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300 Cardio > Week 9 -Pulmonary Rehab > Flashcards

Week 9 -Pulmonary Rehab Flashcards

1
Q

When analysing whether it is a cardio (4), peripheral (3) or respiratory (7) limitation to exercise, what do you look for?

A 
CARDIO
HR
BP
Heart Rhythm
Chest Pain

PERIPHERAL
Leg fatigue
Claudication
RER (VCO2/VO2)

RESPIRATORY
RR
VT
SpO2
POB (look at RR and VT together)
SOB/dyspnoea
EELV (should go down)
VE/MVV (Minute volume over Maxiumum Voluntary vent)
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2
Q

What are the limitations to exercise in people with pulmonary diseases e.g. COPD? (4 main points, p. 2)

A
  1. Ventilatory limitations
  2. Cardiovascular limitations
  3. Peripheral limitaitons
  4. Psychosocial limitations
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3
Q

Discuss the ventilatory limitations to exercise (3 points, p. 2).

A
  1. Reduced EFR due to reduced lung recoil and increased resistance leads to breathlessness, chest tightness and wheeze.
  2. Dynamic hyperinflation occurs because of the flow-volume loop (they have obstruction and the only way to get gas out faster is to inflate the airways more). Hyperinflation affects respiratory mechanics and diaphragm efficiency, increasing WOB
  3. Gas exchange abnormalities- reduced oxygen delivery causes lactic acid build up.
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4
Q

Discuss the cardiovascular limitations to exercise (2 points)

A
  1. Increased pumonary vascular resistance due to hypoxic vasocontriction
  2. Dynamic hyperinflation reduces stroke volume, decreased venous return and limits 02 delivery
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5
Q

Discuss the peripheral muscle limitations to exercises (2 points)

A
  1. Reduced strength due to decreased number of type I fibres, and atrophy of type II fibres
  2. Loss of FFM mass due to malnutrition (struggle to eat due to breathlessness)
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6
Q

Outline the pulmonary limitations to upper limb exercises (4 points, p. 3)

A
  1. Many UL muscles are accessory muscles of respiration
  2. Arm exercises are related to asynchronous POB in COPD
  3. UL muscles require more ventilation and 02
  4. Unsupported exercises are especially beneficial.
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7
Q

What is the evidence for the benefits of pulmonary rehabilitation? (5 points, p. 4)

A
  1. Increased exercise capacity - 1A
  2. Improved QoL - 1A
  3. Decreased dyspnoea levels - 1A
  4. Reduced hospitalisation - 2B
  5. Psychosocial benefits - 2B
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8
Q

List some exercise tests for pulmonary patients.

4 points. p. 8

A
  1. 6MWT
  2. Incremental shuttle walk test
  3. UL tests (e.g. incrememtal unsupported UL ex. test, grocery shelving test)
  4. Strength tests
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9
Q

Discuss precautions, for exercise testing.

3 points

A
  • Generally safe for pulmonary patients
  • Screen for co-morbidities that may be unsafe e.g. cardiac disease
  • Make sure rescue medications are available
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10
Q

When would you delay exercise testing?

3 points

A

HR outside 50-125 at rest

Sp02

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11
Q

What would you monitor?

4 points. p. 6

A

Pulse oximetry >85
Borg dyspnoea score
Chest pain, arrythmias
Nausea, dizziness

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12
Q 
How would you prescribe exercise for pulmonary patients?
Mode
Intensity
Duration
Frequency
A

Mode: Large muscle groups
Intensity: 60-80% of max, 80% of 6MWT, Borg 3-4
Duration: 20-30mins
Frequency: 2x/week + 1 HEP session

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13
Q

How long does a pulmonary outpatient program normally last?

A

3 - 6 weeks

2-3x/week

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14
Q

Which parts of the a pulmonary exercise program have the strongest evidence?

3 points, p. 9

A
  • Training of ambulatory muscles - 1A
  • Strength training - 1A
  • Unsupported UL - 1A
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15
Q

What are the parameters for weight training?

A

Strength: 2 sets x 8-12 reps
Endurance: 3 sets of 12-15 reps
Maybe 3-4 exercises at a time.

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16
Q

What might you include in the education component?

5 points

A 
Anatomy and pathophys
Managing breathlessness
Nutrition
Relaxation
Psychosocial support
17
Q

What are the physiological benefits of exercise training?

4 points

A
  • fitness
  • skeletal muscle oxidative capacity
  • Delayed onset of lactic acidosis
  • Reduced ventilation dyspnoea
18
Q

What are some psychological benefits of exercise training?

A
  • Reduced anxiety about dyspnoea
  • Increased self efficacy
  • Decreased depression
19
Q

How might you evaluate the effectiveness of a pulmonary rehab program?

3 points

A
  • QoL
  • 6MWT
  • Patient goals

300 Cardio (7 decks)

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