?
Diagnosis and treatment, management of chest pain, psychological support, risk factor modification, prescribed medication, early mobilisation, feelings and relationships, work, driving, and local Phase II provisions
This helps patients transition back to normal life.
What types of advice are given to patients and their families in Phase I?
Both verbal and written advice
This aims to alleviate fears upon returning home.
What is the average length of hospital stay following an acute event or surgery?
Five days
For uncomplicated heart attack patients who have undergone revascularisation, it may be as little as two to four days.
What is a consequence of reduced hospital stay for cardiovascular rehabilitation practitioners?
Limited time to achieve expected inpatient interventions
Some expectations may need to be fulfilled by the primary care team or rehabilitation team after discharge.
What conditions must a patient meet before discharge from the hospital?
Clinically stable, able to carry out self-care, able to walk short distances
Self-care includes activities such as washing and dressing.
What is Phase II of the rehabilitation process?
Early discharge phase
This phase covers the time after discharge back to the care of the GP.
What feelings do many patients and their families experience during Phase II?
Vulnerable, isolated, insecure
What activities are included in early post-discharge (Phase II)?
- Assessment of cardiac risk
- Assessment of physical, psychological, and social needs
- Provision of lifestyle advice
- Provision of psychological interventions
- Provision of resuscitation training to family members
True or False: The early post-discharge period is often well-resourced and supported.
False
It is sometimes a neglected area of overall patient care.
What type of advice is given to patients during the early post-discharge period?
Advice about a gradual return to normal activities
This includes a graduated walking programme.
What methods can be used to provide Phase II post-discharge support?
- Telephone calls by health professionals
- Visits by a cardiac specialist nurse
- Visits by community staff nurses or district nurses
- The Heart Manual
What is The Heart Manual?
A resource for patients recovering from MI with editions for different conditions
It includes workbook-style home programmes or digital versions covering health education, exercise, and stress management.
What does Phase III of the rehabilitation process consist of?
Exercise, health education, risk factor modification, relaxation, stress management, psychological and occupational counselling
It is often referred to as core rehab.
What is a common misconception about core rehabilitation (Phase III)?
That it is solely devoted to exercise
Psychosocial interventions and health education are equally important.
When does core rehabilitation (Phase III) typically begin in the UK?
Any time from two weeks after the event
What is the evidence-based benefit of early rehabilitation?
Reducing hospital readmissions
What modes can CPRPs (Cardiovascular Rehabilitation Programs) be delivered in?
- Centre-based
- Home-based
- Manual-based
- Web-based
- App-based remotely
What should interventions in CPRPs address?
The individual’s needs across all relevant core components
Interventions must be evidence-based.
How often should patients participate in a structured exercise program during core rehabilitation?
At least two to three times a week
What is the primary goal of cardiovascular rehabilitation?
To increase physical fitness
Requires documented evidence of regular review, goal setting, and exercise progression.
How long should the documented interaction between the patient and the multidisciplinary team last?
A minimum of 8 weeks
According to BACPR EPG, 2nd Edition, Nov 2020.
What is the initial focus when starting cardiovascular rehabilitation?
Exploring patients’ understanding of their condition and perceived control
This sets the foundation for rehabilitation.
Who is involved in the priority and goal-setting process in cardiovascular rehabilitation?
The patient, their significant other, and the rehabilitation professional.
What kind of information is provided to patients in cardiovascular rehabilitation?
Evidence-based information appropriate to their literacy level
Available in various media to suit patient needs.
What options do patients have for support in behavior change during rehabilitation?
Hospital-based CR team, leisure services, mobile tech, wearable devices.
What does an individual assessment in cardiovascular rehabilitation typically include?
Current clinical status, cardiac history, medication compliance, investigation results, psychological status, risk stratification, functional capacity assessment, physical limitations, and training heart rates.
What is the purpose of risk stratification in cardiovascular rehabilitation?
To assess the risk of further cardiac events during exercise.
What factors increase the risk of further cardiac events during exercise?
The amount of damage to the myocardium and its function.
What is a key characteristic of risk stratification?
It is focused on determining the risk of a patient having a further cardiac event while exercising, rather than on long-term risk factors.
What are examples of submaximal functional tests used in rehabilitation?
- 6-minute walk test
- Cycle ergometer test
- Chester step test
What is the role of exercise tolerance tests (ETT) in cardiovascular rehabilitation?
To provide a basis for safe and effective exercise prescription.
Fill in the blank: Risk stratification is not about risk factors as they do not increase risk during exercise but may cause _______.
[progression of disease long term]
What does BACPR provide to assist with risk stratification?
A Risk Stratification Tool.
What are the types of assessments included in the individual assessment?
- Current clinical status
- Current cardiac status
- Current medication
- Results of investigations
- Psychological status
- Risk stratification
- Functional capacity assessment
- Physical limitations
- Calculation of individual training heart rates.
What is a complication that increases risk during exercise?
Heart failure
Heart failure indicates damage to the myocardium and leads to inadequate cardiac output.
What does post event/procedure ischaemia indicate?
Increased risk of arrhythmias and reduced blood supply to the myocardium
It may suggest that treatment is not yet optimal.
What is the definition of reduced Left Ventricular Function (LVF)?
Indication that the myocardium is struggling to maintain cardiac output
EF <50% is considered reduced.
What EF percentage indicates poor LVF?
EF <35%
This is considered severely impaired LVF.
What EF percentage indicates moderate LVF?
EF 35-49%
Moderate LVF suggests some level of impairment.
What does ongoing angina indicate?
Residual disease and ischaemia
Ongoing symptoms may require monitoring and medication.
What are some ongoing angina symptoms?
- Light headedness
- Dyspnoea at low workload
Silent ischaemia can also be indicated by ST changes on ECG.
Who is considered at high risk for serious arrhythmias?
Anyone with a history of serious ventricular arrhythmias
This includes those with ventricular tachycardia or fibrillation.
What is recommended for patients with a history of ventricular fibrillation?
Implanted ICD
This device helps prevent VF recurrence in high-risk patients.
What indicates maximal functional capacity less than 7 METS?
Heart is not coping with exercise intensity
This can be determined through a maximal or submaximal test.
What is a potential issue with clinically significant treated depression?
Medications can be arrhythmogenic
SSRIs are preferred due to fewer side effects.
What is the drug of choice for cardiac clients with depression?
SSRIs
Examples include fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram.
Which SSRI is the drug of choice post MI?
Sertraline
It is preferred due to its safety profile in cardiac patients.
Why should citalopram be used with caution in CVD patients?
Associated with dose-related arrhythmias
This can pose additional risks for patients with cardiovascular disease.
What are some antidepressants that are not suitable for CVD patients?
Most other antidepressants
Many can have adverse effects in this population.
What is the classification for a patient with reduced Left Ventricular Function (EF <35%)?
Poor LVF (severely impaired)
This classification indicates a severe impairment in heart function.
What EF range indicates moderate Left Ventricular Function?
EF 35-49%
This range signifies a moderate level of impairment in heart function.
What are some symptoms of residual ischaemia?
- Angina
- Light-headedness
- Dyspnoea
These symptoms can occur at low workloads.
What does silent ischaemia refer to?
ST changes on ECG during exercise or in recovery
Silent ischaemia may not present with noticeable symptoms.
Name a serious arrhythmia risk factor.
- History of complex ventricular arrhythmias at rest or exercise
- Implanted ICD
- History of cardiac arrest
These factors significantly increase the risk during exercise.
What is the risk level if all criteria are marked ‘N’?
Low risk
This indicates that the individual has no significant risk factors.
What is the maximal functional capacity threshold that indicates a high risk?
Less than 7 METS
This threshold is critical for risk assessment in cardiovascular rehabilitation.
What is the risk level if any criteria are marked ‘Y’ but not all?
Moderate risk
This indicates the presence of some risk factors but not all.
What is the risk level if any one of the high-risk criteria applies?
High risk
This requires immediate attention in the rehabilitation process.
Fill in the blank: Angina at ______ METS indicates a high risk.
<5 METS
This is a critical threshold for identifying high-risk patients.
What does the BACPR Risk Stratification Tool assess?
Risk factors for cardiovascular rehabilitation
It helps in determining the appropriate level of care needed for patients.
What places a person at high risk for exercise participation?
Any one or combination of the following findings:
* Complex ventricular arrhythmias during exercise testing and recovery
* Angina or other significant symptoms at low levels of exertion (<5 METS)
* High level of silent ischaemia (ST segment depression >2 mm) during testing or recovery
* Abnormal hemodynamics during testing (e.g. chronotropic incompetence, flat or decreasing systolic BP)
* Functional capacity ≤3 METs
* Left ventricular dysfunction with resting ejection fraction <35%
* History of cardiac arrest
* Complex dysrhythmias at rest
* Complicated myocardial infarction or incomplete revascularisation
* Presence of heart failure
* Signs and symptoms of post-event or post-procedure ischaemia
* Clinical depression
* Implanted cardiac defibrillator
What are characteristics of patients at moderate risk for exercise participation?
Any one or combination of the following findings:
* Stable angina or other significant symptoms at high levels of exertion (>7 METS)
* Mild to moderate level of silent ischaemia (ST segment depression <2 mm) during testing or recovery
* Functional capacity <5 METS
* Rest ejection fraction 35-49%
What characteristics must be present for a patient to remain at lowest risk for exercise participation?
All of the following must be present:
* Absence of complex ventricular arrhythmias during testing and recovery
* Absence of angina or significant symptoms during testing and recovery
* Normal hemodynamics during testing and recovery
* Functional capacity ≥7 METS
* Rest ejection fraction 50%
* Uncomplicated myocardial infarction or revascularisation
* Absence of complicated ventricular arrhythmias at rest
* Absence of heart failure
* Absence of signs and symptoms of post-event/post-procedure ischaemia
* Absence of clinical depression
True or False: A patient with a resting ejection fraction of <35% is considered at high risk for exercise participation.
True
Fill in the blank: A patient with a functional capacity of _____ METs is considered at high risk for exercise participation.
≤3 METs
What defines a high level of silent ischaemia during exercise testing?
ST segment depression >2 mm from baseline
What are some symptoms that indicate high risk during exercise participation?
Angina, shortness of breath, light-headedness, or dizziness occurring at low levels of exertion (<5 METS) or during recovery
What is the significance of chronotropic incompetence during exercise testing?
It indicates abnormal hemodynamics and places the patient at high risk
What is the minimum functional capacity that places a patient at moderate risk?
<5 METS
Fill in the blank: A resting ejection fraction of _____ is considered moderate risk.
35-49%
What finding indicates a patient has a history of cardiac issues and increases their risk during exercise?
History of cardiac arrest
True or False: A patient with an implanted cardiac defibrillator is at moderate risk for exercise participation.
False
What is the significance of ST segment depression <2 mm during exercise testing?
It indicates a mild to moderate level of silent ischaemia, placing the patient at moderate risk
What are the key indicators of abnormal hemodynamics during exercise testing?
Chronotropic incompetence or flat/decreasing systolic BP with increasing workloads
Fill in the blank: A patient showing signs and symptoms of _____ is at high risk for exercise participation.
post-event or post-procedure ischaemia
What are CAD risk factors that are not used when assessing the risk of an adverse event during exercise?
Smoking, high fat diet
CAD risk factors are used to predict the likelihood of coronary disease progression.
What is the primary purpose of risk stratification in exercise programmes?
Enhance programme safety
Risk stratification helps determine exercise intensity, level of monitoring, and level of supervision.
What factors are considered when making decisions about exercise prescription in cardiovascular rehabilitation?
Identified risk
This includes exercise intensity, level of monitoring, and level of supervision.
What is paramount when setting up an exercise programme?
Patient safety
Detailed clinical screening and assessment are essential to risk stratify and assess a patient’s needs.
What should patients be screened for before each exercise session?
Changes in medication, symptoms, home exercise activity, problems and concerns
Screening helps ensure patient safety and readiness for exercise.
Name a condition that would exclude a patient from participating in the core rehab exercise session.
Fever or systemic illness
Other exclusions include unresolved unstable angina and resting BP systolic > 180 mmHg.
What is a sign that a condition is deemed unstable or uncontrolled?
Evidence of new or worsening symptoms within the previous month
Medication changes within the previous month also indicate instability.
What should be done if a patient presents with certain signs or symptoms before the next rehabilitation session?
Medical review should be undertaken
This ensures patient safety and proper management of their condition.
What should induction sessions for new patients include?
Explanation of aims, exercises, safe target heart-rate ranges, warm-up and cool-down importance, monitoring
Induction also includes practice in performing exercises safely and effectively.
What might many patients find intimidating when starting an exercise programme?
The idea of taking exercise
Gentle encouragement may be needed for participation.
What is the recommended approach for patients categorized as low risk in terms of supervision?
Less continuous supervision than high-risk counterparts
Low-risk patients can safely engage with less monitoring.
What should patients be set up with from the outset of Core rehab (Phase I)?
A home-based exercise programme
Supervised sessions alone may not meet the recommended exercise frequency.
What is the recommended frequency for exercise in Phase II?
2-3 times per week
What percentage of Heart Rate Reserve (HRR) should be targeted during aerobic endurance training?
40-70% HRR
What is the recommended duration for conditioning in Phase II?
20-30 minutes
What are the two scales used for rating perceived exertion (RPE) in Phase II?
Borg scale (11-14) and CR10 scale (2-4)
What is a key consideration regarding patient attitudes during exercise in Phase II?
Patients may be fearful, anxious, cavalier, or aggressive
What is the ultimate goal of the conditioning component in Phase II?
Achieve a minimum of 20 minutes continuous cardiovascular exercise
What approach is recommended for patients who are too deconditioned to achieve 20 minutes of continuous exercise?
Interval training with periods of active recovery
What should BACPR instructors remember about patients’ progress to 20 minutes of continuous activity?
Not all patients will have achieved the goal upon referral
What are the two types of monitoring used to assess exercise safety and effectiveness?
Subjective and objective monitoring
What are some subjective signs of over-exertion to monitor?
- Excessive shortness of breath
- Sweating
- Angina
- Fatigue
- Loss of coordinated movement
What are some objective measures for monitoring exercise?
- Blood pressure
- Heart rate
- MET level achieved
What is one aim of the exercise component in Phase II?
To foster patient independence in exercising
What is the ideal staff-patient ratio during exercise sessions in Phase II?
Five patients to one trained professional
What should be the humidity and temperature maintained during exercise sessions?
- Humidity: 65%
- Temperature: 65 to 72°F (18-22°C)
What is essential for patient safety during exercise sessions?
Ensuring all clients are asymptomatic and within 10 bpm of pre-exercise heart rate before leaving
Fill in the blank: The conditioning component in Phase II aims for a minimum of _______ minutes of continuous cardiovascular exercise.
20
What should all staff be familiar with during cardiovascular rehabilitation?
Emergency procedures
Staff should be aware of how to respond effectively in case of emergencies.
What is the minimum recommended frequency for exercise training in home-based exercise?
Three times a week
This frequency is essential for gaining maximal benefit from the training.
What is the recommended home exercise program for patients?
Twice per week similar exercises and up to 30 minutes of walking on remaining days
Walking should be at an appropriate speed and symptom-free.
What should unsupervised exercise always be within?
Prescribed target heart-rate range and a rating of perceived exertion of 11-14 on the Borg RPE scale or 24 on the Borg CR10 scale
These guidelines ensure safety and effectiveness during exercise.
How can compliance with home-based activity be improved?
By recording it in an exercise log
This allows for verification of frequency, duration, intensity, and monitoring of RPE scores.
What is the aim of education sessions in core rehab (Phase I)?
To facilitate the patient’s understanding of their illness and treatments
This education supports behavior change and empowers patients.
What topics should education sessions cover?
- Heart disease and investigations
- Risk factors for CAD
- Effects and benefits of exercise
- Healthy heart diet
- Medication
- Relaxation
- Stress management
These topics are crucial for patient awareness and recovery.
What psychological conditions are common in patients with coronary artery disease?
Anxiety, depression, and psychological distress
These conditions can significantly affect recovery and outcomes.
How much does depression increase cardiac mortality post-myocardial infarction?
Three to four-fold increase
This highlights the importance of addressing mental health in cardiac rehabilitation.
What tool is commonly used for psychological assessment in cardiovascular rehabilitation?
Hospital Anxiety and Depression Scale (HADS)
This tool helps screen patients for anxiety and depression levels.
Is the Hospital Anxiety and Depression Scale (HADS) a diagnostic tool?
No
It indicates mood but does not provide a formal diagnosis.
What should be considered if psychological intervention cannot be provided in-house?
Referral to community psychological services
This ensures patients receive the support they need for mental health issues.
What is the effect of psychological interventions in cardiac rehabilitation?
Improvement in depression and anxiety, and small effect on cardiac mortality
Psychological support can also lead to better medication compliance and reduced stress levels.
What is a normal response to the trauma of a cardiac event?
Some degree of anxiety
This response may not necessarily indicate a psychological disorder.
What is an important indicator of psychological well-being?
Quality of life.
Quality of life can be assessed through various tools.
Name one assessment tool used to identify problems in quality of life.
SF 36 (Ware and Sherbourne, 1992).
Other tools include Dartmouth Coop, MacNew, and Heart QoL.
What are two psychological interventions used in cardiovascular rehabilitation?
- Cognitive behavioural techniques
- Motivational interviewing
Other interventions include individual counselling, relaxation, solution-focused therapy, and stress management.
True or False: All cardiovascular rehabilitation patients ideally benefit from access to psychological support.
True.
Evidence shows psychological interventions can improve outcomes.
What should happen for patients with more severe psychological disturbances?
There should be established access and referral routes to appropriate clinical specialists.
This is important for ensuring adequate care.
What is assessed prior to discharge from core rehab (Phase I)?
Whether all rehabilitation goals have been met.
This includes assessing psychological stability and risk stratification.
Fill in the blank: Patients should be able to _______ independently, safely, and effectively according to an individual exercise prescription.
exercise.
This is a key objective for discharge.
What must rehabilitation staff ensure before discharging a patient to the GP?
The patient is medically and psychologically stable and adjusted to the cardiac event.
This includes meeting specific criteria related to functional capacity.
What is the recommended functional capacity for long-term exercise prescription?
Approximately 5 METS, i.e. walking comfortably at 4 mph.
Patients with lower functional capacity should still be accommodated.
What is included in the detailed discharge assessment with the patient?
- Changes in lifestyle behavior
- Functional capacity
- Psychological status
- Level of knowledge
This is important to ensure comprehensive follow-up.
What are some issues considered during post-assessment for long-term management planning?
- Who will monitor risk factors
- Details of medical follow-up
- Local venues/resources for exercise
- Advice on long-term exercise prescription
- Support for behavior change
- Coping with relapses
- Local support group information
This helps in maintaining lifestyle changes after rehabilitation.
What is the role of the rehabilitation team in cardiovascular rehabilitation?
To support patients through various phases of rehabilitation
Why is social support important in cardiovascular rehabilitation?
It enhances patient motivation and compliance
What should be discussed with patients regarding rehabilitation timescales?
Adjustments based on individual progress and needs
What factors can affect the progress of patients in rehabilitation?
Fitness level, psychological distress, and co-pathologies
What is the significance of communication between core rehab and long-term exercise?
Establishes fast-track protocols and two-way communication
What is a critical step before a patient moves to long-term exercise sessions?
Writing a discharge communication to the patient’s GP
What percentage of people drop out of exercise programs within the first 6 months?
50%
What should cardiovascular rehabilitation providers from core rehab and long-term exercise do?
Work closely to address local needs and maintain long-term exercise behavior
What form should be completed and given to each patient upon discharge from core rehab?
BACPR transfer form
Is the length of core rehab (Phase III) intervention fixed?
No, it is flexible based on patient needs
What may be decided following assessment of a patient’s needs?
The most suitable place for the patient to continue exercising
What is the aim of close collaboration between core rehab and BACPR professionals?
To develop fast-track protocols and timely referrals
Fill in the blank: Long-term exercise behavior is an important _______.
issue
What does this chapter describe?
The immediate/acute physiological responses to individual bouts of exercise in healthy individuals and those with Coronary artery disease.
What are the common abbreviations used in this chapter?
- CAD
- DBP
- HR
- SBP
- ADLS
- RT
- AET
What are some health benefits of physical activity for adults and older adults?
- Improved all-cause mortality
- Cardiovascular disease mortality
- Incident hypertension
- Incident site-specific cancers
- Incident type-2 diabetes
- Reduced symptoms of anxiety and depression
- Improved cognitive health
- Better sleep
- Improved measures of adiposity
What additional benefits does physical activity provide for older adults?
- Prevents falls and falls-related injuries
- Prevents declines in bone health
- Maintains functional ability
What do the WHO guidelines on physical activity provide?
Evidence-based public health recommendations for physical activity frequency, intensity, and duration, and their associations with health outcomes.
What is the relationship between physical activity and health benefits?
There is a dose-response relationship; some activity is better than none, but more activity generally confers greater benefits.
What role do cardiac rehabilitation specialists play?
They motivate patients to develop a habitually physically active lifestyle and prescribe aerobic and resistance training.
What principle is used in prescribing resistance training (RT) and aerobic exercise training (AET)?
The principle of progressive overload.
What is the target exercise intensity for cardiac rehabilitation?
Above a minimal level required to induce a training effect but below the intensity that evokes abnormal clinical signs or symptoms.
What physiological challenge does sustained dynamic exercise present?
It requires an increase in cardiac output to meet the metabolic needs of working muscles.
What happens to heart rate just prior to exercise?
It typically rises to well above normal resting levels due to increased sympathetic activity.
What factors regulate the anticipatory heart rate response?
- Increased sympathetic activity
- Increased circulating catecholamines
- Decreased parasympathetic activity (reduction in vagal tone)
How does heart rate respond during exercise?
It increases directly in relation to exercise intensity.
Fill in the blank: In the average individual, resting heart rate typically ranges between _______.
[60 to 80 beats per minute]
True or False: The rise in heart rate continues to increase indefinitely during exercise.
False
What is maximal heart rate (HRmax)?
The highest heart rate value that is achieved in an all-out effort.
HRmax declines steadily with age by about 1 beat per year starting at 10-15 years of age.
How can estimates of maximal heart rate be made?
Based on age.
Maximal heart rate declines steadily with age.
What is a steady state in heart rate during exercise?
A condition where heart rate plateaus after an initial increase in response to a higher workload.
At least four minutes of constant workload is required to ensure steady state is achieved.
What is cardiovascular drift?
The phenomenon where heart rate continues to drift upwards during prolonged exercise at constant intensity, especially in hot conditions.
How does stroke volume change with incremental workload during exercise?
Stroke volume initially increases but does not continue to increase beyond workloads of 40-50% of maximal capacity.
What are the two main factors contributing to the increase in stroke volume?
- Increased contractility of the heart muscle due to increased sympathetic activity
- Increased preload from greater volume of blood returned from the veins.
What happens to cardiac output as exercise intensity increases?
Cardiac output rises due to increases in heart rate and stroke volume.
What is the relationship between stroke volume and cardiac output at high exercise intensities?
Since stroke volume does not continue to increase beyond 40-50% of maximal aerobic capacity, further increases in cardiac output must rely on increasing heart rate.
How much can cardiac output increase during strenuous exercise in relatively sedentary men?
As much as four-fold above resting level.
What happens to systolic blood pressure during exercise?
It increases in direct proportion to exercise intensity, potentially exceeding 200 mm Hg at maximal exertion.
How does diastolic blood pressure (DBP) change with increasing exercise intensity?
DBP hardly changes at all as exercise intensity increases.
Fill in the blank: Maximal heart rate declines by about _______ beat per year starting at 10-15 years of age.
1
What is the effect of the Valsalva manoeuvre during resistance training?
It can induce a large increase in venous return, leading to increased cardiac output and blood pressure.
Proper breathing technique can help avoid the Valsalva manoeuvre.
In exercises with the same absolute energy expenditure, how does systolic blood pressure differ between arm and leg exercises?
Systolic blood pressure is greater during arm exercises compared to leg exercises.
This is due to smaller active muscle mass resulting in less vasodilation.
What is the relationship between muscle mass and total peripheral resistance during exercise?
Smaller active muscle mass results in reduced vasodilation and less reduction in total peripheral resistance.
This affects blood pressure response in different muscle groups.
What is the Rate Pressure Product (RPP) and how is it calculated?
RPP is an indirect measure of myocardial oxygen consumption, calculated as HR x SBP.
It indicates the stress on the myocardium during exercise.
How does static work or dynamic work restricted to the upper body affect myocardial oxygen consumption?
It imposes a greater stress on the myocardium for any given absolute workload compared to lower limb exercises.
Examples include comparing arm exercises to leg exercises at the same workload.
What role does the sympathetic nervous system play during exercise?
It controls the redistribution of blood from less active tissues to skeletal muscle.
Active muscles can receive up to 80-85% of cardiac output at maximal exercise.
What percentage of cardiac output goes to skeletal muscle at rest versus maximal exercise?
15-20% at rest and up to 80-85% at maximal exercise.
What happens to blood flow to organs during exercise?
Blood flow is reduced to the kidneys, liver, stomach, and intestines.
This is due to the need for increased blood flow to active tissues.
What is the efficiency of the human machine during exercise?
The human machine is only about 20% efficient.
80% of the energy expended appears as heat.
What physiological response occurs during prolonged exercise in hot or humid environments?
Blood is redirected to the skin to promote heat loss, and blood volume is reduced due to sweating.
What is the impact of reduced blood volume on stroke volume during exercise?
It diminishes venous return, leading to a reduced stroke volume.
What must happen to heart rate to maintain cardiac output during reduced stroke volume?
Heart rate must increase, a phenomenon known as cardiovascular drift.
What is the arterial-venous oxygen difference [(a-v) O2 diff]?
It represents the amount of oxygen extracted by the tissues, calculated as the difference between oxygen content in arterioles and venules.
How does the (a-v) O2 diff change from rest to maximal exercise?
It may increase approximately threefold.
What happens to blood plasma volume at the onset of exercise?
There is an immediate loss of blood plasma volume to the interstitial fluid space.
What causes the loss of blood plasma volume during exercise?
Increase in blood pressure and concentration of waste products in active muscles.
By how much can plasma volume reduce during prolonged exercise?
10% to 20%.
How does the myocardium’s state differ from skeletal muscles at rest?
The myocardium is never really in a resting state; it constantly contracts and relaxes.
What is the typical oxygen extraction rate of the myocardium at rest?
Around 70%.
What is the oxygen extraction rate of skeletal muscles at rest?
25%-30%.
During exercise, how does the myocardium increase its oxygen supply?
By increasing coronary blood flow.
How much does coronary blood flow increase during exercise?
More than threefold.
What happens to the coronary arteries during exercise?
They vasodilate.
What is the biggest driver for vasodilation of coronary arteries during exercise?
Increased metabolic activity of the myocardium.
Name some substances that contribute to vasodilation during exercise.
- Adenosine
- Hydrogen ions
- Potassium ions
- Acetylcholine
- Blood lactate
- Drop in blood O2 content (hypoxia)
What role does the vascular endothelium play during exercise?
Triggers relaxation of artery smooth muscles and contributes to vasodilation.
What are some chemicals produced by the vascular endothelium that aid in vasodilation?
- Nitric oxide (NO)
- Prostacyclin
True or False: Sympathetic drive has no effect on coronary vessels during exercise.
False.
What is a potential concern for individuals with heart disease during exercise?
Increased heart rate may raise myocardial workload, leading to ischaemic or arrhythmic episodes.
What compensatory mechanism occurs in patients with impaired cardiac output during exercise?
Heart rate rises rapidly.
Fill in the blank: The heart has a very poor capacity to produce energy _______.
anaerobically.
What can immediate challenges to oxygen supply in the heart result in?
Impaired muscle function and symptoms of angina.
What is the effect of damage to the endothelial lining on coronary artery vasodilation?
Coronary artery vasodilation is less responsive than in healthy arteries.
Why should the warm-up period be more gradual and prolonged for certain patients?
Due to damage to the endothelial lining, warm-up should be more gradual and prolonged than for healthy participants.
In patients with severe heart failure, how may systolic blood pressure respond to increasing exercise intensity?
Systolic blood pressure may not rise and may even decrease due to reduced cardiac output.
Why is it important to monitor hypotension in participants with left ventricular dysfunction during exercise?
Any indication of hypotension must be taken seriously.
What determines myocardial workload?
Myocardial workload is the product of heart rate and systolic blood pressure.
How should training heart rate be adjusted for patients with elevated pre-exercise systolic blood pressure?
The training heart rate should be reduced for that session.
What medications can blunt heart rate and blood pressure responses during exercise?
Beta-blockers and some calcium channel blockers.
How is blood redistributed to active skeletal muscle during exercise?
Through sympathetic stimulation causing vasodilation of blood vessels.
What is the impact of medications like beta blockers and ACE inhibitors on blood pressure during exercise?
They increase the potential for hypotensive episodes.
What should patients be encouraged to do during exercise to ensure good venous return?
Keep their feet moving or toes wiggling.
What happens to total peripheral resistance after exercise ceases?
It is reduced for some time.
Why is fluid intake during exercise important for individuals on diuretics?
Due to reduction in blood plasma volume from the outset of exercise.
What principle is crucial for the effectiveness of exercise prescriptions?
The FITT principle: frequency, intensity, time, and type of training.
What adaptations occur in the body with regular exercise training?
Functional, structural, and biochemical changes in skeletal muscle, the heart, and the circulation.
What factors influence the extent of exercise training adaptations?
Intensity, frequency, duration of training, and initial fitness of the subject.
Do exercise training adaptations occur in individuals with cardiac disease?
Yes, they occur in men and women, young and old, with and without cardiac disease.
What are the benefits of both Aerobic Exercise Training (AET) and Resistance Training (RT)?
They offer an array of cardioprotective benefits.
What is the optimal approach for exercise programming in managing coronary heart disease?
A combination of Aerobic Exercise Training (AET) and Resistance Training (RT).
What specific benefit does AET provide for people living with coronary heart disease?
It effectively lowers resting heart rate.
What should exercise programming incorporate for patients with coronary heart disease?
Resistance Training (RT) following the FITT principle guidelines.
Fill in the blank: Myocardial workload is determined by the product of heart rate and _______.
systolic blood pressure.
What are whole-body adaptations in exercise physiology?
Changes in muscle strength, muscle mass, bone mineral density, VO2peak, and physical function.
What is VO2peak?
Peak oxygen uptake.
How does exercise impact Type II diabetes risk?
Improves glycaemic control and insulin signalling.
What cardiovascular disease risk factors are influenced by exercise?
Blood pressure, blood lipids, high-density lipoprotein, low-density lipoprotein, and cholesterol.
What does AET stand for in exercise physiology?
Aerobic training.
What does RT stand for in the context of exercise training?
Resistance training.
What is the relationship between ageing and exercise adaptations?
Exercise can mitigate negative effects of ageing on muscle and bone health.
Fill in the blank: VO2peak is also known as _______.
peak oxygen uptake.
True or False: Resistance training has no effect on muscle mass.
False.
List three adaptive responses to aerobic training.
- Increased VO2peak
- Improved glycaemic control
- Enhanced physical function
What is the significance of high-density lipoprotein in cardiovascular health?
It helps reduce cardiovascular disease risk.
Fill in the blank: The adaptive response of blood pressure to resistance training is indicated by an _______.
upward arrow.
What is indicated by a downward arrow in adaptive responses to training?
A decreasing effect.
What do triglycerides influence in the context of exercise?
Cardiovascular health.
True or False: Exercise training can negatively affect bone mineral density.
False.
What is VO2max?
The highest rate of oxygen consumption attainable during maximal or exhaustive exercise.
What type of training leads to greater increases in VO2max?
Aerobic exercise training (AET) results in greater increases in VO2max compared to resistance training (RT).
What is the typical increase in VO2max for healthy individuals after 12 to 16 weeks of training?
An increase of 10% to 25%.
What two factors determine VO2max?
- Maximum cardiac output * Maximal ability of active skeletal muscle to extract and utilize oxygen.
What central change occurs in healthy individuals due to training?
A significant increase in maximum cardiac output.
Does maximum heart rate change with training?
No, maximum heart rate does not alter with training.
What primarily causes the increase in maximal stroke volume during training?
An increase in left ventricular mass and chamber size.
What is the effect of training on total peripheral resistance during maximal exercise?
A reduction in total peripheral resistance.
Why might cardiac patients not show similar adaptations in left ventricle mass and volume as healthy individuals?
Typical cardiac rehabilitation programs may be too brief or of insufficient intensity.
What are some peripheral changes that contribute to increased oxygen extraction and utilization?
- Improved capillarisation * Increased myoglobin concentration * Increased number and size of mitochondria * Increased oxidative enzyme activity within mitochondria.
How does improved capillarisation aid trained individuals during maximal exercise?
It accommodates increased blood flow without shortening capillary transit time.
What is the predominant reason for improvement in VO2max for most coronary heart disease (CHD) patients?
Peripheral adaptations in skeletal muscle that increase oxygen extraction and utilization.
What factors influence the extent of training adaptations in individuals with heart disease?
- Intensity and duration of training * Initial fitness * Severity of disease * Co-morbidity * Medication * Psychological status * Motivation.
What adaptations are most relevant for cardiac patients during exercise?
Adaptations evident at submaximal levels of exercise.
What happens to heart rate at rest and at specified rates of submaximal work after training?
Heart rate is lower after training.
What is the proposed mechanism for the reduction in heart rate after training?
Increased parasympathetic activity and reduced sympathetic activity.
What effect does training have on circulating catecholamines?
It reduces circulating catecholamines (adrenaline and noradrenaline).
True or False: Life is lived at maximal levels of exercise intensity.
False; life is lived at varying levels of submaximal intensity.
What happens to stroke volume at rest after training?
Stroke volume increases after training
This increase is due to greater filling of the left ventricle, reduced heart rate, increased plasma volume, greater blood volume entering the left ventricle, and increased ventricular mass.
What are the factors contributing to increased stroke volume after training?
- Greater filling of the left ventricle during diastole
- Reduction in heart rate
- Increased plasma volume
- Greater volume of blood entering the left ventricle
- Increased ventricular mass
What is the effect of training on cardiac output at the same exercise intensity?
Cardiac output decreases at the same exercise intensity following training
This is due to increased muscle oxygen extraction and increased oxygen usage economy of the skeletal muscle.
How does training affect resting and submaximal blood pressure?
Resting and submaximal blood pressures are reduced by training
The reduction may be as much as 10 mm Hg for SBP and 8 mm Hg for DBP.
What is the Rate Pressure Product (RPP) and how is it affected by training?
RPP is reduced due to the training-induced reduction in heart rate and blood pressure
This reduction benefits individuals with coronary artery disease, improving symptom control and quality of life.
True or False: Following training, the myocardial oxygen requirement is increased at a given workload.
False
The myocardial oxygen requirement is reduced at a given workload following training.
Fill in the blank: Following training, the _______ threshold is improved, allowing more work before the onset of symptoms for angina patients.
[ischaemic]
What happens to muscle perfusion at rest after training?
Muscle perfusion at rest remains unaltered
However, at a given submaximal workload, redistribution of blood to active muscle is reduced.
What is the consequence of reduced blood flow to muscle after training?
Preserves blood flow to other areas of the body
This is advantageous during prolonged exercise or under hot or humid conditions.
How does oxygen extraction by active skeletal muscle change after training?
The amount of oxygen extracted from each 100 millilitres of blood is greater after training
The difference in oxygen content between arterial and venous blood is increased.
What significant change occurs in plasma volume after training?
A significant increase in plasma volume occurs after approximately 5 training sessions
This enhances oxygen transport and temperature regulation.
How does training affect coronary blood flow during diastole?
Training-induced reduction in heart rate extends the period of diastole
This results in improved myocardial perfusion since blood flow to the left ventricle wall occurs during diastole.
What effect does training have on blood pressure?
Blood pressure is reduced
Training can lead to significant improvements in cardiovascular health.
How does training affect total cholesterol levels?
Total cholesterol is reduced; the effect is enhanced by concomitant weight/body fat reduction
Weight loss alongside training can lead to greater improvements in cholesterol levels.
What happens to high-density lipoprotein cholesterol with training?
High-density lipoprotein cholesterol is increased
This is beneficial as HDL cholesterol helps reduce cardiovascular risk.
What is the effect of training on glucose metabolism?
Glucose metabolism is improved with increased sensitivity to insulin
Improved insulin sensitivity is crucial for preventing type 2 diabetes.
What change occurs in fibrinolytic activity with training?
Fibrinolytic activity is increased with a reduction in platelet ‘stickiness’
This reduces the risk of blood clots.
What is preserved while losing body fat through training?
Lean body mass is preserved, thereby maintaining resting metabolic rate
Preserving lean mass is important for overall metabolic health.
What improvements are associated with training regarding physical function?
Improved physical function and mobility
Enhanced mobility can lead to a better quality of life.
What is the effect of training on the immune system?
Improved immune system function
Regular training can enhance the body’s ability to fend off infections.
What changes occur in muscle mass and strength due to training?
Increased muscle mass and strength
Resistance training is particularly effective for building muscle.
What is the effect of training on oxidative capacity?
Greater oxidative capacity
Improved oxidative capacity enhances endurance and overall fitness.
