VIVA Peter (70)

Question 1

Conduct a functional lower limb functional strength test for capacity (hint, repeated calf raises, repeated sit-to-stand, Timed Up and Go)

Answer 1

• Arms crossed at the front, feet shoulder width apart, sitting at a comfortable sitting height, feet closer to the chair to make it easier. Sit up straight, lean forward and squat upwards.
• Perform as many as Peter can tolerate in 30 seconds. How hard he felt like he was pushing /10.

Question 2

Teach an appropriate uni joint upper limb resistance exercise for Peter.

Answer 2

Bicep curls
Purpose: arm strength, lifting things, getting up from a lying position

Question 3

Explain to the examiner the most suitable initial loading parameters (reps, sets, loading RPE, reps in reserve, frequency) for this resistance exercise (ie safety, competency, novice, intermediate, experienced). Base this on his clinical presentation.

Answer 3

Based on 410 met score. Max HR 220-age(70)=150
Warm-up
Safety phase
Get Muscles Working Again
Under 5 RPE (3-4)
Sets 2
Reps 10
Rest 2 minutes
Frequency - daily

Question 4

Teach an appropriate squat pattern resistance exercise to Peter. (hint: there are many options here so learn a handful)

Answer 4

BW squat (with or without chair)
Feet stay flat, even pressure
Hips back
Knees over toes
Back straight but not over extended.
Lower until comfortable (touch chair)
Come back up

Question 5

Explain to the examiner what an appropriate aerobic exercise program for Peter might look like (FITT) and the considerations you have given to his medical history and medications. (hint: intensity can be described in many ways like heart rate, moderate/vigorous, talk test etc)

Answer 5

Frequency: most days

Intensity: low to moderate

Type: Walking
Water aerobics

Time: 150 minutes distributed through week (20-30 minute sessions)

Doctors clearance pre screening

Inhaler for exercise

Question 6

What would be the indications for terminating the exercise with Peter?

Answer 6

• Some - Stopping request by patient
• Patients - Poor perfusion
• Don’t - Dizziness (lightheaded, confusion, ataxia)
• Show - Skin changes (pallor, cyanosis)
• New - Nausea
• Angina - Angina-like symptoms (chest pain)
• But - Breathing issues (wheezing)
• May - Muscle pain (leg cramps, claudication)
• Have - Haemodynamics (drop in HR)
• Fatigue - Fatigue (severe physical/verbal signs)

Question 7

What is the limiting factor for exercise for someone like Peter with COPD?-(hint:It is not the lungs and generally more likely to be fatigue in the legs. Explain why.

Answer 7

• Deconditioning from lack of exercise
• Lower lactic acid threshold - Reduced O2 from COPD means reduced exercise tolerance, hyperinflation of lungs creates higher CO2 in blood, increasing lactic acid

Question 8

STS functional test

Answer 8

Explain
30 seconds as many as he can do
Using arms to get up, the rep is calculated as a 0
Normative data 70+ (12-18)

Question 9

Timed Up and Go functional test

Answer 9

Chair with armrest, stopwatch, tape (3 metres)

Start in seated position, patient stands up and walks 3 metres, turns around and walks back and sits down. Time stops when patient is seated.

Patient >12 seconds has an increased risk of falls