cardio aerobic exercise dropout

initial stage

1-6 weeks, uses 30-60% HR Max

Target RPE is 11-12

15-30 min sessions, 3-4x week skipping days

improvement stage

5-6x a week, 30-40 mins per session (continuous w/o breaks)

last 4-8 months, has at least 2 weeks w/o signs of fatigue/muscle soreness

intensity 50-85% (no more than 5% every 6 sessions)

maintenance stage

fitness will decrease within 4-12 wks, decrease boredom, increase enjoyment

review goals

Duration of Exercise

Continuous 20-60 mins per session

Warm up: prepares HR, RR, perfusion

Cool down: to reverse effects lowly/gradually

Frequency of exercise

Usually 3-5x/wk

Fit individual 3-4x/wk

Unfit will have daily or bidaily activities, need lower intensity

recumbent bicycle

advantages: seat comfort, improved back support, relatively quiet, easier to monitor vitals, wider BOS, easier to mount/dismount

disadvantages: lower extremity fatigue, difficult to increase HR

adjustments: need 15-20 of knee flexion, 90 of dorsiflexion

stationary bike

advantages: non weight bearing, relatively quiet, easier to monitor vitals, little time/effort for habituation

disadvantages: lower extremity fatigue, difficult to raise HR, not all ppl are familiar with bicycling, no weight bearing

adjustments: need 15-20 of knee flexion, 90 of dorsiflexion

Nu-Step recumbent stepper

advantages: larger seat, stepping is more familiar, low impact, easy mount/dismount, uses all 4 extremities → easier to achieve target HR, total body workout

disadvantages: no weight bearing, increase difficulty to measure vitals bc usage of upper extremities

adjustments: allow slight knee flexion

stair climber

advantages: stepping is familiar, weight bearing, provides low impact, occupies less floor space

disadvantages: may aggravate/cause knee problems, supervision, poor posture (forward lean), use of UE for support, difficult to mount, requires good balance

treadmill

advantages: walking/running very familiar, weight bearing adjustments, uses larger LE muscles (less energy), HR can be elevated & kept at range, easy to adjust

disadvantages: weight bearing, obese, orthopedic limitations, lots of space, expensive, vital signs monitoring, noise/loud

total body system

advantages: uses all 4 extremities, easily achieve target HR; low impact

disadvantages: requires greater coordination & floor space, difficult to monitor vitals & mount/dismount

upper body ergometer

advantages: eliminates LE, impairments of LE, arthritics, arterial disease, easy to mount/dismount disadvantages, quiet

disadvantages: local muscle fatigue, limited performance, lower HR due to smaller muscle groups, unfamiliar to most, difficult to monitor vitals

adjustments: allow slight elbow flexion, back remains in contact to rest, shoulder height even with axis of arm crank

personal predictors of drop out

smoking, sedentary leisure time/occupation, type A personality, blue collar occupation, overweight, poor self image, depression, anxiety, poor credit rating

type A personality

ambitious, high status, sensitive, truthful, impatient, take more than can handle, workaholics, rigidly organized, dislikes delays

type B personality

lower stress level, don’t mind loosing, creative & explore ideas/concepts, enjoy achievements but not stressed if so

program predictors of dropout

inconvenient time/location, excessive cost, high intensity, lack of variety, solo participation, lack of positive feedback, inflexible goals, poor leadership

additional predictors

lack of spouse support, inclement weather, excessive job travel, injury, medical problems, job change/move

precontemplation

no intention to make change

“i presently don’t exercise & do not plan to start exercising in the next 6 months”

contemplation

considering change

“i presently don’t exercise, but i have been thinking about starting exercise within the next 6 months”

preparation

beginning to make change

“i presently get some exercise but not regularly “

action

actively engaging in new behavior

“i presently exercise on a regular basis, but have only been doing so within past 6 months”

maintenance

sustaining that change over time

“i presently exercise on a regular basis & have been doing so for longer than 6 months”

5 stages of grief

denial, anger, bargaining, depression, acceptance

denial

pt will develop a false & preferable reality instead of accepting their current one

anger

emotions will be misplaced with rage, anger & envy

direction of hate may be towards themselves, others or a higher power & can be incredibly difficult for caregivers or family to assist the pt

bargaining

as the patient begins to accept their fate, they believe they can sacrifice something important in exchange for more time

depression

pt begins to understand the certainty of their condition & begin to feel that living is pointless

pt can become silent, refuse visitors & spend most of their time crying or sulking

allows them to disconnect from those they love or care for

acceptance

pt has come to terms to the limits of their mortality