Special Pops: PAD and knowledge checks

What are the risk factors for PAD?

• men

• age>65

• family history of PAD

• smoking

• sedentary lifestyle

• obesity

• diabetes (29% of PAD)

• HTN

• hyperlipidemia

• chronic kidney disease

Cardio special considerations for PAD

• RPE may be used to guide intensity in pts. without leg pain

• primarily free or treadmill walking

• no optimal work: rest ratio

• allow pain to completely subside before restarting activity

Resistance special considerations

• if available time is limited for session, emphasis on lower limbs

• RT effects on pain free walking are unclear

Miscellaneous special considerations

• non-weight bearing exercise okay for warm-up but not as primary exercise mode

• cold weather may aggravate IC symptoms, may need longer warm up

• stretching exercises are integral for treatment

Ankle-brachial index (ABI) formula

• highest ankle systolic pressure/highest brachial systolic pressure

Cardio FITT

• F: greater/equal 3 days/week

• I: 40-59% HRR to point of moderate pain (3/4 on claudication scale), 50-80% max walking speed

• 30-45 min for minimum of 12 wks. May progress up to 60 mins/d

• T: weight bearing intermittent exercise with seated rest when pain presents

Resistance FITT

• F: greater/equal 2 days/week

• I: 60-80% 1RM

• T: 2-3 sets, 8-12 reps, 6-8 exercises targeting major muscle groups

• T: whole body large muscle groups

Ex training goals PAD

• increase pain free walking distance

• increase independence

• increase walking distance, time onset pain, vo2 max

• decrease claudication pain

• decrease recovery time

Acceptable ABI values

• greater equal 0.9

Mild-moderate ABI values

• 0.40-0.89

Severe ABI value

less than 0.40

What is the most prominent contributing risk factor for PAD?

• smoking

The atherosclerotic target lesion spot for hypertension includes

• the full leg (can occur anywhere in the leg)

Leg pain that is brought on by physical activity is called

• intermittent claudication

The site of pain provides an indication of the site of disease (true/false)

• true

An API of ____ or less suggest critical limb ischemia

• 0.5

The ankle-brachial index is the _____ ankle systolic pressure/_____ brachial systolic pressure

• highest/highest

Claudication experienced at a distance of < 200 meters is considered stage ___

• IIB

Pentoxifylline, one of just two meds approved for claudication, is recommended because it improves walking distance (true/false)

• false

For exercise testing a patient with PAD, a treadmill test is suggested with the following guidelines:

• start at 2mph and then increase grade by 2% per stage

• avoid using handrail if possible

Non-weight bearing cardio exercises are recommended for patients with PAD (true/false)

• false

Patient 1: FEV-1/FVC ratio 69%, FEV1 65% of predicted

• moderate

FEV1/FVC ratio 45%, FEV1 40% of predicted

• severe

FEV1/FVC ratio 72%, cough and mucous production

• normal (does not have copd)

FEV1/FVC ratio 65%, FEV1 85% of predicted

• mild

FEV1/FVC ratio 51%, FEV1 29% of predicted

• very severe

Atherosclerosis is a major cause of which conditions?

• CVD

• Myocardial infarction

• Chronic heart failure

• PAD

Systolic dysfunction is the inability to contract, and diastolic dysfunction is the inability to fill (true/false)

• true

A normal ejection fraction is ____% indicating the percentage of blood pumped out of the left ventricle with each contraction

• 55-65%

Which of the following are true?

a. A peak VO2 < 14 ml/kg/min indicates an ~50% risk for death in 3 years

b. a peak VO2 > 17 ml/kg/min indicates an ~20% risk for death in 3 years

c. a peak VO2 < 17 ml/kg/min indicates an ~50% risk for death in 3 years

d. peak VO2 > 14 ml/kg/min indicates an ~20% risk for death in 3 years

• a

• b

You can use prediction equations to estimate VO2 with CHF patients.

False

VO2 peak is ~10-15% lower when measured with cycle ergometry than with a treadmill

true

If a patient has a heart transplant, the recipient is unable to experience the sensation of angina due to ischemia.

True

A graded exercise test (GXT) is recommended for all CABG patients to start a supervised exercise program.

True

Arm ergometry is an appropriate modality for aerobic exercise testing following an CABG.

false

Test termination end points for blood pressure are

SBP>250

DBP>115

Decrease in SBP > 10 mmHG

Approximately ___ percent of people who need cardiac rehab actually start it

19

Only ___ percent of patients complete the full course of cardiac rehab

27

When exercise test information has not been gathered, the UPPER limit HR during exercise is

RHR + 20 bpm

If a patient is positive for ischemia during a graded exercise test, the prescribed exercise intensity should stay ______ bpm BELOW the ischemic threshold.

10

All of the following are modifications for Resistance Training following a CABG procedure, EXCEPT

Option A

No arms until sternum is healed

Option B

Limited ROM movements within first 4 weeks

Option C

Heavy resistance training avoided until 8 weeks post op

Option D

All of these are correct

D

Benefits of participating in a supervise exercise program include:

Improved exercise capacity (aerobic and strength)

improve angina free exercise tolerance

less likely to smoke at 6 months following completion

improved cardiac performance