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111 Cards in this Set

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Basic recommendations from ACSM and AHA

guidelines for healthy adults under 65

moderately intense cardio 30 mins/day, 5x/week
vigorous cardio 20 mins/day, 3x/week
8 to 10 strength-training exercises, 8 to 12 reps, 2x/week
Basic recommendations from ACSM and AHA
Guidelines for adults over age 65
(or adults 50 to 64 with chronic conditions, such as arthritis)

mod intense cardio 30 mins/day, 5x/week
OR vigorous cardio 20 mins/day, 3x/week
8 to 10 strength-training exercises, 10 to 15 reps, 2 to 3x/week
AND balance exercises if at risk of falling

Aerobic FIT: mental health

30 to 60 mins
40 to 85% intensity
3 to 5 times/week

All aerobic modes acceptable.

QOL: Mental health

CAD comorbidity may have accelerated cognitive decline.

Over long term, can decrease functional outcomes & increase mortality.

Has impact on self-esteem, motivation, relationships, & ability to function in everyday life.

Stress management & good physical health associated w/ good mental health.

Resiliency may help determine mental health.

Precautions: Mental health

Be careful in how you approach client you believe has mental health issues.

Be aware of substance abuse signs -- common in mentally ill clients.

Know positive coping skills & identify those with and without -- those without are at greater risk of depression.

Assessments: mental health

Need to monitor condition over period of time to ensure improvement or stability.

Monitor to know when to refer to health care provider.

Can use SF-36 (QOL measure) or HANDS.

Aerobic focus: mental health

Enjoyment is critical.

Group exercise can be good.

Strength FIT: mental health

Follow ACSM resistance training guidelines.

Start with low weight, high reps to decrease muscle soreness.

Pain is not a "friend."

Safety: mental health

If you suspect illicit drug use or alcohol abuse, refer to proper health care professional.

Too much too soon can discourage client from returning for next session.

Educate client on need to not push too hard at start of program.

Medications: mental health

Anti-depressants may cause drowsiness and should be monitored, but no effect on exercise response.

QOL: Rheumatoid arthritis

Exercise has significant effects on joint function and mobility -- improved QOL and ADLs.

Loss of flexibility and joint mobility as a result of inactivity due to movement-induced pain are significantly reduced with exercise.

Improvements in function, strength, and pain tolerance through ROM are often associated with a regular exercise and PA program.

Precautions: Rheumatoid arthritis

Joint instability may be common in spine, foot/ankle, hip, and knee joints.

Pain tolerance may vary depending on patient, time of day, and previous exercise experience.

Exercise testing is indicated if necessary, based on traditional risk stratification.

Assessments: Rheumatoid arthritis

Timed chair rise.

Timed get up and go.

Symptom-limited GXT.

6-minute walk test.

Functional ROM/symmetry assessment.

Berg balance test.

Additional field assessments based on client history and function may be used effectively.

Aerobic FIT: Rheumatoid arthritis

3 to 5 days/week

60 to 80% peak HR; 11 to 16 RPE

Aerobic focus: Rheumatoid arthritis

Avoid high-impact exercise to reduce joint stress.

Use large-muscle movements/activities.

Increase duration before intensity.

Increase warm-up duration.

Train within pain tolerance.

Exercise in early morning may be difficult due to joint stiffness.

Strength focus: Rheumatoid arthritis

Dynamic exercise may elicit pain.

Train below pain threshold.

Isometric exercise may be indicated (contract and hold position for 6 secs, 2 to 6 reps); often prescribed to minimize inflammatory response.

Functional exercises help improve ADLs.

Encourage daily flexibility training.

Safety: Rheumatoid arthritis

Avoid overstretching unstable joints.

Avoid excessive medial-lateral forces on affected joints.

Cervical spine subluxation due to instability, compression, and chronic nerve degeneration may increase difficulty of some exercise positions (e.g., supine).

Joint pain/instability may cause loss of grip strength.

Medications: Rheumatoid arthritis

NSAIDs and disease modifying drugs as indicated by pain and disease progression.

No significant effects on exercise response, tolerance, or commonly monitored parameters, including HR, BP, etc.

QOL: Low back pain

Benefits of exercise are largely dependent on etiology, nature, and tolerance of condition with and without exercise.

Episodic LBP may not require treatment, but may be minimized with chronic exercise training.

QOL may be significantly improved if patients are encouraged to continue exercise and perception of painful behaviors is diminished or reduced.

Precautions: Low back pain

May be exacerbated by certain exercise positions that are not well tolerated.

Seated & standing exercise positions may increase pain and should be modified to a recumbent or non-load-bearing position of modality (e.g., water exercise).

Fear of pain and injury may be a significant limiting factor.

Exercises performed in a "neutral spine" position may limit pain exacerbations.

Assessments: Low back pain

Most effectively used to determine limiting factors for exercise and estimating aerobic capacity.

GXT not needed except if indicated by traditional risk factor stratification.

Functional strength testing.

Trunk flexibility testing -- standard sit & reach as tolerated.

Aerobic FIT: low back pain

3 to 5 days/week

60 to 80% peak HR; 11 to 16 RPE

Aerobic focus: low back pain

Avoid high-impact exercises.

Avoid awkward body postures and positions.

Focus on duration rather than intensity.

Prolonged warm-up with stretching to improve functional performance.

Strength focus: low back pain

Focus on abdominal and back extensor strength and flexibility.

Focus on trunk and hip flexor/extensor ROM.

Instruct proper lifting technique.

Increase repetitions and decrease weight for elderly or those with significant pain.

Exercise below pain threshold.

Exercise 2 to 3 days/week.

Medications: low back pain

NSAIDs are commonly prescribed -- no effect on exercise response.

Anti-depressants and muscle relaxants may cause drowsiness and should be monitored -- no effect on exercise response.

QOL: chronic pain

Improvements are highly dependent on site, etiology, duration and tolerance.

Significant improvements in symptomatology may be noted with regular rehabilitative exercise.

No specific exercise program has been determined to be superior for management.

FIT: chronic pain

Based on general guidelines for exercise prescription.
Modifications made based on specific site, tolerance, and positional considerations.

Medications: Chronic pain

NSAIDs are commonly prescribed -- no effect on exercise response.

Anti-depressants and muscle relaxants may cause drowsiness and should be monitored -- no effect on exercise response.

QOL: Osteoporosis

Regular weight-bearing & resistance exercise training has been shown to improve and/or suspend bone mineral density declines.

Decreased risk of fracture is associated with participation in a regular exercise program.

Critical for decreased fracture risk in elderly to prevent complications associated with fractures, infection, and internal bleeding.

Precautions: Osteoporosis

High impact exercise should be avoided.

Avoid transverse plane exercises if spinal osteoporosis is present.

Careful monitoring of posture and positioning is key during exercise (particularly resistance training) to prevent fracture and pain.

Balance and functional training should be incorporated with caution.

Assessments: Osteoporosis

Symptom-limited GXT as indicated based on traditional risk stratification.

10 RM strength testing.

Dynamometer testing.

Gait analysis.

Balance testing.

Fall risk assessments.

Functional field testing.

6-min walk.

Aerobic FIT: Osteoporosis

40 to 70% peak HR

3 to 5 days/week

30 to 60 mins/session

Aerobic focus: Osteoporosis

Avoid high-impact exercise.

Promote weight-bearing exercise with minimal fall risk.

Increase duration rather than intensity.

Avoid uneven surfaces during exercise training.

Strength FIT: Osteoporosis

All modalities are indicated at modest levels (~75% 1RM).

2 sets, 8 to 10 reps, 2 to 3 days/week, all major muscle groups.

Strength focus: Osteoporosis

To promote bone mineral density improvement and remodelling.

Improve trunk, hip flexors/extensors, lower extremity, back and abdominal muscle strength, and flexibility.

Safety: Osteoporosis

Avoid sudden movement that may compromise balance.

Avoid high-impact exercise and contact activities.

Close attention paid to posture and movement patterns to prevent injury.

Medications: Osteoporosis

Medications often include estrogen receptor modulators or other antiresorptive medications, hormone replacement therapies, or a combination.

No known effect on exercise responses or tolerance.

QOL: Osteoarthritis

Resistance training to improve joint stability and decrease joint friction is important -- damaged cartilage in load-bearing joints causes pain during movement.

Decreased joint pain has been shown after exercise program implementation.

Exercise in water is excellent to minimize weight-bearing and joint friction -- decreasing pain during exercise due to buoyancy and environment.

Exercise is important for overall joint health and strength, improving pain tolerance during activity, and decreasing internal joint stress.

Precautions: Osteoarthritis

High-impact exercise should be avoided.

Load-bearing exercises may increase pain and should be avoided.

Pool exercises may increase exercise tolerance, but use cautiously and with proper balance aids and slip/fall precautions in place.

Exercising to the point of increased pain should be discontinued.

Assessments: Osteoarthritis

Symptom-limited GXT as indicated based on traditional risk stratification.

Dynamometer testing.

Gait analysis.

Balance testing.

Fall risk assessments.

Functional field testing.

6-minute walk.

Aerobic FIT: Osteoarthritis

40 to 60% HRR

3 to 5 days/week

20- to 40-minute aerobic sessions as tolerated with pain

Goal: Greater than 150 mins/week or better

Aerobic focus: Osteoarthritis

Avoid high-impact load-bearing exercise -- may increase pain in affected joints.

Increase duration rather than intensity.

Avoid uneven surfaces during exercise training.

Water exercise (walking, aerobics) are excellent.

Strength FIT: Osteoarthritis

All modalities indicated.

Modest resistance levels (40 to 60% 1 RM).

2 sets, 3 to 12 reps based on tolerance, 2 to 3 days/week, all major muscle groups.

Strength focus: Osteoarthritis

Affected joints are typically load-bearing joints (knees, hips, ankles) and should be trained carefully.

Concentrate on increasing pain threshold during exercise and strengthening surrounding musculature.

Safety: Osteoarthritis

Avoid high-impact exercise and contact activities.

Discontinue exercise at point of increased pain in joints.

Pay close attention to posture and movement patterns to prevent further joint injury.

Medications: Osteoarthritis

NSAIDs and other analgesic medications may be used to manage pain.

No known effect on exercise response or tolerance.

Encourage cold therapies (ice) if pain or swelling increase.

QOL: Obesity

An independent risk factor of CVD, T2DM, some cancers, etc.

Exercise decreases the risk of mortality by improving overall risk factor profile and improving metabolic health and fitness independent of BMI; improved fitness decreases mortality by approximately 10 to 18% per MET increase in fitness.

Lowering body weight by 10% has significant impacts on joint health, mobility, overall function, and risk of other chronic disease.

Precautions: Obesity

Exercise may cause overheating leading to dizziness, shortness of breath, and premature fatigue.

Hydration is very important during exercise.

Equipment size should be considered, particularly in the larger individuals; may compromise exercise effectiveness and personal comfort level.

Monitor for other comorbidities (e.g., BG) that may be affected by exercise.

Assessments: Obesity

Clients are often at a higher risk of CVD; therefore, GXT may be indicated.

Protocols may require modification due to low exercise tolerance -- many protocols need not be modified, but it is at the fitness pro's discretion.

Circumference measurements for body comp.

Goniometry for ROM assessments.

Gait analysis.

Balance assessment to avoid falls.

Aerobic FIT: Obesity

40 to 60% peak HR; up to 75% if lower risk.

5 to 7 days/week for 30 to 60 mins total; may be separated into shorter sessions as tolerated.

Goal should be to achieve 300 mins or more of mod intensity aerobic exercise over the course of a week.

Aerobic focus: Obesity

Duration is significantly more important for weight management over intensity; encourage increasing duration and non-exercise physical activity on a daily basis.

Strength focus: Obesity

Resistance training serves as a very valuable adjunct to aerobic exercise; however it is often overlooked due to lower acute caloric expenditure.

Regular, consistent resistance training during weight loss can help preserve healthy lean body mass.

Strength FIT: Obesity

40 to 50% RM (light to mod weight)

2 to 3 days/week

1 to 3 sets of 8 to 15 reps

All major muscle groups.

Increase sets and resistance as tolerated.

Safety: Obesity

Avoid high-impact exercises.

Joint pain is common during load-bearing exercises.

Postural changes may be difficult in this population (supine to prone, etc.).

Machine size restrictions during exercise programming.

Consider seat positions on machines as high as possible to assist with mounting/dismounting.

Recommend "dry-fit" clothing to prevent chafing.

Medications: Obesity

Some appetite suppressants may increase BP and cause an exaggerated response during exercise.

Be aware of medications used for comorbidities that may affect exercise responses.

Special considerations: Post bariatric surgery

Rapid weight loss may accelerate lean muscle loss, which may lead to balance issues, weakness, and fatigue.

Endurance and exercise tolerance may be severely impaired (VO2 peak less than 20 is not uncommon)

Focus: Post bariatric surgery

Exercise may be introduced slowly as tolerated shortly after surgery.

Short (5 min) intervals of exercise may be appropriate early in a program.

QOL: Type 2 Diabetes

An independent risk factor for developing CVD and may lead to chronic kidney failure, periopheral neuropathies, and vascular degeneration.

BG control is achieved through pharmaceutical and lifestyle management.

Both aerobic and resistance exercise have significant and very positive effects on BG levels; however, a combination has the most dramatic effect.

Precautions: Diabetes

Newly diagnosed, or those new to exercise, should monitor BG levels within 30 min prior to exercise and again immediately following for 3 to 5 exercise sessions or when sig changes made to an exercise program or medication regime.

Be aware of comorbidities that might affect exercise tolerance and responses (e.g., hypertension, obesity, etc.).

Medication schedule is key for managing exercise responses to avoid BG crashes.

Carbohydrate consumption may require modification and monitoring depending on exercise duration and intensity.

Medications: Diabetes

Insulin is prescribed based on release time (rapid or long-acting); knowledge of time and dosage is important as BG response may be augmented by exercise.

Medications may require titration or modifications to dosing schedules by the doctor, depending on individual exercise responses.

Clients not using insulin are unlikely to experience hypoglycemia related to exercise; those on insulin should supplement with carbohydrate as necessary to prevent drop in BG to less than 100 mg/dL during and after exercise.

QOL: Coronary Artery Disease

Exercise helps prevent coronary lesion/plaque development and is beneficial during ongoing rehabilitation following a cardiac event and/or intervention.

Improved MET capacity and is inversely proportional to all-cause mortality, including coronary disease.

Regular exercise has significant benefits to QOL and functional performance.

Precautions: Coronary Artery Disease

Be aware of client's comorbidities.

Define clear exercise parameters based on assessments, physician restrictions, and state of condition.

Monitor hemodynamic responses to exercise and screen for acute events as this can be indicative of CV stability.

Assessments: Coronary Artery Disease

Medically supervised GXT is highly recommended prior to any moderate intensity exercise.

Gas analysis (VO2 uptake) may offer additional information, useful for exercise Rx.

1-10 RM strength testing.

Sit & reach flexibility testing.

6-minute walk test & other field tests may provide additional useful information.

Aerobic: Coronary Artery Disease

40 to 80% HR reserve;11 to 16 RPE

3 to 5 days/week

20 to 45 mins as tolerated

Intensity should be titrated based on fitness and risk stratification

Aerobic: Coronary Artery Disease (early)

CABG & PCI: resting HR + 20 bpm

MI: resting HR + 30 bpm

3 to 5 days/week

20 to 45 mins as tolerated

Avoid exercises involving arms for CABG 6 to 8 weeks post surgery to avoid injury to sternotomy.

Aerobic recommendations: Coronary Artery Disease

All modalities are appropriate as tolerated.

Swimming and water exercise may be appropriate for select, stable patients.

Include prolonged warm-up and cool-down.

Training for competitive participation is possible in stable patients with adequate MET capacities for desired activity.

Aerobic focus: Coronary Artery Disease

Low-fit clients may train at 40 to 50% HR reserve.

> 70% is appropriate for moderate- to higher-fit clients.

Monitor for abnormal signs & symptoms

Intensities approaching 90% HR reserve may precipitate CV complications.

Select exercises/equipment that may be increased in intensity by 1 MET increments.

Strength FIT: Coronary Artery Disease

1 set; 10 to 15 reps

8 to 10 exercises

2 to 3 days/week

Stretch major muscle or tendon groups 2 to 3 days/week.

Begin with modest resistance (50 to 70% 1 RM), functional training, and flexibility training.

Progress based on tolerance to 70 to 80% 1RM.

Strength focus: Coronary Artery Disease

Restrict to light weights (1 to 2 lbs):

CABG -- 12 weeks

MI -- 4 weeks

PCI or stent -- 2 weeks

Begin with modest resistance and progress to higher levels. Advanced resistance training may be employed safely and effectively for select, stable, clients.

Safety: Coronary Artery Disease

Watch for common symptoms associated with angina: chest pain, pressure, burning, discomfort; left jaw pain; arm numbness/discomfort (often only left arm); upper back pain or pressure; unusual difficulty breathing with minimal exertion; dizziness and unnecessary fatigue.

Exercise should be terminated if any of the above are noted or change during an exercise session.

Suspected Cardiac Emergencies: Dial 911 & initiate appropriate emergency response.

Medication considerations: Coronary Artery Disease

Many common medications have effects on exercise response, tolerance, and symptomology.

Daily reminders about meds and follow-up are necessary as med timing, dosage, and frequency changes may significantly change hemodynamic response to exercise on a day-to-day basis.

Oral nitroglycerine (fast-acting) may be used to relieve exercise-induced chest discomfort (as prescribed); however, if no relief is realized after 1st dosage, terminate exercise and contact cardiologist or primary care physician.

Common CV medications

Beta blockers, diuretics, ace inhibitors, calcium channel blockers, anticoagulants, digitalis, nitrates, aspirin, statins, combination drugs

CAD medications: Beta blockers

Decrease HR at rest and during exercise.

Decrease BP at rest and with exertion.

Decrease ischemic response during exercise (strain on heart muscle due to lack of O2).

May increase exercise capacity and tolerance in clients with exercise-induced angina.

atenolol/Tenormin, bisoprolol, metoprolol/Lopressor/Toprol SL, sotalol, propanolol/Inderal, carvedilol/Coreg

CAD medications: diuretics

No effect on HR.

May decrease BP or have little effect.

May show a false positive "ischemic strain" if fluid loss is excessive.

HCTZ, furosemide/Lasix, torsemide/Demadex, triamterine/Dryrenium, spironolactone/Aldactone

CAD medications: ace inhibitors

No effect on HR at rest or during exercise.

Decreases BP at rest and during exertion.

No ECG effects.

No effect on exercise tolerance, except potentially in symptomatic heart failure patients.

benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril/Prinivil), quinapril (Accupril), ramipril (Altace)

CAD medications: calcium channel blockers

Decreases resting and exercise HR.

May slightly decrease resting and exercise BP.

Decreases ischemic response shown on ECG.

May increase exercise tolerance in patients with exertional angina.

• dilatazem (Cardizem/Dilacor/Tiazac), verapamil (Calan, Isotopin)

CAD medications: Anticoagulants

Coumadin (warfarin) is commonly prescribed for patients with clotting risk; atrial fibrillation presents significant risk.

No effect on HR or BP.

CAD medications: statins

No effect on HR, BP, or exercise tolerance.

Intended to lower total cholesterol or specific sub-particles of cholesterol (e.g., LDL).

Most widely prescribed pharmaceutical in the country (Lipitor).

• Lipitor (atorvastatin), Crestor, Tricor, Zocor (simvastatin)

CAD medications: nitrates

Increase resting HR and may also increase exercise HR.

Decreases resting and exercise BP.

Descreases ischemic ECG response.

Increases exercise capacity in patient with exercise-induced angina.

• isosorbide mononitrate (Imdur), nitroglycerine (Nitrostat/Nitroquick/Nitrolingual/Nitrogard/Nitro-Bid)

QOL: Hyperlipidemia

Classified as an independent risk factor for developing CVD.

Exercise has been shown to indirectly reduce total cholesterol by improving HDL profile of patients undergoing treatment for hyperlipidemia.

No direct influence on exercise response or tolerance.

Assessments: Hyperlipidemia

GXT may be indicated depending on additional risk factors and patient status.

All field tests and assessments may be performed without restriction based solely on lipid profile.

FIT: Hyperlipidemia and hypertension

Based on general guidelines for exercise prescription.

Modifications made based on comorbidities as necessary.

QOL: Hypertension

Classified as an independent risk factor for developing CVD.

Exercise trianing has been shown to reduce resting BP and acute response to exercise and physical activity, thus lowering chronic stress on arterial walls and reducing risk of damage.

No direct influence on exercise response or tolerance.

Assessments: Hypertension

GXT may be indicated depedning on additional risk factors and patient status.

All field tests and assessments may be performed without restriction based solely on BP.

Resting BP measures should be validated on two or more accasions.

Safety considerations: Hypertension

Resting BP above 200/110 is a contraindication for exercise participation.

Resistance exercise should not increase BP or myocardial O2 demands beyond acceptable levels (SBP x HR = Rate Pressure Product).

Exercise training and/or testing should be stopped with drop in SBP > 20mmHg or rise above 250/110mmHg.

QOL: Aging and fall prevention

Exercise has demonstrated significant improvements in CVD risk, functional mobility, metabolic fitness, psychological health, and general health measures in seniors engaged in a regular exercise program.

Improvements in MET capacity confer reduced mortality; exercise improves metabolic capacity.

Exercise delays disability by improving muscular strength and endurance.

Falls account for a significant risk of acute health issues in seniors, leading to mortality.

Assessments: Aging and fall prevention

GXT may be indicated depending on risk factor profile prior to moderate exercise program.

6-minute walk test.

Timed up and go.

Sit to stand.

10 RM strength assessment.

Standardized fall risk assessment.

Aerobic FIT: aging and fall prevention

mod intense (40 to 60% VO2max), 30 mins or more (at least 10 mins/bout), at least 5 days/week OR

vigorous (greater than 60% VO2max), 20 mins or more, at least 3 days/week

Strength FIT: aging and fall prevention

10 to 15 reps/set, 2 to 3 times/week

Modalities: dumbbells/barbells, machines, calisthenics, resistance bands, etc. Alternatively, can use squeeze sponges or ball newspaper

Flexibility FIT:

3 to 4 times each, every workout, 10 to 30 seconds/stretch

Strength recommendations: aging and fall prevention

To improve balance: stand on one leg, sit on large ball, walk on heels, sideways or crossover walking, balance disc/board.

To improve reaction time, agility, & kinesthetic awareness: Toss balls of various sizes, shapes, and surfaces; challenge visual acuity and hand-eye coordination.

Strength focus: aging and fall prevention

Encourage core stability exercise using calisthenic and isometric exercises to improve balance.

Use of unstable surface training techniques should be adequately supported to prevent falls.

General exercise recommendations: aging and fall prevention

Adjust for decreased vision, hearing, balance, stamina, strength, and flexibility.

Keep exercises simple, safe, and enjoyable.

Avoid high-impact exercises.

Increase repetitions before resistance.

Encourage pain-free ROM and train for ADLs.

Consider benefits and risks of all weight training modalities.

Safety: Aging & fall prevention

Avoid sudden postural changes, uneven surfaces, and excessive weight/intensity to prevent falls.

Monitor for acute cardiac symptoms, hemodynamic abnormalities, and pain tolerance during exercise progressions and intensity changes.

Incorporate chair/seated exercises, balance bars, and other support for deconditioned and frail individuals.

QOL: Cancer

Regular exercise during therapy may result in reduced fatigue, greater body satisfaction, body weight maintenance, improved mood, decreased Tx side effect severity, and better overall QOL.

Aerobic and resistance exercise programs have the potential to improve bone remodeling and reduce muscle atrophy effects of glucocoticoids that are common in Tx regimens.

Significant improvements in functional tests have been shown in clients who participated in a regular exercise program during Tx.

Precautions: Cancer

Easy and premature fatigue is common, especially during exercise, and must be considered during exercise program development.

Exercise testing has similar endpoints and considerations as typical parameters.

Clients may be limited by muscle weakness and/or pain from tumor, surgery, or other Tx.

An acute change in general health status is a relative contraindication to exercise testing/training.

Assessments: Cancer

GXT may provide useful insight; however, is not required for exercise participation.

Functional fitness assessments.

6-min walk test.

Sit & reach.

10 RM strength assessment.

Sit to stand.

Stair climbing.

Gait analysis.

Special considerations: Cancer

Assess client's medical condition prior to each session.

Exercise program should accommodate special needs related to Tx regimen.

Sessions may need to be adjusted on a daily basis based on client's ability at each session.

Adapt training to client's Tx schedule.

Modify exercise program based on current status, medical condition, and Tx regimen.

Aerobic FIT: Cancer

Symptom limited at moderate intensity.

40 to 60% of HR reserve.

3 to 5 days/week; 20 to 60 mins/session.

All CV modalities appropriate.

Increase duration and intensity as tolerated.

Aerobic focus: Cancer

Exercise for improved mood, fatigue level, weight management.

Daily exercise should be individualized based on acute symptoms and fatigue.

Strength FIT: Cancer

40 to 60% RM; increase slowly as tolerated.

1 to 3 sets, 3 to 5 reps, increasing to 8 to 15 reps.

2 to 3 days/week as tolerated.

All major muscle groups may be targeted.

Strength focus: Cancer

Maintenance of arm, leg, and core strength with consideration for fatigue and any Tx areas of weakness.

Lymphedema related to breast cancer Tx may be augmented using ROM exercise and lymph drainage techniques.

Safety: Cancer

Consider risks of CV comorbidities, especially anemia.

Exercise should be postponed if there is:

* uncontrolled vomiting/diarrhea

* neutropenic fever (infection-related)

* bleeding risk is high or unknown

* acute anemia is suspected

* abnormal blood counts and levels are present

Medical considerations: Cancer

Tx may affect exercise performance but unlikely to alter exercise responses.

* surgery: pain, loss of flexibility, nerve damage

* radiation: pain, fatigue, scar tissue & loss of flexibility, premature osteoporosis leading to fracture

* chemotherapy: fatigue, nausea, anemia, bone loss, general pain, neuropathy

* immunotherapy: fatigue, nerve damage, myopathy

QOL: Pregnancy

Exercise may have very positive results regarding minimizing weight gain, musculoskeletal discomfort, and post part weight management and psychological health.

Exercise should be cleared by the OBY-GYN prior to participating and avoided during higher risk pregnancies.

Exercise improves overall function and may impact delivery and recovery if done safely and effectively.

Supporting documentation: Pregnancy

Exercise significantly decreases incidence of gestational diabetes and preeclampsia.

Supports general health of both the mother and fetus during pregnancy and post-partum.

Precautions: Pregnancy

Avoid exercise for abdominal muscles and in supine positions.

Prevent falls and avoid any contact and high-impact exercises.

Terminate exercise immediately if any bleeding, unusual nausea, dizziness, or other unexpected symptoms occur.

Avoid vigorous exercise in hot, humid weather conditions and wear comfortable clothing to remain cool.

Recommend wearing a bra that fits well and provides ample support -- sport bra might not be sufficient.

Aerobic recommendations: pregnancy

Exercise is encouraged during first 2 trimesters of pregnancy.

Do not start, stop, or restart exercise during pregnancy.

Consult physician prior to participation.

Avoid high-impace exercises and activities where balance may be compromised.

Aerobic focus: pregnancy

Progressively increase duration rather than intensity of aerobic training.

Strength recommendations: Pregnancy

Exercise during third trimester should be closely monitored and approved by physician.

Emphasize range of motion and lower body exercises.

Avoid abdominal and core resistance training.

Avoid exercises with increased risk of falls.

Water exercise may be very beneficial.

Safety: Pregnancy

Terminate exercise if client becomes dizzy, disoriented, or unusually fatigued.

Discontinue exercise if there are signs of bleeding/spotting, cramping, unusual SOB, or other unusual symptoms; consult physician immediately.

Do not start an exercise program with a formerly sedentary client during a pregnancy unless cleared by a physician.