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103 Cards in this Set
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screenings
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-all facilities should conduct preparticipation screenings!
-why? helps ID those with health conditions that require special attention ID medical contraindictations that require exclusion from exercise. |
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who needs screenings?
high risk moderate risk low risk |
-needs medical exam, exercise test and MD supervision of an exercise test before engaging in moderate or vigorous exercise
-only need a medical exam before engaging in vigorous exercise -can engage in moderate or vigorous exercise without any exams/test |
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how do we know risk level?
high risk moderate low |
- individuals who have known cardio. pulmonary or metablic diseases or one or more signs and symptoms.
-asymptomatic men and women who have greater than 2 risk factors -asymptomatic men and women who have less than 2 CVD risk factors. |
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what are risk factors?
-age -family history -cigarette smoking -sedentary -obesity |
-men older than 45 and women older than 55
-myocardial infartction (really any heart disease) or sudden death before age 55 for men (father or first degree male family member) or before age 65 for women (mother or other first degree relative) - current smoker or who have quit within the last 6 months or exposure to environmental tobacco smoke - not doing at least 30 mins of moderate PA at least 3 days a week for at least 3 months -bmi over 30 or waist for men greater than 102cm/ 40inches. and 88cm/35inches for women |
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more risk factors:
-hypertension -dyslipidemia -prediabetes |
systolic BP greater than 140 or diastolic greater than 90. needs to be confirmed on two seperate occasions. or if on antihypertensice meds.
LDL greater than 130 or HDL less than 40. if on lipid lowering meds. or total cholesterol is greater than 200. negative factor if HDL is greater than 60 IFG greater than 100 mg/dl and less than 125 or IGT greater than 140 or less than 199 (ex: 128= Diabetic not pre!) |
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what if we dont know a measurement?
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always count a point for each risk factor that is unknow except for prediabetes. . Only count this if client is at least 45 years old, especially with a BMI of at least 25 kg/m2 OR if under 45 years old but has additional CVD risk factors for prediabetes such as a family history of diabetes
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Major signs and symptoms of cardio. pulmonary and metabolic disease
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-Pain/ discomfort in chest, neck, jaw, arms, or other areas that may result from ischemia
-shortness of breath at rest or with mild exertion (dyspnea) -dizziness or syncope (loss of consciousness) -orthopnea: dyspnea occurring at rest in the recumbent position- relieved promptly by sitting upright or standing -paroxysmal nocturnal dyspnea: dyspnea beginning 2-5 hours after onset of sleep that can be relieved by sitting on side of bed getting up or going potty! |
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more signs and symptoms!
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ankle edema-bilateral: most evident at night
palpations or tachycardia intermittent claudication: pain occuring in muscles with inadequate blood supply that are stressed by exercise known heart murmur: functional vs. pathological what is a heart murmur? noises produced by turbulent blood flow. funx: murmur due to conditions outside of the heart. benign. pathological= more serious unusual fatigue or shortness of breath with usual activity |
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known diseases that take you right to the top! (high risk)
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CVD:
cardiac disease peripheral vascular disease cerebrovascular disease Pulmonary disease: COPD asthma interstitial lung disease cystic fibrosis Metabolic disease: diabetes renal disease |
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recommendations for exercise testing prior to PA
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necessary for high risk (need physician present for sub and max testing)
can be beneficial in preping an exercise prescription for those at low risk health/fitness and clinical exercise pros should choose most appropriate intensity for their setting and population when making decisions about the level of health screening needed. |
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who needs to supervise an exercise test?
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physician must be immediately available for those at high risk
physician does not necessarily have to be present when testing those at moderate risk. it all depends on.. local policies, circumstances AED emergency plan training of the lab staff health of client |
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cardio vascular conditioning :
Principles of training |
1.adaptation: When people increase their effort a little more than normal (“overload”) their bodies respond by improving strength, flexibility, aerobic capacity, or any other component of fitness that is challenged. Each bout of exercise-overload-results in temporary fatigue and decrease in performance, then body adapts. As system recovers, capacity increases to a level greater than the original (TIME BETWEEN BOUTS IS RECOVERY)
-Due to physiological adaptations (size of left ventricle, Q, increase in mitochondria, increased motor unit recruitment, etc) 2.overload: : physiologic capacity must be challenged past a minimal intensity called the “training threshold” 3.progression: the exercise stimulus must increase over time in order to elicit continued improvements 4.specificity : specific to clients needs (lose weight, build muscle, etc,) |
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detraining and overtraining
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Workouts must be spaced carefully to obtain the best results
Body needs time to recover for adaptive process to take place As training stress increases (intensity or volume) so does recovery time |
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the FITT principle for cardiorespiratory endurance
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F: at least 5 days a week (moderate( or 3 days a week (vigorous)
I: moderate: 40-60% or vigorous 60-90% T: 30-60 mines moderate or 20-60 mins vigorous T: rhythmic movements using large muscle groups volume= F*I*T (vigorous 5 days a week for 150 mins) progression: Made gradually; Increase any components of FITT; when first starting program, increase Time by 5-10 min every 1-2 weeks over first 4-6 weeks, then increase any component of FIT over next 4-8 months (longer if older or deconditioned) to meet recommended quantity |
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how to determine the F in FITT
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if you want to improve cardio fitness:
sedentary individuals = 3 days a week as they become more fit then increase frequency duration and intensity. for patients with some chronic conditions: higher frequency (several times per day), longer duration, lower intensity |
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determine the I of FITT
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you must challenege the body in order to see changes
the higher the initial aerobic capactiy the higher the minumum intensity must be to further increase that capacity VO2 max less than 40 (low to medium initial fitness)= 30% VOR or HRR 40-51 average to good= 45% VOR or HRR 52-59 high (75% VO2R or HRR) above 60 very high= 90-100% Regardless of way, we want intensity to fall between 50-85% of VO2reserve Sedentary: 50-60% (occasionally 40%) Average, healthy, somewhat active: 60-75% Highly fit and motivated: 75-85% As the client progresses, we need to update their prescription (progression and overload) |
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determining the Duration or T of FITT
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20-30 mins initially
rarely exceed 60mins (injury risk increases) consider frequency and duration together: only change one variable at a time can do 10 min bouts time does not include warm up and cool down |
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determining mode or T type in FITT
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rhythmic, large muscle groups, at least moderate intensity
safety for client and what they prefer |
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exercise prescription by HR
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use either : % of max HR OR % of HRR
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when would exercise prescription by HR not be appropriate?
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Clinical conditions/medications that impair HR response to exercise (cardiac transplant, beta blockers, pacemaker)
Medications/drugs that elevate HR Pregnancy (TT or RPE) Difficulty measuring HR “Talk Test”: if the client is still able to speak in complete sentences, the intensity is not excessive -This only gives an upper limit -Lower limit: Hard enough to make you aware of your breathing Rating of Perceived Exertion (RPE) scale |
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cardiac disease!
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part of CVD
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manifestation of CVD:
-acute coronary syndrome -CVD -cerebrovascular disease (stroke) -CAD -myocardial ischemia -Myocardial infarction (heart attack) -peripheral artery disease (PAD) |
-manifestation of Coronary Artery Disease (CAD) with increasing symptoms of angina pectoris, myocardial infarction (MI), or sudden death
-diseases that involve the heart and/or blood vessels; includes hypertension, CAD, PAD, & atherosclerotic arterial disease -Diseases of blood vessels that supply the brain -disease of the heart's arteries -lack of adequate coronary blood flow-not enough O2 for the heart, manifests as angina pectoris -injury or death of heart's muscular tissue -disease of arteries outside of the heart and brain |
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Following a cardiac event or procedure requiring hospitalization, goals for an inpatient program include:
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Identify cardiovascular, physical, or cognitive impairments that may influence PA
Offset effects of bed rest Provide medical surveillance of exercise Enable patients to return to ADLs Prepare patient & support system for return home Refer to an outpatient cardiac rehab program |
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inpatient cardiac rehab FITT
F: |
mobilization, 2-4 times a day for first 3 days of hospital stay.
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inpatient I of FITT
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seated or standing resting HR + 20 bpm for patients with MI, +30 bpm for patients recovering from heart surgery. upper limit is less than 120bpm and RPE of less than 13 on Borg scale
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inpatient T in FITT (time/ duration)
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intermittent walking bouts for 3-5 mins as tolerated. progressively increase duration.
rest can be slower walking or complete rest; but should give a 2:1 ratio of walking to rest periods |
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inpatient T for FITT (type)
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walking
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inpatient P (progression)
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when 10-15 minutes continuous walking bouts are reached, increase intensity up to the heart rate and RPE listed above
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for inpatient cardiac rehab, at time of hospital discharge patient should...
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Be familiar with exercises that are too extreme
Have a safe, progressive plan for exercise Have performed a low-level, submax exercise test Be counseled to identify abnormal signs or symptoms suggesting exercise intolerance & need for medical evaluation Be educated & encouraged to join an outpatient cardiac rehab program (clinically supervised if patients are still at moderate or high risk according to Box 2.4) Be educated on use of at home exercise equipment |
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outpatient cardiac rehab goals:
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Develop & assist patient to implement a safe & effective formal exercise and lifestyle PA program
Provide monitoring to detect change in clinical status Provide data to patient’s health care providers for medical management Return patient to normal activities or modify them based on patient status Provide patient & family education to modify risk factors |
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outpatient cardiac rehab beginning assessment:
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Medical/surgical history
Physical exam emphasizing cardiopulmonary/musculoskeletal systems Review of recent cardiovascular tests (ECG, etc.) Current medications CVD risk factors |
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what we want to monitor for outpatient cardiac rehab:
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HR, BP, body weight (weekly)
Evidence of change in clinical status (dizziness, chest discomfort, etc.) Symptoms of exercise intolerance Changes in medications/dosage ECG monitoring or the like |
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out patient F in FITT
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greater than 3 days a week, preferably all days
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the I in FITT of outpatient
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one of the following:
40-80% of exercise capacity from baseline exercise test (either HRR, VO2R, or VO2Peak) RPE of 11-16 on Borg Scale HR <10 beats below ischemic threshold Medications β-blockers, diuretics may influence HR & exercise capacity |
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the T (time) for FITT for outpatient
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Warm-up/Cool Down for 5-10 min
Aerobic conditioning for 20-60 min; start with 5-10 min bouts, increase 1-5 minutes each exercise session or 10-20% each week |
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T (type) for outpatient
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-Rhythmic, large muscle group activities
Emphasize increased caloric expenditure to maintain healthy body weight |
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P (progress) for outpatient
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based on the patient
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resistance FIT for cardiac patients
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F-2-3 days/week w/ @ least 48 hours rest in between sessions; performed after aerobic exercise so adequately warmed up
I-RPE of 11-14; Begin with 1 set of 10-15 reps (or 30-40% 1 RM upper body; 50-60% 1 RM lower body; Low risk may progress to 8-12 reps at 60-80% 1 RM T-Bands, cuffs & hand weights, free weights, wall pulleys, machines (dependent on weight of level arms/ROM) P-Increase slowly as patient adapts (~2-5 lb/week upper body & 5-10 lb/week lower body); more sets can be added as tolerated *avoid valsalva maneuvers |
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why resistance train for cardiac patients?
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Muscular strength and endurance
Self-confidence Ability to perform ADLs Maintain independence Decrease cardiac demands of muscular work during daily activities Prevent the development of other diseases Slow age and disease related declines in muscle strength and mass |
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special considerations:
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1. Patients with heart failure
Aerobic exercise is the main method used Resistance training has been shown to enhance strength/improved quality of life 2.Patients after cardiac transplantation First several months post-surgery: HRrest elevated HR response to exercise abnormal Prescribe exercise based on RPE of 11-16 Include warm-up, cool down, ROM exercises 3. Patients with Cerebrovascular Disease (Stroke) VO2Peak reduced by half Focus on mobility, recovery of ADLs |
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ohhh hypertension
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the high blood pressure beast!
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what is hypertensive systolic of diastolic BP?
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greater than 140/ 90 (more than 2 occasions)
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what can hypertension lead to?
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increased risk of CVD, stroke heart failure PAD and chronic kidney disease
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normal bp?
prehypertensive? hypertensive? |
LESS than 120/ 80
120-139/80-89 greater than 140/90 |
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lifestyle modifications for hypertension?
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QUIT SMOKING!
weight management reduce sodium intake moderation of alcohol DASH diet (dietary approaches to stop hypertension) make a habit of PA most patients are on at least 2 BP meds |
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BP meds
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We’re not pharmacists or physicians, but we should educate ourselves on those medications and how they may affect exercise
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exercise testing for hypertension
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If BP is not controlled (>140 and/or >90 @ rest), must consult physician prior to initiating an exercise program
Once medially controlled, can begin @ intensity of 40-<60% VO2R without consulting physician Those with hypertension & in the High Risk category need a medical evaluation prior to an exercise test Those with hypertension & in the High Risk category & with target organ disease (e.g. left ventricular hypertrophy) who want to perform moderate to vigorous exercise need a symptom-limited exercise test first |
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more exercise tests for hypertension:
β-blockers? If resting BP is >200 systolic or >110 diastolic? If exercising BP gets to >250 systolic or >115 ? |
-Patients typically take their BP meds as usual for an exercise test
relative contraindication for exercise testing exercise test should generally be stopped |
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how does exercise help with hypertension?
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Aerobic exercise can reduce resting BP by 5-7 mm Hg in those with hypertension
Exercise training lowers BP response to submaximal loads Focus on aerobic training, however, moderate intensity resistance training can be added to this regimen Flexibility exercises added in as for healthy adults |
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F in FITT for hypertension
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aerobic exercise on most preferably all days of the week. resistance 2-3 days/week
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I in FITT for hypertension
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40-<60% VO2R or HRR; RPE 11-13
supplemented by resistance training at 60-80% 1 RM |
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T (time) in FITT for hypertension
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30-60 minutes per day of aerobic training
Resistance training: at least 1 set of 8-12 reps for each major muscle group |
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T (type) in FITT for hypertension
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Emphasis on aerobic activities like walking, jogging, cycling, swimming; Resistance training: use either machines or free weights & consist of 8-10 exercises for major muscle groups
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the P (progress) for hypertension
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Generally progress gradually like with healthy population, but pay attention to BP control, changes in medications, adverse effects
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special considerations for hypertension
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Patients with uncontrolled hypertension (>180 systolic and/or >110 diastolic) should exercise train only after physician evaluation & medication prescription
When exercising, BP needs to remain <220 systolic and/or <105 diastolic β-blockers and other medications reduce HR and may decrease exercise capacity; Rely on RPE of 11-13 or talk test Focus on caloric expenditure/reduction if overweight Avoid Valsalva maneuver during resistance training |
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PAD and
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pulmonary disease
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PAD is characterized by systemic atherosclerosis
symptoms? |
Mismatch between oxygen supply & demand causing ischemia in calf, thigh, or glutes
aching or cramping sensation in one or both legs that typically is triggered by weight bearing exercise (induce by exercise and relieved by rest) patients have a 6.6 times greater chance of dying of CVD |
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treatment for PAD
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drug therapy
exercise peripheral interventions amputations |
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exercise testing for PAD
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Measure pre & post bilateral ankle & brachial blood pressures
Divide highest ankle BP by highest brachial BP Exercise test must be done with physician present (high risk) Use graded exercise test Use a pain scale to record time & distance to onset of pain & maximal pain After laying in supine position for 15 minutes, measure ankle & brachial BPs again |
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exercise prescription for PAD: F of FITT
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3-5 days per week aerobic. more than 2 days of resistance training
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I of FITT for PAD
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: 40-<60% VO2R; To the limit of pain tolerance (to “moderate claudication”)
No more than a 3 (intense pain) on the 4 point pain scale Intervals help! Between bouts, allow time for pain to subside before resuming exercise |
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T (time) of FITT for PAD
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30-60 mins
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T (type) of FITT for PAD
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Weight-bearing exercise, walking, & supplement with others
Cycling may be used as a warm-up, but should not be the primary type of activity Resistance training recommended to maintain muscular strength/endurance |
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special considerations for PAD
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A cold environment may aggravate the symptoms of intermittent claudication longer warm up
Encourage patients to stop smoking if they are current smokers Exercise program should also be designed to target CVD because of its association with PAD Optimal benefit is seen in a supervised exercise program lasting @ least 6 months |
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pulmonary disease results in what?
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Results in shortness of breath with mild exertion
May lead to limited PA and thus, deconditioning Exercise is an effective intervention that lessens the development of functional impairment examples: COPD -emphysema -chronic bronchitis -experience of dyspnea Asthma |
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exercise prescription for asthma: F of FITT
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2-3 days a week
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I of FITT for asthma
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@ ventilatory threshold or 60% of VO2Peak or 80% of maximal walking speed during 6-minute walk test (D=rt)
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T (time) of FITT for asthma
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at least 20-30 minutes per day
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T (type) of FITT for asthma
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aerobic activities using large muscle groups, swimming in non-chlorinated pool.
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resistance training for asthma
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follow the same principles for healthy adults
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exercise prescription for COPD
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F: 3-5
I: vigorous or light if necessary or 4-6 on borg scale T: discontinuous short bouts, interval training T: walking/cycling resistance/ flex same as healthy adult focus on muscles of shoulder girdle |
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and the password is..
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diabetus
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what kind of disease is diabetes and what does it result from?
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metabolic disease reasulting from defects in insulin secretion and/ or ability to use insulin
characterized by high fasting blood glucose (greater than 126) impaired fasting glucose greater than 100 most is type 2 |
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normal functioning vs type one and type two diabetes
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Eat a meal
Gets digested and absorbed, blood glucose goes up High blood glucose causes the B-cells of the pancreas to secrete insulin Insulin causes muscle and fat cells to take up glucose Results in lower (normal) blood glucose level Type I diabetes: autoimmune disease, B cells of the pancreas don’t produce insulin Treatment: insulin Type II diabetes: dysfunction in insulin receptors in adipose and muscle cells (still plenty of insulin, elevated), cells are “insulin resistant” Treatment: oral hypoglycemic agents and sometimes insulin |
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what does exercise do for diabetes?
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exercise has an insulin-like effect:
increase of sensitivity of insulin receptors allows cells to absorb more glucose goals of exercise: reduce risk f CVD for both types for type 2 or prediabetes: increase cellular insulin sensitivity for type 1: may reduce need for insulin |
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FITT for diabetes
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F: 3-7
I: 40-<60% VO2R, 11-13 RPE; higher intensity for long-term exercisers better glucose control T: at least 10 min bouts. total 150min/wk. no more than 2 consecutive days of rest T: large muscles, repetitive, aerobic Progression: to increase caloric expenditure increase duration Retinopathy: persistent or acute damage to the retina of the eye Some evidence that combination of aerobic & resistance training improves blood glucose control more than just one modality |
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potential exercise complications for diabetics
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hypoglycemia: low blood glucose is the most common problem for exercising diabetics (insulin and exercise both reduce blood glucose)
symptoms: weak, light headed, shaky, tingling fingers and mouth |
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interrpretting glucose levels post exercise
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>250-300 mg/dl. Plus ketones; postpone exercise; consult physician/inject insulin
>250-300 No ketones; exercise okay, but use caution 100-250 exercise is recommended less than 100 consume CHO before exercising Ketones are substances that are made when the liver breaks down fatty acids for energy. Normally, your body gets the energy it needs from CHO, but stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with sugar (glucose) for energy or if your body cannot use blood sugar (glucose) properly. Ketosis (large amounts of ketones) occurs when in starvation state or the above. Body tries to get rid of it in urine, which may cause dehydration, hypotension, and/or tachycardia Newer home blood sugar meters can also measure ketone levels in the blood. Home urine tests to measure ketones are available. |
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special considerations for diabetes
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Glucose levels pre & post activity
Fast acting glucose source readily available Timing of insulin administration & CHO intake may need to be altered Foot care Sock and shoe type Keep feet dry to prevent ulcers/blistering by using silica gel, air insoles, & polyester or blend socks BP monitoring/Use of RPE Lower impact movements may be advised Vigorous exercise & resistance training greatly increases BP and can lead to hemorrhage of the eye in those who are at risk of retinopathy |
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hyperglycemia
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...increases risk of heat illness and affects thermoregulation
Proper hydration is key Avoid extreme temperatures Always workout with a partner & wear diabetes tag! |
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weight control and
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metabolic syndrome
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what is metabolic syndrome?
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a condition leading to higher risk of type 2 diabetes, CVD
combination of obesity hypertension dyslipidemia insulin resistance |
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metabolic syndrome
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must have three of the following:
waist circumference obesity triglycerides greater than 150 HDL for women greater than 50 and for men greater than 40 BP greater than 130/85 fasting glucose greater than 100-110 |
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treatment for metabolic syndrome
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weight control
PA treatment of the associated CVD RF which may include pharmacotherapy |
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FITT for metabolic syndrome
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F: most days
I: Initial training should be mod. intensity (40-<60% VO2R or HRR) Progress to more vigorous (>60% VO2max or HRR) T: 150 mins/wk increase to 300 many bouts of 10 mins to promote or maintain weight loss workout 60-90 a day T: large muscle cardio |
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health benefits of weight loss
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losing 5-10% of weight gives significant health benefits
lower CVD risk Better glucose control |
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how to find BMI
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weight in kg (lbs/2.2) divided by height in m squared
(inches to meters is inches times 2.54 divided by 100) |
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Jim’s current weight is 240 lb and height is 5 ft 10 in. His goal BMI is 29. How much weight should he lose?
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240/2.2 = 109 kg
70(2.54) = 178 cm/100 = 1.78 m current BMI = 109/(1.78)2 = 34 kg/m2 Weight he wants to be at: 29 = X/1.782 Weight he wants to lose = current weight - X |
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exercise effects on obesity
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Promotes fat loss in abdominal sites
particularly effective for those with visceral adiposity Metabolic rate declines with weight reduction through caloric restriction alone Exercise may help prevent this decline in metabolic rate Caloric restriction (or changing eating behaviors) is necessary to achieve weight loss |
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most successful losers continue to exercise for how long?
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250 mi/wk
Continuing appropriate dietary & exercise patterns as PERMANENT behavior change (want a negative energy balance of 500-1,000 kcal/day) |
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weigth loss FITT
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F: greater than 5 days
I: moderate (40-60%) progress to vigorous ( greater than 60% of HRR/ VO2R) T: 150mins/wk progress to 300 *Incorporating vigorous intensity exercise into the total volume may provide additional health benefits & should be encouraged in those willing to do it-utilize 10 min bouts if needed. T: aerobic activity |
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how do we get people to exercise?
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Utilize the flexibility available in the FITT principles
Create individualized programs Aid in increasing perceived exercise benefits & self efficacy Provide social support during weight loss & on into weight maintenance |
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arthritis
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49% diagnosed with arthritis and will go up b/c of baby boomers
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what is osteoarthritis and rheumatoid arthritis?
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Degenerative joint disease affecting one or multiple locations in the body; loss of articular cartilage
*Generally impacts knees, hips, spine, hands *Symptoms: Pain, tenderness, locking Stiffness after getting out of bed Effusion-extra intra-articular fluid |
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what is rheumatoid?
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Inflammatory disease resulting from pathologic activity of the immune system against joint tissue
Impacts wrists, fingers, neck, shoulders, elbows, hips, ankles, and feet Symptoms: *Warm or swollen joints *Stiffness early in the morning that may increase over an hour after waking(osteoarthritis pain typically starts to subside then) |
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effects of exercise
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Exercise is essential for managing these conditions!
Decreased joint pain Maintains muscle strength around affected joints Prevents functional decline Improved mental health Improved quality of life |
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FITT for arthitis
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cardio:
Frequency: 3-5 days/week Intensity: 40-<60% HRR/VO2R; may be limited by pain or deconditioning-then use light intensity Time: intermittent (discontinuous) 10 min bouts (or less if needed), progress based on tolerance (goal >150 min/week) Type: low joint stress (walking, cycling, swimming) respiratory: Frequency: 2-3 days/week Intensity: low weight, high reps (40-60% 1 RM; 10-15 reps) Type: All major muscle groups as seen for healthy adults Flexibility/ROM exercises: stretch all major muscle groups daily |
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VO2max-true physiological limit shows what?
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: shows a plateau in VO2
Those with certain diseases (CVD, etc.) may not actually reach this level before they have to stop, thus VO2 peak is how high they get (probably won’t see VO2 plateau, but peak is useful for ExRx) |
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1 MET=
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resting VO2 = 3.5 ml O2/kg/min
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VO2/3.5=
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METs
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min/mile to MPH
MPH to min/mile |
60 min/1 hour * 1 mile/___min (ex. 8)= 60miles/8mins= 7.5 mph
1hour/ 6.8 miles* 60mins/ 1hour= 60mins/ 6.8miles= 8.82min/mile (.82*60)= 8 mins 45 seconds per mile |
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1 MET=
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3.5 ml/kg/min (rest)=1 kcal/kg/hour
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For every 1 L of O2 we consume= calories?
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we use ~5 kcals
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