Exercise Prescription Flashcards
1
Q
What is a risk for participants who find it difficult to monitor their exertion levels?
A
Increased risk of an exertion-related cardiac event
Such participants should receive additional guidance on monitoring exertion levels. This is not an absolute contradiction to exercise.
2
Q
List the 8 absolute contraindications to exercise.
A
- Unstable angina
- Unstable or acute heart failure
- Unstable diabetes
- New or uncontrolled arhythmias
- Tachycardia (>100)
- Hypertension (>180/100)
- Symptomatic Hypotension
- Febrile illness
These contraindications require evaluation before resuming exercise.
3
Q
What 3 criteria indicate the client is stable enough to exercise
A
Durng the preceeding month there has been:
1. No change in symptoms
2. No significant prescription changes
The exercise level & skill they are able to abtain is:
1. moderate intensity
2. Reach borg scale 11-14 or RPE 2-4
3. 40-70% HRR
4. Self monitoring skills obtained and maintained
4
Q
What other pre-exercise self assessment criteria should be discussed with the instructor prior to exercise
A
- New Test Results (eg cholesterol, BP)
- New or worstening joint problems
- New medication side effects
5
Q
What should clients always bring to class?
A
- GTN spray
- Water
Even if not used on a regular basis
6
Q
What should the aims and objectives of a long-term exercise programme do?
A
- Encourage Independance (self help, monitoring and self motivation)
- Advice & support re lifestyle change
- Individualised goal oriented prescription
- Supervised regular sessions to improve:
* Muscular Fitness
* Aerobic capacity
* Balance
* Flexibility - Review and alter as client improves or deteriorates
7
Q
It is advisable to increase CV duration and increase intensity at the same time. True or false?
A
False
Only one FITT variable should be increased at a time
8
Q
Increasing the HRR from 60% yo 65% is a good way of progressing the client. True or false.
A
True
Progression is requiring further overload after the initial stimulus to create necessary adaptation.
9
Q
What is meant by ‘Progressive Overload’?
A
The coupling of progression and overload in exercise training.
10
Q
What is the term for losing adaptations due to stopping training?
A
Detraining.
11
Q
How long can it take to lose training adaptations completely with no activity?
A
A few months.
12
Q
What is a recommended practice regarding resistance training (RT) frequency?
A
RT should not be performed on consecutive days.
13
Q
What are the main components of fitness to consider in programme design?
A
Aerobic and resistance training
Balance and flexibility should also be considered.
14
Q
What should be considered for motor skills development and fall prevention?
A
Balance and flexibility
These are important for aiding motor skills.
15
Q
What is the recommended duration for a warm-up before aerobic exercise?
A
A minimum of 15 minutes
Warm-up should include pulse-raising, mobility, and stretching.
16
Q
What are the key mechanisms triggered during pulse-raising activities?
A
Increased coronary blood flow due to vasodilation, raised ischaemic threshold, and reduced risk of angina and arrhythmias
These mechanisms are essential for matching myocardial demands.
17
Q
By what mechanisms do Coronory Arteries Vasodilate?
A
- Increased metabolic activity through a number of metabolic by products
- Endothelial Vasodilators eg Nitric Oxide
- Sympathetic Activity (to a lesser degree)
18
Q
What is the key point regarding coronary arteries during exercise?
A
Coronary arteries are dilated, and the risk of ischaemia is reduced
This is critical for safe exercise.
19
Q
What is advisable for the older average age group during range of motion exercises?
A
A relatively gradual progression of range of motion exercises is advisable.
20
Q
What activities should be combined to maintain elevated cardiac output during warm-up?
A
Pulse (metabolism) raising and mobility activities.
21
Q
For clients with impaired motor skills, what type of activities may be necessary?
A
Activities that intersperse flexibility/mobility activities with light intensity aerobic activities.
22
Q
What types of stretches should be included in the warm-up?
A
Either slow full-range moving stretches or short duration static stretches.
23
Q
What are four benefits of including stretches in the warm-up?
A
- Ensure participants explore their full natural range of movement
- Encourage good balance and alignment
- Help identify tight or sore muscles prior to exercise
- Practise positions for maintaining or developing flexibility.
24
Q
What should be performed with upper body stretches during the warm-up?
A
Upper body stretches should be performed with the feet moving.
25
What should be interspersed with lower body stretches?
Dynamic movements designed to maintain an elevated heart rate.
26
What is the target heart rate range by the end of the warm-up period?
Within 20 bpm below the lower end of their target training heart rate.
## Footnote
Or no higher than 3 or 11 on PRE scales
27
What is the the heart rate target at the end of the warm up for those on Beta Blockers
10 beats below the the lower end of their target training heart rate
## Footnote
Or no higher than 3 or 11 on PRE scales
28
Why is it suggested to limit the use of music during warm-up?
* Music can over-motivate participants
* It prevents self-pacing
* Competing for attention with the instructor's voice can hinder information absorption.
29
What should be included prior to starting the conditioning component?
A 're-warm' consisting of simple pulse-raising movements (2-3 minutes).
30
What is the recommended FITT for cardiac patients?
* Frequency = 3 times a week
* Intensity = 40 - 70% HRR. RPE 11-14. CR10 2 -4
* Time = 20 - 60 mins
* Type = large muscles, rhythmic manner
31
What does continuous training involve?
Uninterrupted activity, usually performed at a constant sub-maximal intensity.
32
What is an example of continuous training?
Going for a 2-mile walk at a relatively constant speed of 3 mph at steady RPE.
33
What does interval training entail?
Bouts of relatively more intense work interspersed with bouts of lighter activity or Active Recovery.
34
The safest way to progress an individuals aerobic endurance prescription initially is through added intensity. True or false?
False
| Added duration as we are trying to build to 20 min continuous
35
What does Active Recovery (AR) involve?
Performing short-term lighter intensity activities in-between bouts of targeted conditioning exercises
36
What are the two key factors that determine the length of the AR period?
* Intensity and duration of the preceding bout of targeted conditioning exercise
* Fitness level of the client
37
Why should toes be kept wriggling or feet moving during upper body AR exercises?
1. To encourage venous return
2. To prevent postural hypotension
38
Why are CAD patients suseptible to postural hypotension?
1. Medication side effects from Nitrates, Beta Blockers and ACE Inhibitors
2. Age: baroreceptors are less responsive when suddently changing position
39
What is one advantage of the interval approach to exercise?
A greater total volume of aerobic exercise may be achieved than with continuous exercise
40
Why is the interval approach beneficial for clients with low fitness levels?
It provides a greater stimulus for physiological adaptation
41
What is the eventual goal of exercise based on the FITT principle?
To achieve continuous aerobic exercise
42
What is the duration of the cool-down in the exercise programming?
10 minutes
43
What is the rationale for extended cool down?
To guard against
1. venous pooling and hypotension
2. Arrythmias
Overall, to ensure the patient goes home with pre exercise levels of ciculating catcholamines and a normal heart rate (which takes longer in older adults)
## Footnote
1. Medication, age cause these 2. Circulating hi levels catecholamines
44
What is High Intensity Interval Training (HIIT)?
A mode of exercise training that alternates between short bouts of high and low intensity exercise.
45
What intensity is often considered 'high intensity exercise'?
>85% peak power output or VO2max.
46
Is HIIT a safe method of exercise for patients with stable CAD and Chronic Heart Failure?
Yes.
47
How does HIIT compare to moderate intensity continuous exercise training in improving peak aerobic fitness?
HIIT can improve peak aerobic fitness to a greater extent.
48
When should floor work be done in the program?
After the cool down
49
What is the key point regarding an extended cool-down period?
Reduces risk of arrhythmias and hypotension.
50
Which exercise is noted as being unable to be performed bilaterally?
Triceps kick back
51
What is the purpose of increasing range of motion or adding arm movement to exercises?
To increase the intensity and progress the exercise.
52
What is generally recommended for setting the rate of exercise in aerobic stations?
Set the rate and alter the resistance to elicit a heart rate response within the THRR.
## Footnote
THRR = Training Heart Rate Range
53
What is the target RPE for brisk walking during the main workout?
12-14
54
What are contraindications for resistance training?
Ischaemia on activities < 5 METS
55
What should be considered for safety in resistance training?
* Recovery from bypass surgery
* Exercise technique
* Muscle balance
* Breathing pattern (avoid Valsalva manoeuvre)
* Appropriate training for exercise professionals
56
Does muscle stretching after exercise influence exercise-induced muscle damage (DOMS)?
No, muscle stretching performed after exercise does not influence DOMS levels
## Footnote
However, repeated bouts of stretching during the days following exercise may reduce muscle stiffness
57
What is the structure of an individualised resistance training (RT) programme?
1-3 sets of 10-15 reps covering 8-10 major muscle groups.
58
What is the target RPE after 10 reps in a resistance training programme?
12-13
59
What is the recommended duration for the concentric and eccentric phases per repetition?
1-2 seconds concentric, 3 seconds eccentric
60
What is adaptive shortening?
Muscles becoming less flexible due to age, inactivity, or poor posture.
61
Why are PNF stretches generally not appropriate for patients with coronary heart disease?
The isometric contraction involved leads to increased blood pressure.
62
What is the recommended exercise frequency for individuals with coronary heart disease who have graduated from Phase III programmes?
At least three times per week.
63
What is the target duration for exercise sessions for these individuals?
20-60 minutes.
64
What percentage of HRmax is recommended for exercise intensity in this population?
60-80% of HRmax.
65
What signs and symptoms should be monitored to determine appropriate response to exercise?
* Excessive breathlessness
* Loss of quality of movement
* Skin colour
* Sweat rate.
66
What is the estimated heart rate threshold for exercise based on %HRR?
Between 40% and 70% of heart rate reserve.
67
What is the formula used to estimate maximum heart rate for individuals over 45 years?
206 - (0.7 x age)
68
What is the error range for estimated maximum heart rate?
As much as 20 bpm above or below the estimate
69
True or False: Individuals on B-blockers may have increased resting and maximum heart rates.
False
70
What is the typical expected reduction in maximum heart rate for patients on B-blockers or Ivabradine?
20-30 bpm
71
What does the heart rate reserve (HRR) method take into account?
The difference between maximum heart rate (HRmax) and resting heart rate (RHR)
72
What is the typical range for anaerobic ventilatory lactate threshold?
40-70% HRR
73
Fill in the blank: HRR = HRmax - _______.
RHR
74
How do you calculate the 40% HRR?
(HRR x 0.4) + RHR
75
How do you calculate the 70% HRR?
(HRR x 0.7) + RHR
76
What does RPE stand for in exercise programming?
Rating of Perceived Exertion
77
Who devised the RPE scales?
Professor Gunnar Borg
78
What does the CR10 scale focus on?
Differentiated or localised sensations of strain, exertion, or pain
79
Fill in the blank: The intensity at which a client works should be initially determined by _______.
[heart rate or MET level]
80
What is one way to establish the validity of RPE?
By getting the patient to provide an RPE for different levels of work rate during exercises.
81
Fill in the blank: A rating of 12-13 on the 6-20 scale corresponds to approximately ______ of heart rate reserve or VO2max.
60%
82
What does 1 MET represent in terms of oxygen consumption?
3.5 millilitres of oxygen per kilogram of body weight per minute
83
What RPE rating corresponds to 85% of heart rate reserve or VO2max?
16 on the RPE scale
84
What does VO2max represent?
Maximal oxygen uptake
## Footnote
VO2max is a measure of the maximum amount of oxygen that an individual can utilize during intense exercise.
85
What is the significance of METs max?
Maximal metabolic equivalents
## Footnote
METs max indicate the highest level of energy expenditure during physical activity.
86
Define HRRmax.
Maximal heart rate reserve
## Footnote
HRRmax is the difference between maximal heart rate and resting heart rate.
87
What is the Borg RPE scale range?
6-20
## Footnote
The Borg RPE scale is a subjective measure of perceived exertion during physical activity.
88
What is the Borg RPE CR10 scale range?
0-10
## Footnote
The CR10 scale is a simplified version of the RPE scale for ease of use.
89
What is the required intensity level for activities in a community setting?
40%-70% HRR or RPE Borg scales 11-14 or 2-4.
90
How long may patients stay with a qualified BACPR Specialist Exercise Instructor?
Approximately 12 weeks.
91
What should happen if there has been a new cardiovascular event reported since completing the transfer form?
The exercise prescription will not be carried out.
92
True or False: Patients with decompensated heart failure can be referred for long-term exercise.
False.
93
How long is the BACPR Transfer Form (T) valid after discharge?
3 months
94
What is the referral to Primary Care warranted for?
Identified criteria such as deteriorating exercise performance or worsening angina
95
What symptoms indicate a need for referral to Primary Care?
* Deteriorating exercise performance
* Worsening of angina
* Worsening of other symptoms (e.g., suspected arrhythmias)
96
What is the referral process if a patient has a further cardiac event?
Referral to Core / Phase III for assessment
97
What are the main aims of Phase IV training?
1. Increase the tolerability of aerobic endurance training
2. Individualising exercise prescriptions
3. Reduce risk factors with health advice
4. Increase independence
98
Why is it important to have a checklist available at the start of each session
Symptoms and medication may change
99
What does MET stand for?
Metabolic Equivalent of Task
## Footnote
MET is a unit that estimates the amount of oxygen consumed during physical activities.
100
What is one criterion for suitability to transfer from Phase III to Phase IV?
Clinically stable, meaning there has been no change in symptoms or significant change in medication during the preceding month
## Footnote
This indicates that the patient has maintained a consistent health status, which is crucial for progression.
101
What intensity range of activities must an individual be able to sustain to qualify for transfer?
Moderate intensity within the target range of 40-70% HRR or at an RPE Borg scale of 11-14 or 2-4
## Footnote
HRR stands for Heart Rate Reserve, and RPE stands for Rate of Perceived Exertion.
102
What does risk stratification involve?
Risk stratification involves the following:
* Current clinical / cardiac status
* Investigations / results
* Lipid profile, blood glucose and HbA1c levels BMI
* Medication - compliance?
* Psychological status - anxiety? - agrophobia?
* Functional capacity assessment eg Exercise Tolerance Tests
* Calculation of TRAINING Heart Rate
* Physical limitations eg hip replacement
* Personal goals - what do they like & want.
* Habitual activity
* Habits to twin with new regimes to make them stick
## Footnote
These elements help in assessing an individual's risk for cardiac events.
103
What is included in the lipid profile during risk stratification?
The lipid profile includes cholesterol levels and triglycerides.
## Footnote
It is essential for assessing cardiovascular risk.
104
Fill in the blank: Medication _______ is a factor in risk stratification.
compliance
105
What psychological statuses are considered in risk stratification?
Anxiety and agoraphobia
## Footnote
These can impact a patient's ability to engage in physical activity.
106
What is a functional capacity assessment?
It evaluates a person's ability to perform physical activities, often using Exercise Tolerance Tests.
## Footnote
This assessment helps determine safe exercise levels.
107
What are examples of physical limitations considered in risk stratification?
Hip replacement and other similar conditions.
## Footnote
These limitations affect exercise options and safety.
108
What does ISWT stand for?
Incremental Shuttle Walk test
109
What does 6MWT stand for?
6 minute walk test
110
What does CST stand for?
Chester Step test
111
What is the name of the exercise test that involves cycling?
Incremental cycle ergometry
112
What measurements are taken during submaximal tests?
HR, RPE, time to completion, stage/level attained
## Footnote
HR stands for heart rate, and RPE stands for rating of perceived exertion.
113
What are the uses of submaximal tests?
* Set exercise prescription
* Predict aerobic capacity
* Assess changes over time - outcome measure
## Footnote
Submaximal tests provide valuable insights into an individual's fitness level and progress.
114
True or False: The results of submaximal tests are used in risk stratification.
False
## Footnote
Submaximal test results are not utilized for risk stratification.
115
What is the recommended patient-to-staff ratio during exercise?
1:3 staff to patient ratio
## Footnote
This ratio helps ensure adequate supervision and monitoring during exercise.
116
What is residual ischaemia?
Ongoing angina symptoms or silent ischaemia indicated by ST V down on ECG during exercise or in recovery if known.
117
What type of arrhythmias are of concern in risk stratification?
Ventricular arrhythmias (NOT atrial).
118
What history is significant for ventricular arrhythmias?
History of complex ventricular arrhythmias, implanted ICD, or survivor of cardiac arrest.
119
What risk levels are associated with <5 METs and <3 METs?
<5 METs indicates moderate risk and <3 METs indicates high risk.
120
What are the criteria that increase risk when exercising?
Complicated Event, Reduced Left Ventricular Function, Residual Ischaemia Symptoms, Serious Arrhythmias, Other
## Footnote
These criteria are used to assess risk during exercise for individuals with cardiac conditions.
121
What constitutes a complicated event in risk stratification?
Heart failure, Post event/procedure ischaemia/angina
## Footnote
These events indicate significant cardiac issues that can elevate risk during exercise.
122
What is considered poor left ventricular function (LVF)?
EF <35%
## Footnote
An ejection fraction (EF) below 35% indicates severely impaired function of the left ventricle.
123
What is the range for moderate left ventricular function (LVF)?
EF 35-49%
## Footnote
This range indicates a moderate level of impairment in left ventricular function.
124
What are residual ischaemia symptoms during exercise?
Angina, Light-headedness, Dyspnoea, Silent Ischaemia
## Footnote
These symptoms can occur at low workloads and indicate underlying cardiac issues.
125
What are serious arrhythmias that increase risk?
History of complex ventricular arrhythmias, Implanted ICD, History of cardiac arrest
## Footnote
These factors significantly raise the risk of complications during exercise.
126
What is the significance of maximal functional capacity in risk stratification?
Less than 7 METS indicates increased risk
## Footnote
METS (Metabolic Equivalent of Task) is a measure of exercise capacity and lower values suggest higher risk.
127
What does clinically significant depression on medication indicate in risk stratification?
Increased risk
## Footnote
Mental health conditions can affect exercise tolerance and safety.
128
What level of ST segment depression is associated with high risk?
≥ 2mm ST segment depression
## Footnote
Significant ST segment changes during exercise testing are critical indicators of risk.
129
What METS value indicates high risk associated with angina?
< 5 METS
## Footnote
This indicates very limited exercise capacity and higher likelihood of cardiac events.
130
What is the primary reason heart failure increases risk during exercise?
The ventricles are unable to maintain a good cardiac output.
## Footnote
This leads to inadequate blood supply to the body during physical activity.
131
How does ischaemia/angina immediately post event/procedure affect exercise risk?
Ischaemia can be a precursor to arrhythmias and indicates reduced blood supply to the myocardium.
## Footnote
This is critical for assessing safety during exercise.
132
What does impairment in LV function indicate regarding cardiac output?
The myocardium is struggling to maintain cardiac output.
## Footnote
The amount of impairment determines the level of risk.
133
What ongoing symptoms should be monitored during exercise?
Chest pain, light-headedness, dyspnoea at low workload.
## Footnote
These symptoms can indicate worsening cardiac conditions.
134
How should increases in exercise duration and intensity be approached for patients with heart failure?
Increase should be gradual.
## Footnote
This minimizes risk of exacerbating symptoms.
135
What does ongoing angina symptoms suggest about a patient's condition?
There is some residual disease (ischaemia) which may be controlled with medication.
## Footnote
Ongoing monitoring is necessary to ensure stability.
136
What monitoring is required for patients with known silent ischaemia during exercise?
Monitor ST segments on ECG during exercise or in recovery.
## Footnote
Silent ischaemia is common in diabetics.
137
What symptom should be watched for at low workloads as a sign of angina?
Breathlessness.
## Footnote
It can indicate underlying cardiac issues.
138
What can increase risk and implications for prescription, monitoring, and management?
Criteria related to complex ventricular arrhythmia history
## Footnote
Includes history at rest or during exercise
139
What types of arrhythmias might someone be at risk for?
Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)
## Footnote
These are types of potentially life-threatening arrhythmias
140
What device might be implanted in a patient with a history of arrhythmias?
Implanted Cardioverter Defibrillator (ICD)
## Footnote
This device monitors and can correct arrhythmias
141
What should be monitored in patients with complex ventricular arrhythmia?
Heart Rate (HR) response and symptoms such as palpitations and dizziness
## Footnote
Patients should report ICD activation for follow-up
142
How does decreased fitness affect risk?
Increases risk of events
## Footnote
Lower fitness levels correlate with higher health risks
143
What action should be taken if a patient reports palpitations?
Refer back to GP and keep intensity down
## Footnote
Ensures proper medical evaluation and adjustment of exercise intensity
