Chapter 13 - Considerations for Chronic Disease

Question 1

Chronic conditions that general exercise guidelines apply to.

Answer 1

The general guidelines apply to conditions such as uncomplicated coronary artery disease, hypertension, dyslipidemia (blood lipid disorder), diabetes, MetS (metabolic syndrome), asthma, cancer, and osteoarthritis

Question 2

Modifications to exercise programs for someone with a chronic disease should be based on:

Answer 2

1. Characteristics to the disease
2. Restrictions that the disease places on someone
3. Disease severity
4. Activities to emphasize
5. Activities to avoid

Question 3

Three factors that would dramatically reduce chronic disease

Answer 3

Smoking, Physical Activity, Poor diet

Question 4

Information a PT should gather from a client’s physician

Answer 4

Medical release (permission to exercise)
Exercise limitations - HR limitations
Exercise guidelines

Question 5

SOAP Notes

Answer 5

A way to document client progress. Documents patterns of self image vs actual performance.
Subjective - client observations of status, description of symptoms, challenges w/program, progress made
Objective - Measurements taken, exercise & nutrition log (include date)
Assessment - Summary of client status based on S and O
Plan - Description of next steps based on assessment

Question 6

PT Responsibility When Working with Clients Who Have Chronic Disease

Answer 6

Expand knowledge and skills through continuing education and close communication with healthcare professionals

Question 7

Nutrition Statistics Regarding Chronic Disease

Answer 7

45% of deaths caused by heart disease, type 2 diabetes, and stroke were attributable to dietary habits. (US study)

Question 8

Recovery from a cardiac event (MI, procedure, surgery, angioplasty, stent)

Answer 8

Recovery is almost always improved with an appropriate exercise program. Avoid Valsalva maneuver. Stop exercise if angina, dyspnea, lightheadedness, dizziness, pallor, or rapid HR.

Question 9

Description of low-risk CAD clients (Cardiovascular Disease)

Answer 9

1. Uncomplicated clinical course in hospital
2. No evidence of resting or exercise induced ischemia
3. Functional capacity >=7 METS after 3 wks post treatment
4. Normal ventricular function (ejection fraction >50%)
5. No resting or exercise induced arrhythmias

Question 10

FITT Recommendations for Clients with Cardiovascular Disease

Answer 10

Frequency - cardio 3-5days/wk, strength 2-3days/wk
Intensity - moderate to vigorous, moderate
Time - cardio goal of 20-60 min w/warm up and cool down, no specific duration for strength
Type - Rhythmic large muscle groups, various exercises for strength one set initially

Question 11

Two types of hypertension

Answer 11

Essential or Primary Hypertension - most prevalent, no know cause
Secondary Hypertension - caused by another disease such as kidney disease

Question 12

Lifestyle Changes to Manage Hypertension

Answer 12

1. Maintain normal bodyweight (5-20 mm/Hg)
2. Adopt DASH eating pattern (dietary approaches to stopping hypertension) (8-14 mm/Hg)
3. Dietary sodium reduction (2-8 mm/Hg)
4. Physical activity (4-9 mm/Hg)
5. Moderation of alcohol (2-4 mm/Hg)

Question 13

FITT Recommendations for Clients with Hypertension

Answer 13

Frequency - cardio every day preferable, strength 2-3 days/wk
Intensity - cardio RPE 12-13, strength 40-50% or 60-80% 1-RM
Time - 30min, 2-4 sets, 8-12 reps
Type - rhythmic large muscle , free weights or machines no Valsalva maneuver

Question 14

Stroke definition

Answer 14

Stroke occurs when the blood supply to the brain is compromised by a blocked vessel (ischemic stroke) or when a blood vessel bursts in the brain (hemorrhagic stroke). Number one cause of disability globally.

Question 15

Signs of Stroke

Answer 15

FAST - Face drooping, arm weakness, speech difficulties, time to call EMS

1. Sudden numbness or weakness in arms, legs, face
2. Sudden confusion or trouble speaking or understanding others
3. Trouble seeing in one or both eyes
4. Sudden walking problems, dizziness, loss of balance or coordination
5. Sudden sever headache with no known cause

Question 16

FITT Recommendations for Clients with Stroke

Answer 16

Follow same guidelines as CAD & Hypertension
Frequency - cardio 3-5days/wk strength 2days/wk
Intensity - light to vigorous RPE 11-14, 50-70% 1-RM
Time - 20-60min/day multiple bouts ok, 1-3 sets, 8-15 reps
Type - consider cognitive ability, consider safety

Question 17

Peripheral Artery Disease PAD definition & considerations

Answer 17

Atherosclerosis of the arteries of the lower extremities. Most prominent risk factors are smoking and diabetes. Causes pain due to ischemia or lack of blood flow to the muscle. Pain is brought on by exercise and sometimes at rest. Medical evaluation required before exercise. Proper foot care important.

Question 18

FITT Recommendations for PAD

Answer 18

Frequency - cardio 3-5 days/wk, >=2days/wk
Intensity - moderate, 60-80% of 1-RM
Time - 30-45min, 6-8 exercises 2-3 sets 8-12 reps
Type - weight bearing, whole body-large muscles-lower muscles

Question 19

FITT Recommendations for Dyslipidemia

Answer 19

Frequency - cardio >=5 days/wk, 2-3days/wk
Intensity - below VT2, 50-85% of 1-RM
Time - 30-60min, 6-8 exercises 2-4 sets 8-12 reps or more for endurance
Type - rhythmic large muscle, variety

Question 20

Exercise considerations for Dyslipidemia

Answer 20

Decreasing total and LDL cholesterol involves exercise of at least 250-300 minutes per week, expending approx 2,000 cal/week. Definition - undesirable levels of lipids

Question 21

Lipid definition

Answer 21

A group of organic compounds that are oily to the touch and insoluble in water. Includes fatty acids, oils, waxes, sterols, triglycerides (TG). They are a source of stored energy and a component of cell membranes.
Cholesterol is manufactured in liver and transported in plasma while attached to protein.

Question 22

Lipid Types

Answer 22

LDL - low density lipids-bad- 60-70% of body chol.
VLDL - very low- carrier of TG, 10-15% of body chol.
IDL - Intermediate, similar to LDL, from VDL breakdown
HDL - high density, good, 20-30% of body chol
Non-HDL - Total cholesterol minus HDL

Question 23

Cholesterol Classifications - LDL

Answer 23

<100 -      Optimal
100-129 - Near Optimal
130-159 - Borderline High
160-189 - High
>190    -   Very High

Question 24

Cholesterol Classifications - HDL & Total

Answer 24

HDL - low <40, high >=60
Total Cholesterol
<200 -     desirable
200-239 borderline high
>=240     high

Question 25

Triglyceride (TG) Classifications

Answer 25

<150 desirable 150-199 borderline high 200-499 high >=500 very high

Question 26

FITT Recommendations for Diabetes

Answer 26

Frequency - cardio 3-7 days/wk, 2-3days/wk Intensity - mod to vigor, below VT2, 50-85% of 1-RM Time - 150min/wk, 6-8 exercises 1-3 sets 8-10 reps Type - rhythmic large muscle, variety

Question 27

Type 1 Diabetes Considerations

Answer 27

With advances in insulin delivery systems, persons with type 1 diabetes can eat and exercise just a a person without the disease.

Question 28

Characteristics of Type 1 Diabetes

Answer 28

``` Onset <35 years Abrupt onset Family history not always Normal to thin body composition Reduced or absent blood insulin Absent or minor cell insulin resistance Treatment - Insulin, diet &/or exercise ```

Question 29

Characteristics of Type 2 Diabetes

Answer 29

Onset >40 years Gradual Family history - yes Usually obese (central type) body composition Normal or increased blood insulin Present- cell insulin resistance Treatment - Weight loss, drugs, insulin, diet

Question 30

FITT Recommendations for Metabolic Syndrome (MetS)

Answer 30

Frequency - cardio >=5 days/wk, 2-3days/wk Intensity - below VT1, 50-85% of 1-RM Time - 30-60min/day, 8-10 exercises 1-3 sets 8-10 reps Type - rhythmic large muscle, variety

Question 31

MetS definition

Answer 31

A cluster of conditions that increases a person's risk for developing heart disease, type 2 diabetes and stroke. Identified by the presence of 3 or more of these: Elevated Waist Circumference W - >35in, M - >40in Elevated TG >=150 or on drug treatment Reduced HDL w,<50, m<40 or on drug treatment Increased BP - >= 130/85 Elevated fasting glucose - >= 100mg/dL or on drug treatment

Question 32

Asthma Considerations

Answer 32

In general, people with asthma should be able to participate in regular exercise and sports with minimal restrictions if properly medicated. 1. Always have rescue medication 2. Drink plenty of fluids 3. Avoid asthma triggers - heat or cold 4. Utilize prolonged warm up and cool down 5. Start with low intensity and gradually increase 6. PT should closely observe client for EIB 7. Activate EMS if medication isn't helping 8. Mid to late morning workouts may be better 9. If well controlled, client can use regular guidelines for exercise

Question 33

FITT Recommendations for Asthma

Answer 33

Frequency - cardio 3-5 days/wk, 2-3days/wk Intensity - initially below VT1, 50-85% of 1-RM Time - increase to at least 30-40min/day, 8-10 exercises 1-3 sets 8-10 reps Type - rhythmic large muscle, variety

Question 34

FITT Recommendations for Bronchitis and Emphysema

Answer 34

Frequency - cardio at least 3-5 days/wk, 2-3days/wk Intensity - mod to vigor, 50-85% of 1-RM Time - 20-60min/day intermit., 2-4 sets 8-12 reps Type - walking/cycle/upper body, variety

Question 35

Cancer Stats

Answer 35

Cancer is the second leading cause of morbidity and mortality worldwide. Cancer death has declined 27% in the past 10 years. Lifetime risk of cancer for women is 38%, for men 41%. Exercise helps reduce risk.

Question 36

FITT Recommendations for Cancer

Answer 36

Frequency - cardio 3-5 days/wk, 2-3days/wk Intensity - mod to vigor, 30% of 1-RM and increase 5% increments Time - 150min/wk mod or 75min vigor, >=1 sets 8-12 reps Type - prolonged rhythmic large muscle, variety

Question 37

American Cancer Society Guidelines for Cancer

Answer 37

1. Aim for a healthy weight 2. Regular physical activity including cardio & strength, avoid inactivity 3. Nutrition - avoid processed meats & red meat, 2.5 cups fruit/veggies per day, whole grains, limit alcohol

Question 38

Osteoporosis Considerations

Answer 38

Characterized by low bone mass and disrupted microarchitecture. Defined as Bone Mineral Density (BMD) that is >=2.5 deviations below mean. Affects more women than men. Hip fractures are caused by falls 90% of the time. Common areas for fracture are hip, vertebrae and wrist. One in two women will break a bone due to osteoporosis and 1 in 4 for men.

Question 39

Osteopenia Definition

Answer 39

1-2.5 deviations below mean for BMD

Question 40

Osteoporosis Nutrition

Answer 40

Calcium and Vitamin D Vitamin D aids calcium absorption If calcium is inadequate it gets resorbed from the bones Excessive alcohol is detrimental to bone health

Question 41

FITT Recommendations for Osteoporosis

Answer 41

Frequency - cardio 4-5 days/wk, 1-2 to 2-3days/wk Intensity - mod some to vigor, adjust so 2 reps are challenging - high intensity if tolerated Time - 20min progress to 60min, start at 1 sets 8-12 reps then 2 sets no more than 8-10 exercises Type - weight bearing, emphasize balance, gait, function movement

Question 42

FITT Recommendations for Arthritis

Answer 42

Frequency - cardio 3-5 days/wk, 2-3days/wk Intensity - light to mod, 50-80% of 1-RM Time - 150min/wk mod or 75/wk vigor, 2-4 sets 8-12 reps Type - low impact large muscle, variety within pain free ROM

Question 43

Arthritis Considerations

Answer 43

1. People with arthritis have higher rates of depression & anxiety 2. People with diabetes are almost twice as likely to have arthritis 3. Having arthritis increases risk of developing CVD 4. Higher uric acid with gout is linked to higher risk of hypertension 5. Obesity increases risk of OA due to higher load on joints 6. Obesity is also associated with RA and lupus 7. Higher in women than men

Question 44

Arthritis OA cause

Answer 44

Overuse, trauma, obesity, or degeneration of joint cartilage that takes place with age.

Question 45

Arthritis RA cause

Answer 45

RA is an autoimmune disease in synovial tissue and progresses to an erosion of articular cartilage and bone. More disabling than OA and causes greater deformity. Exercise is integral part of treatment.