Exercise Safety Guidelines

Question 1

Normal response

Answer 1

• Increased RR
• Rise in SBP
• Minimal (+/- 10) or no change in DBP
• Rise in HR

Following 5 min rest: BP w/in 10 mmHg of resting value, HR w/in 10 bpm resting value

Question 2

When to stop: Cardiovascular

Answer 2

• SBP 200-220 w/o EKG (>250 w/ EKG)
• Sudden >10 mmHg SBP
• Failure of SBP to rise
• DBP 100-110 w/o EKG (>115 w/ EKG)
• Decrease in HR below baseline

Question 3

When to stop: neurological

Answer 3

• Dizziness/lightheadedness
• Confusion
• Ataxia
• Shaking/tremors

Question 4

When to stop: integument

Answer 4

• cyanosis
• pallor
• diaphoresis (excessive sweating)
• cold/clammy skin

Question 5

When to stop: pain

Answer 5

• leg cramps
• severe claudication
• chest/arm/jaw pain
• moderate to severe angina

Question 6

when to stop: respiratory

Answer 6

• mod-severe dyspnea (unable to say 5 words)
• abnormal breathing pattern
• drop in O2 sats >10% below baseline or <88% (does not recover w/in 5 min rest)

Question 7

When to stop: endocrine/GI

Answer 7

• suspected hypoglycemic response
• nausea/vomiting

Question 8

Cancer possible contraindications

Answer 8

Bone metastasis sites
Tumors in targeted strength training areas
Medication effects

Question 9

MSK possible contraindications

Answer 9

No high intensity strength training on involved limb:
- recent fracture <6 weeks
- Unstable fracture
- osteomyelitis (bone infection)
- avascular necrosis
- wounds w/ exposed tendon or muscle

Question 10

Surgical possible contraindications

Answer 10

Craniotomy <6 weeks
- no bending, lifting >10 lbs, valsalva

Abdominal <6 weeks
- no crunches, valsalva, lifting >10 lbs

sternal <6 weeks
- no UE high intensity, valsalva, lifting >10 lbs

Question 11

Steroid use precautions

Answer 11

• HTN
• immunosuppression
• osteoporosis
• muscle weakness/myopathy
• thin skin, poor wound healing

Question 12

Beta blocker use precautions

Answer 12

• Hypotension
• bradycardia
• drowsiness

Question 13

Contraindications to high intensity exercise (12)

Answer 13

Unstable angina (pain at rest)

Decompensated heart failure (evidenced by worsening edema, fatigue, and SOB at rest)

Acute cardiac event w/in 6 weeks (MI, vtach/vfib, pacemaker placement, CABG)

Severe mitral or aortic valve stenosis

Mitral or aortic valve of any severity WITH history of syncope and w/o corrective surgery

Severe pulmonary hypertension (MAPpulm > 55 mHg)

PE w/in 6 weeks

Proliferative diabetic retinopathy

CVA w/in 6 weeks

Cerebral aneurysm of any size if untreated, or treated w/in 6 weeks

Rhabdomyolysis w/in 6 weeks

Physician ordered “no strenuous activity” restrictions

Question 14

Precautions to high intensity exercise

Answer 14

Limb specific conditions (fracture, osteomyelitis, avasc necr, bone cancer, DVT w/in 6 weeks w/ anticoag)

Abdominal precautions or chronic condition (hernia; avoid valsalva)

Severe osteoporosis or compression fx (avoid spinal flexion and rotation)

Moderate or severe non-proliferative diabetic retinopathy (avoid valsalva; keep BP < 150/100)

Aortic aneurysm (no lifting >75 lbs, avoid valsalva, keep BP <150/100)

Question 15

Submax exercise testing assumptions

Answer 15

A steady-state HR is obtained for each exercise work rate

A maximal HR for a given age is uniform (220-age)

Mechanical efficiency is the same for everyone (VO2 at given work rate)

Linear relationship between HR and workload

HR will vary depending on fitness level between subjects at any given workload

Question 16

Signs/symptoms of obstructive lung disease

Answer 16

SOB
dyspnea on exertion
orthopnea
wheezing
peripheral cyanosis
digital clubbing
pursed lip breathing
malaise
chronic cough
weight loss
increased use of accessory mm.
prolonged expiratory period

Question 17

Obstructive lung disease

Answer 17

Inability to get air out

COPD (emphysema, chronic bronchitis)

Decreased FEV1/FVC ratio (decreased amount of air that can be forcefully expired in 1 second - FEV1)

Question 18

Physiologic effects of exercise and obstructive lung disease

Answer 18

impedes lung emptying, req more time

increased breathing leads to hyperinflation, small tidal volume

impairment of gas exchange

Question 19

Positive effects of exercise and obstructive lung disease

Answer 19

CV reconditioning

desensitization to dyspnea

improved ventilatory efficiency

Question 20

restrictive lung disease

Answer 20

inability to get air in

diminished lung volume

increased or normal FEV1/FVC ratio (decreased FVC - amount of air that can be forcefully exhaled in 1 min)

Question 21

Extrapulmonary causes of restrictive lung disease

Answer 21

Neuromuscular disorders (DMD, ALS, GB, SCI)

chest wall disorders (obesity, compression fx, ankyl spondy)

pleural disorders (fibrosis, effusion)

Question 22

Intrapulmonary causes of restrictive lung disease

Answer 22

pulmonary fibrosis
RDS
malignancy
pulmonary edema
lung resection
radiation

Question 23

How to assess lung function as a PT

Answer 23

O2 sats
Cyanosis
Pulmonary function test (differential)

Question 24

impact of exercise on cardiovascular function

Answer 24

increase in HR, SV, CO, SBP

with training, HR can decrease w/ same intensity

CO and SV plateau at max cardiac function (HR at max capacity)

can use relationship between HR and VO2 to predict VO2max

Question 25

Angina scale

Answer 25

Stop at 3+ (severe, very uncomfortable)

Question 26

Double product/rate pressure product

Answer 26

HR x SBP = RPP

fixed anginal threshold

improve HRR and SBP response to increase exercise tolerance

Question 27

atrial fibrillation

Answer 27

uncontrolled: >100 bpm
controlled: up to 100 bpm

greater risk for throwing clots
pulse rate does not work with dysrhythmias

Question 28

How to monitor heart function as a PT

Answer 28

HR (consider meds)
BP
RPP/double product
EKG rate and ST level (differential)
symptoms (angina, lightheadedness, Borg dyspnea scale)