Exercise prescription

Question 1

what info do you need to review prior to prescribing exercise?

Answer 1

1: review of systems : MD eval or last office note
2: current medical hx
3: past medical hx
4: medications

5: symptoms:
- angina or equivalent
- dyspnea
- syncope
- orthopnea
- edema
- palpitations
- claudication
- orthopedic pain
- lightheadedness/dizziness

6: blood pressure (sitting/standing): orthostatic changes

7: risk stratification
- apparently healthy
- known disease

8: work status and physicality of work
9: recreational activities
10: risk factors
11: goals

Question 2

FIT M

Answer 2

= volume of exercise

frequency: # of sessions
intensity: how hard
time: duration of session
mode: type of activity

*higher volume needed for pt looking to lose weight

Question 3

what is the guideline for the MINIMUM frequency of exercise?

Answer 3

more days than you don’t

Question 4

what is the guideline for the MINIMUM duration of exercise?

Answer 4

30 minutes

Question 5

volume of exercise for cardiovascular benefit

Answer 5

120-200 minutes per week
10,000 steps per day
750-1200 cals/week

Question 6

volume of exercise for weight loss

Answer 6

200-300 minutes
>12,000 steps/day
1200-2000 cal/week

Question 7

intensity

Answer 7

Target heart rate:

• % max (from GXT or est max of 220-age)
• Karvonen
• % VO2 max (linear relationship to HR)

Rate of perceived exertion (RPE)
Rating of perceived dyspnea (RPD)
METS
ischemic threshold
oxygen saturations

Question 8

mode

Answer 8

due to specificity of training, mode of activity is especially important in relation to patient’s goals

Question 9

considerations for progressing exercise

Answer 9

1: RPE or RPD
2: THR
3: oxygen saturation
4: change in clinical status- symptoms, orthopedic
5: ejection fraction
6: blood pressure
7: blood glucose
8: GOALS!

Question 10

resistance training

Answer 10

= >50% 1 rep max

MI: 5 weeks post AND 3 weeks continuous cardiopulmonary exercises

CABG: 8 weeks post AND 3 weeks of continuous cardiopulm exercise

stent: 2 weeks post

ok to start light handweights and theraband immediately

Question 11

contraindications for resistance training

Answer 11

-symptomatic heart failure
-severe valve disease
-uncontrolled arrhythmias
-unstable symptoms
-uncontrolled hypertension:
SBP >= 160; DBP >=100
-high intensity training with active retinopathy

Question 12

warm up

Answer 12

gradually increasing lower level active cardiopulmonary exercise
5-10 min

Question 13

cool down

Answer 13

active lower lever activity
5-10 minutes
stretching

Question 14

diabetes

Answer 14

• atypical symptoms or none at all
• medications: insulin vs. oral agent vs. diet controlled
• do not inject insulin into working muscle group
• monitor blood glucose
  (critical: 400 (MD notified immediately); >100 to exercise)
• timing of last meal
• amount and combo of foods
• exercise IS insulin
• neuropathy (balance!!)
• retinopathy (caution with resistance training)
• maximize calorie burn
• foot care

Question 15

obesity

Answer 15

-maximize calorie burn
-aware of changes in orthopedic status
-mode of exercise (NWB vs WB)
-change up routine to keep the body burning fuel inefficiently
-dietary changes
-remember volume of exercise
(decreased intensity-> more frequency and longer duration)

*can they fit on machines?
want to maximize caloric burn

Question 16

pulmonary

Answer 16

• postural and breathing training
• oxygen saturations with exercise
• supplemental oxygen use
• resistance training especially to increase upper extremity strength

Question 17

heart failure/low ejection fraction

Answer 17

• monitor for fluid retention
• increased HR
• prone to increased fatigue, slower progression
• prone to increased ventricular ectopy (may have ICD (implantable defibrillator))

Question 18

pacemakers

Answer 18

HR response to exercise via:

• UE movement
• heel strike
• respiratory rate

Rarely see fixed rate settings

demand pacing=may see some intrinsic beats, if HR too low pacer will kick in or if too high pacer will slow rate

Question 19

arthritis

Answer 19

• mode of activity primary thought
• stretching and flexibility
• balance issues
• adjustment based on daily changes in pain

***common for rotator cuff injuries with severe cardiac-open heart surgery patients

Question 20

anxiety/fear/depression

Answer 20

• build self confidence
• empower patient to believe in themselves
• you have to be confident and anticipate their needs
• reinforcement of progression from first week
• interval training

**need to know when it is appropriate to push them!

Question 21

peripheral vascular disease

Answer 21

• treadmill training!
• walk to moderate claudication, rest and restart in 5-8 min intervals
• remember some risk factors as heart disease