Inpatient Cardiac/ • Status of HR, BP, O- Respiratory Endurance traininPulmonary Rehab (Acute) Sat, RR and ECG • Increased lung volume/ exercises will alw readings. capacity beneficial unlessOutpatient Cardiac/ • Increased diffusion indicated due to tPulmonary Rehab • Failure of the systolic capacity severity of a cond(Sub-acute) pressure to rise as • Increased ventilatory and/or medical st exercise continues capacity.Community Exercise Endurance traininProgram • A hypertensive blood Cardiovascular easiest and most(Post-acute) pressure response • Decrease in convenient form including a systolic sympathetic drive exercise for any i pressure of > 200 • Increase in myocardial whether disabledMI patients mmHg, and/or a contractility Careful with activity diastolic pressure >110 • Increase in ventricularprogression mmHg volume 3-5 x per wk • Increase in cardiac No inc. fatigue output Goal: 30-40 mins (L notes) • A progressive fall in • Increase ability of the systolic pressure of 10 muscle to extractCHF patients to 15 mmHg. oxygen. Low-level ifhemodynamically stable • Respiration should not Metabolic Monitor O-Sat be labored. • Glycogen sparing-a Regular and inc. duration decrease rate of Box 16-6 (O’Sul.) for depletion of musclecontraindications to exerc. • No perception of glycogen at subTraining for CHF pts. shortness of breath. maximal work levels. • Increase number andCardiac Transplant • Factors affecting size of mitochondria Caution with orthostatic exercise performance • Increase myoglobinhypotension (heat, cold, equipment, concentration Bed exercs, and inc. medications, etc.) • Increase capillarygradually Meds side effects density (K & C) • RPE- rate of perceived HR monitoring (Table exertion • decrease in body fat16-10 O’Sul.) • decrease in bloodPacemakers cholesterol and Pacemaker type triglyceride levels HR & intensity threshold • increase in heat(Table 16-10 O’Sul.) acclimatization • increase in the breakingDiabetes patients strength of bones and ligaments and theObese and/or overweight tensile strength ofpatients tendons(k &c)
The F.I.T.T principle:FREQUENCY: -Depend on the person’s age, musculoskeletal limitations, and fitnesslevel. -Optimal frequency for endurance exercise would be three to four timesa week but should be increase if working intensity is low. (Hillegass) (K & C)INTENSITY: -Could be monitored by using a rating of perceived exertion skill(RPE), by measuring heart rate, performing a talking test, or Defining specific distance to be covered in a specific amount of time. -Determining maximum heart rate and exercise heart rate for training programs provides the basis for the initial intensity of the exercise. (Hillegass)Determine maximum heart rate (HR) • From multistage test (for young and healthy) • HR achieved in predetermined sub maximal test • 220 minus age (less accurate) MHR and exercise heart rate is used for the exercise prescription for individuals at risk for CAD, individuals with CAD or other chronic diseases and individuals who are elderly are ideally determined from performance on the stress test (K&C).Determine exercise heart rate • Percentage of maximum heart rate (dependent on level of fitness) • Karvonen’s formula (heart rate reserve • Exercise heart rate = HRrest +60-70%(HRmax-HRrest)TIME: -Duration of the exercise session depends on the intensity, frequency, and fitnesslevel. -Greater intensity = shorter duration, while lesser intensity = longer duration. - High intensity =10-15 mins - Moderate intensity = 20-30 mins - Low intensity = about 45 mins (K & C)TYPE: -The mode should use a large muscle group, rhythmic in nature, could be done ina continuous manner, and be enjoyable. -Can consist of any form of aerobic exercise, including walking, jogging, cycling,swimming, cross-country skiing, aerobics classes, and can vary during the week.Maximum Oxygen Consumption (VO2 max)-It is a measure of the body’s capacity to use oxygen. It is the maximum amount ofoxygen consumed per minute when the individual has reached maximal effort. It isdependent on the transport of oxygen, the oxygen-binding capacity of the blood, cardiacfunction, oxygen extraction capabilities, and muscular oxidative potential.
Cardiopulmonary Exercise for sedimentary adults (Obtained from references 5,6)Together, the benefits associated with regular exercise and physical activity contribute toa more healthy, independent lifestyle, greatly improving the functional capacity andquality of life for the fastest growing segment of our populationWalking groups and physical activity programs especially designed for older adults canhelp seniors become—and remain active.Aerobic activity (also known as cardiorespiratory or cardiovascular endurance activity) isalso important. It keeps the heart strong, lowers blood pressure, and relieves anxiety anddepression. Older adults can obtain significant health benefits with moderate physicalactivity, such as walking or gardening.The CDC/ACSM recommends that all adults should accumulate at least 30 minutes ofmoderate-intensity physical activity on five or more days of the week. Cardiorespiratory(aerobic) endurance, strength, balance, and flexibility exercises should all be part of aphysical activity program for older adults. No one type of activity will bring about all thebenefits of physical activity. It is important to include all of them. Older adults can meetthe physical activity recommendation with a combination of these activities using thefollowing sample schedule: • Cardiorespiratory: Participate in moderate-intensity aerobic activities 3-5 days a week for at least 30 minutes each session. • Flexibility: Stretch every day. • Strength training: Do strength-building activities 2-3 days per weekImproving your cardiorespiratory endurance will allow you to do things like climbingstairs, dancing, or playing with grandchildren without getting out of breath. Cardio respiratory Strength Flexibility Walking Chair exercises Stretching Swimming Lifting weights or cans Yoga Dancing Carrying laundry or Tai chi groceries Skating Working in the yard Hiking Washing the car Rolling your wheelchair Scrubbing the floorTips for People Who Have Been Inactive for a WhileUse a sensible approach by starting out slowly.
• Begin by choosing moderate-intensity activities you enjoy the most. By choosing activities you enjoy, youll be more likely to stick with them. • Gradually build up the time spent doing the activity by adding a few minutes every few days or so until you can comfortably perform a minimum recommended amount of activity (30 minutes per day). • As the minimum amount becomes easier, gradually increase either the length of time performing an activity or increase the intensity of the activity, or both. • Vary your activities, both for interest and to broaden the range of benefits. • Explore new physical activities. • Reward and acknowledge your References 1. O’Sullivan, Susan, Schmitz, Thomas. Physical Rehabilitation, Assessment and Treatment. 4th Edition. Davis Company, 2001. Chapters: 4, 16. 2. Kisner, Carolyn, Colby, Lynn. Therapeutic Exercise, Foundations and Techniques. 4th Edition. Davis Company, 2002. Chapter 4. 3. Hillegass, Ellen, Sadowsky, Steven. Cardiopulmonary Physical Therapy. 2nd Edition. Saunders, 2001. Chapter 17. 4. O’Sullivan, Susan, Siegelman, Raymond. National Physical Therapy Examination, Review and Study Guide. 2007 Version. International Educational Resources, 2007. Chapters: 3, 4. 5. Centers for Disease Control website. Are There Special Recommendations forOlder Adults? Available at: http://www.cdc.gov/nccdphp/dnpa/physical/recommendations/older_adults.html.Accessed: May 30, 2007. 6. Robert SM, Peter C, Williams JE, Maria F, James H, Edward M, Jill S. Exerciseand physical activity for older adults. Journal of Medicine & Science in Sports & Exercise. 1998; 30:6. -