Heart Failure Exercise Prescription

Question 1

what do pts with HF demonstrate?

Answer 1

significant ventricular dysfunction, decreased CO, low functional capacities

Question 2

Class I HF

Answer 2

• mild
• no limitation in physical activity (up to 5-6 METs)
• comfortable at rest
• ordinary activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain

Question 3

Class II HF

Answer 3

• slight
• slight limitation in PA (up to 4.5 MET)
• comfortable at rest
• ordinary PA results in fatigue, palpitations, dyspnea, or anginal pain

Question 4

Class III HF

Answer 4

• Marked
• marked limitation of PA ( up to 3 METs)
• comfortable at rest
• less than ordinary activity causes fatigue, palpitations, dyspnea, or anginal pain

Question 5

Class IV

Answer 5

• severe
• unable to carry out any PA (1.5 MET) without discomfort
• symptoms of ischemia, dyspnea, anginal pain present at rest, increasing with exercise

Question 6

AHA Stages of HF- Stage A

Answer 6

at high risk for heart failure but without structural heart disease or symptoms of HF

Question 7

AHA stages of HF - Stage B

Answer 7

structural heart disease but without signs of symptoms of HF

Question 8

AHA stages of HF - Stage C

Answer 8

structural heart disease with prior or current symptoms of HF

Question 9

AHA stages of HF - Stage D

Answer 9

refractory HF requiring specialized interventions

Question 10

criteria for exercise training

Answer 10

• compensated or chronic HF; no signs of acute HF
• exercise induced ischemia and arrhythmias poor prognostic indicators

Question 11

exercise training guidelines

Answer 11

• advocate for increased total daily PA as an essential component of care
• educate on disease management
• aerobic training
• UE and LE resistance training
• inspiratory muscle trining
• NMES

Question 12

assess for signs of decompensation at each visit

Answer 12

increased SOB, sudden weight gain, increased LE edema or abdominal swelling, increased pain or fatigue, pronounced couch, lightheadedness or dizziness

Question 13

monitor at rest and during activity

Answer 13

• use RPE that is correlated with objective measures of hemodynamic response and clinical signs of exercise intolerance
• HR response may be impaired
• at risk for persistent post exercise vasodilation and hypotension with later stages of HF

Question 14

what should you use caution when exercising in supine or prone

Answer 14

orthopnea

Question 15

respiratoring muscle training

Answer 15

• monitor SaO2 via pulse oximetry

Question 16

emphasis on….

Answer 16

training in energy conservation, set monitoring techniques

Question 17

see exercise prescription parameters and guidance for patients with stable, NYHA class II and III HF with reduced ejection fraction

Answer 17

table 4-17 and 4-18 pg 273