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53 Cards in this Set
- Front
- Back
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What is the recommended continuum of care for CR services? (cardiac rehab)
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Inpatient
Transitional care Outpatient programming Maintenance |
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What's an example of transitional care? (3)
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subacute facility
home care pretraining at home |
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What's an example of outpatient programming
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cardiac rehabilitation center
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What is an example of Maintenance care
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community facility or at home (life long)
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What are the acute phase exercises designed for?
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to prevent detrimental effects of bedrest
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How many METs are the Phase 1 Acute phase exercises?
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3-5 METs
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What is the training goal (duration/frequency) of Phase 1 exercises?
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30min/day, 4-6day/week
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What are the upper limit of Phase 1 Acute phase exercises?
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10bpm below 1st sign of adverse effects or hemodynamic compromise
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How long does phase 1 actue phase last?
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Usually no more than 1 week
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What are some phase 1 exercises?
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Simple AROM in stand/sitting
Reciprocal exercises Balance activities Progressive ambulation |
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What are some Phase 1 aerobic exercises?
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Walk/treadmill
Stationary biking Upper body ergometry Stair stepper/master Swimming (limited with acute pt) |
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Is sub-acute phase 2 IP or OP?
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OP
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When does phase 2 start, and lasts for how long?
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1-2 weeks after d/c
lasting for 1-3 month |
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What kind of equipment requirements are needed for phase 2?
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ECG and hemodynamic monitoring, with on-site MD for emergencies
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What do you monitor in phase 2?
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HR, BP, O2 sat, RPE, EKG
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What are the goals during phase 2?
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to tolerate 20-30 min of areobic exercise
to tolerate ~60% of peak work capacity |
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What is performed at the end of this phase?
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GXT, at low-level or sub-max
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What should be the Phase 2 RPE limit?
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11-14
light but before you get to hard component. |
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What should be the Phase 2 THR?
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resting heart rate + 20
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What should be a target MET in Phase 2?
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50-70% of intiial test
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What are some aerobic exercises for Phase 2 Subacute
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walking/treadmill
stationary bike upper body ergometry stair stepper/master swimming |
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What are 3 characteristics of phase 3 OP maintenance phase?
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supervised session
intermittent EKG monitoring Program adjusted based on fitness goals` |
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What are 3 characteristics of Phase 4 Community Independence Phase
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NO EKG monitoring
NO professional supervision Lifelong commitment to lifestyle changes |
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What 4 things to you evaluate before each session?
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symptoms
weight auscultation vitals |
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What are some signs/Sx for upper limit?
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onset of angina or other CV insufficiency
plateau or decrease in SBP SBP > 240 DBP > 110 >1 mm ST segment depression/down sloping evidence of moderate-severe wall motion abnormalities increased ventricular arrhytmias ECG disturbances (significant) other signs of intolerance |
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What is overload principle
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Regular application of a specific exercise overload enhances function to bring about a training response
(training at intensities higher than normal) |
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How do you manipulate overload principle?
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frequency
intensity duration mode (main focus) |
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What is specific principle?
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Specific exercise elicits specific adpations creating specific training effects
(resistance vs aerobic) (note patient goals) |
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What is specificity of VO2 max?
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training a person aerobically in the same manner in which they will be tested/function/compete
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What are musts for specificity of Vo2 max
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use the same muscles required by activity
provide a stress to CV or pulmonary system |
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What are some of the imrovements in specificity of local changes?
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overall exercise perofrmance
aerobic power (O2 transport/use) improved blood flow locally (capi. & CO) |
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What is the reversibility principle?
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Reverse occuring within 1-2 weeks of detraining
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What can reduce in reversibility?
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metabolic capacity
exercise capacity VO2 max Capillary density CO and SV |
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How fast does VO2 max drop in detraining?
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25% after 20 days of bedrest
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How fast does capillaryd ensity decrease in detraining?
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14-25% in 3 weeks
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How fast does CO and SV decrease in detraining?
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~ 1% a day
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What are 4 adapations to exercise in the CV system?
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1 increased CO, blood volume RBC
2 increased blood flow to skeletal muscles 3 reduced sub-maax HR 4 improved thermoregulation |
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How does CO change with adaptation to aerobic training?
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+ CV
- HR |
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at adapted submax level, why is there decreased CO?
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improved blood flow distribution and muscle O2 extraction
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How does blood volume & RBC adapt to exrercise?
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+ plasma volume
+ RBC |
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How does blood flow to skeletal muscles adapt? (3)
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larger max CO
improved flow from non-exercising muscles increased vascular cross-sectional area |
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How does sub-max HR adapt?
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decrease due to decreased firing of SA node and increased parasympathetic activity
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What are pulmonary adapations to exercise?
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enhanced O2 exchange
improved blood flow in lungs decreased submax RR |
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How does O2 exchange in lungs improve?
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+ tidal volume
+ RR + capillary density + CO |
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How does RR decrease in submax adaptation?
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reduces total energy cost of breathing
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How to determine pulmonary intensity for exercise?
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50% of VO2 max
or max limits by symptoms also self monitoring using dyspnea scale (must be individualized) |
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What are some special considerations for pulmonary patients?
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COPD: pursed lip breathing
O2sat < 88%: supplemental O2 Upperbody resistance training ventilatory muscle training |
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How much can VO2 max increase for untrained vs elite athletes?
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+ 50% for untrained
+ 5-10% for elite athletes (generally 5-25%) |
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Who is interval training good for?
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Deconditioned patients
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Who is continuous training good for?
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endurance athletes
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What is the intensity for continuous training?
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prolonged moderate intensity
60-80% VO2max |
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What is Fartlek training?
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"speed play"
combo of interval and continuous training during the same session |
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What are some guidelines for community independence?
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>= 8MET, or 2x occupational demand
appropriate hemodynamic and ECG response to exercise stable/absent cardiac SX stable baseline HR/BP adequate risk management strategy knowledge of disease process, signs, sx, meds and side effects |
