topic 10

optimal BP at rest

<120/<80

preHTN

120-129/<80

HTN 1

130-139/80-89

HTN stage 2

greater or equal to 140/greater or equal 90

emergency

greater or equal 180/greater or equal 120

which intensity for HTN

moderate

avoid large increases in ____ especially ____

FIT, intensity

focus on _____

breathing

BP during exercise HTN

< or equal 220/less or equal 105

atherosclerosis

plaque buildup in vessel

MI

myocardial imfarction- heart attack

MI is result of ____

coronary arteries blockage

CVA

stroke- arteries on brain

peripheral artery disease

blockage in arteries in extremities

CAD

coronary artery disease. before MI, thickening forms in coronary arteries but not yet severe enough

begins in _____ and can be _____

childhood, reversed

peripheral artery disease

atherosclerosis of extremities arteries

complain of intermittent ____

claudication (cramping/pain)

peripheral artery disease exercise

frequent rest break. intermittent exercise, intensity below symptoms to prevent pain

physiological consequences of CAD

blockages cause supple demand mismatch. contractility goes first. LV cant pump effectively which precedes pain or ECG changes

angina

chest pain caused by insufficient O2 to heart

silent ischemia

ECG changes indicate inadequate O2 but NO ANGINA

baloon angioplasty

open lumen then put stent in there

stent

keeps lumen open to prevent blockage. then remove balloon and leave stent in

coronary artery bypass graft

too blocked to get balloon in there

sternal precautions

cant raise arms above shoulders, cant reach behind body, cant lift over 5 lbs cux risks opening graft back up

mind sternal precautions for ____ weeks

6-8 weeks

pacemaker

left arm movement, electric stimulation precautions, dont use MRI/metal detectors, sternal precautions apply

for pacemaker, dont set intensity using _____

HR

modified karvonen formula

TSBP=(SBPmax-SBPrest) (50-80%) + SBPrest

extended ______, monitor ____

warm up and cooldowns, SBP

O2 consumption and HR _____ relationship

nonlinear

heart transplant patients monitor BP when in exercise

monitor BP before during after

aerobic exercise for heart transplant patients

4-6day/wk from 15-60 mins

low resistance training 2-3 days/wk once allowed

heart failure

loss of heart contractility leading to reduced CO

causes of heart failure

CAD, cardiomyopathy, HTN, valvular heart disease

symptoms of heart failure: peripheral edema

RV cant pump effectively so backtracks and leads to edema in extremities

pulmonary edema

LV cant pump effectively. edema in lungs

other symptoms of heart failure

fatigue, exercise intolerance,

should we do supine in folks w/ heart failure?

FAWKK NOOOO

should people with heart disease exercise?

yusss

lower risk of death associated with higher

functional capacity and intensity

#1 predictor of death

functional capacity- what intensity can be tolerated

for every 1 met increase, inc survival by %

12% or more

congestive heart failure: criteria to start exercise

speak without SOB, exercise >3mets, RR<30 (norm 12-18), everyday things are less than mod fatigue, HR rest <120

CHF warm up and cool down time

10-15 mins

start training mins total

10-20

mins of work followed by rest

2-6 mins of work followed by 1-2 mins rest

increase from 10-20 to ____ mins

20-40

frequency of this?

3-7 days/wk

at what VO2max?

40-75%

avoid which exercise and position?

isometrics and supine

can they exercise if angina is stable?

yes

target heart rate at least ___ beats below angina

10

acute myocardial infarction special considerations

could be no angina or signs of poor perfusion

stroke emergency signs

dizziness, sudden weakness/numbness, loss of vision in one eye, sudden severe headache, motor function still works, brain works but cant verbalize anything

heart attack emergency signs

chest pressure, upper body discomfort, SOB, nausea, cold sweat, light-headed, purple/blue/grey

when to stop exercising: what kind of pain?

angina

SBP increase of ?

> 140

BP of

250/110

plateau or decrease in ____ when increasing ____

SBP, intensity

unusual HR response?

STOP

signs/symptoms?

STOP

turning diff colors, getting lightheaded?

STOP

best way to stop exercising

reduce intensity slowly

in emergencies, stop exercise without ____

cool down, even if its not the best

how many days after heart attack for submax testing?

4-6

how many days after heart attack for max test

over 14

angina during exercise test?

STOP

BP drops by ___ or plateaus? STOP

20

BP over ____ STOP

SBP >260 OR DBP >115

should we stop with poor perfusion?

yes

should we stop if theres an increase in HR with intensity?

NO, stop if it goes down or plateaus

stop with change in heart rhythm?

yes

if they wanna stop should you?

yes bro be nice

stop with minimal fatigue?

NO, with severe fatigue

stop if the instrument fails?

duh yes

if NO exercise testing, start with target HR ___BPM OVER resting HR

20 BPM

no exercise testing, start training at ___ METS

2-3 mets

increase by ___ mets as tolerated

0.5-1

also monitor ___ and ___

RPE and ECG

cardiac rehabilitation is exercise training for who

CV disease or after heart attack/surgery

phases 1-4

inpatient, outpatient with monitoring, outpatient with intermittent monitoring, no monitoring with limited supervision

phase 1: inpatient intensity- RPE, HR, symptom presence

RPE < or equal to 13 on a scale of 6-20

post MI HR <equal 120 OR HR at rest + 20

post surgery HR at rest + 30

asymptomatic

phase 1: inpatient duration

3-5 mins work followed by rest

total of 10-15 mins per session

phase 1: inpatient Frequency

days 1-3: 2-4 x/day

days 4+: 2x/day

phase 1: inpatient progression

increase duration then intensity

phase 2: outpatient with monitoring- are they on ECG?

YES still

phase 2: outpatient with monitoring intensity RPE and HR

high enough for training effects without symptoms

RPE 12-14

target HR

phase 2: outpatient with monitoring frequency

2-5x/wk

phase 2: outpatient with monitoring duration

20-60 mins

phase 2: outpatient with monitoring progression

inc every 1-3 weeks

do 20-30 min continuous before inc in intensity

phase 3 and 4: outpatient with intermittent monitoring and 4 no monitoring limited supervision intensity

RPE 12-16

THR

watch for signs and symptoms

phase 3 and 4: outpatient with intermittent monitoring and 4 no monitoring limited supervision progression

every 1-3 weeks

20-30 min continuous prior to inc in intensity

resistance frequency

2-3x/wk

resistance intensity

10-15 reps

40-60% 1RM

watch for signs and symptoms

1-3 sets, 8-10 different exercises

no accepted guidelines for HIIT

when to reevaluate

goals achieved

change in medical status

group 1 endurance activities

constant intensity

variation in energy expenditure low

precise control

group 2

rate of energy expenditure related to skill, but individual intensity constant

useful in early stages

group 3

skill and intensity variable

useful for group interaction and variety

cautions in high-risk, low-fit and or symptomatic individuals