Overview of Ther ex in adult neuro populations

What are precautions for resistance exercise?

-avoid valsalva

-about substitutions

-be aware of overtraining & overwork

-monitor exercise-induced muscle soreness

-review medical hx

What mode of exercise should be done for resistance exercise?

-isometrics, concentrics, eccentrics

-OKC and CKC

-isokinetics

-manual & mechanical resistance

-constant and/or variable resistance

What are the beginner, intermediate, and advanced reps/sets/loads/frequency?

beginner = 8-12reps, 2-3 sets, 65-75% 1RM, 1-2x/week

intermediate (>3mo training) = 5-8 reps, 3-4 sets, 75-85% 1RM, 2-3x/week

advanced (>12mo training) = 1-5 reps, 4-5 sets, 85-100% 1RM, 2-3x/week

What is the definition of physical activity?

any bodily movement produced by a skeletal muscle that results in an increase over resting energy expenditure

Training produces adaptation in what time frame, if it is based upon specificity?

10-12 weeks

What is the F in FITT? Describe it

frequency

-depends on age/health of person

-3-4x per week

-lower intensity may require greater frequency

What is the I in FITT? Describe it

intensity

-most important component or successful change in aerobic fitness

-overload principle

What is the most important component for successful change in aerobic fitness?

intensity

What is overload principle?

exercise load must be above the regularly encountered stresses to elicit a change; progression needs to continue as adaptation occurs

How can intensity be determined for ther ex?

determine HR max and exercise HR gives baseline initial intensity

What is a general calculation for HR max?

220-age

What is the intensity of conditioning for response to occur?

60-90% max HR

What are the intensity and duration variables that appear to lead the greatest increase in VO2 max?

high intensity, short duration

Moderate intensity exercise is rated what range of RPE?

5-6 / 10

Vigorous intensity exercise is rated what range of RPE?

7-8 / 10

What is the optimal time (duration) for ther ex?

depends upon the total work done

-20-30min at 60-70% max HR

-lower max HR needs +45minutes

-higher intensity exercise for 10-15minutes

What duration of exercise may be effective for deconditioned patients?

3 5-minute periods

What is the type of ther ex that should be one?

-involving large muscle groups

-specific to the activity you're working towards

What should the volume of ther ex be?

>500-1000 MET-min/week

(1000kcal / week)

What is the reversibility principle?

decreased work capacity can be seen in 2 weeks of not training; improvements can be lost in several onths

What are the general recommendations for aerobic PA for children, 6-17yo?

60 min/day mod-vig intensity

What are the general recommendations for aerobic PA for adults, 8-65yo?

-30m 5x/week moderate intensity

-20 m 3x/week vigorous intensity

-combo of mod & vigorous

What are the general recommendations for aerobic PA for older adults, >65yo OR 50-65yo with chronic conditions?

-30m 5x/week moderate intensity (5-6/10 intensity)

-20 m 3x/week vigorous intensity (7-8/10 intensity)

-combo of mod & vigorous

What is the purpose of warm-up period?

-allows for physiological responses to catch up to activity onset

-prevents / decreases susceptibility for musculoskeletal injury / arrhythmias

-gradually increases core temp without fatigue

What type of aerobic exercise is best for endurance?

continuous sub-max training

What is the work:recovery ratio for interval aerobic exercise training?

can range from 1:1 to 1:5

What is the cool-down period? What is its purpose?

-5-10o minute of total-body movements and static stretching

-prevents pooling of blood

-prevents fainting

-enhances recovery periods

-prevents CV complications

What are exercise guidelines for adults with chronic health conditions and/or adults with disabilities?

-150-300minutes / week of moderate intensity exercise OR 75-150minutes / week of vigorous intensity exercise

-muscle strengthening involving all major muscle groups 2 or more days per week

What should adults with chronic health conditions and/or disabilities do if they cannot meet the recommended guidelines?

still engage in PA according to their ability. AVOID inactivity

In general, sedentary behavior increases risk of what?

-all cause mortality

-CV disease mortality

-CV disease

-Type 2 DM

-colon, endometrial, and lung cancers

Most benefits of exercise/activity are attained at what range of time when doing moderate PA?

150-300 minutes per week of moderate activity

What are some benefits of PA for adults and older adults?

-improved cognition

-reduced risk of dementia

-lower fall risk, and fall injuries

-lower risk of cancers

-improved sleep

-reduced anxiety

-wt loss

-etc. etc.

What are methods that work to help increase PA for individuals or small groups?

-guidance from peers/professionals

-support from others

-technology

What are methods that work to help increase PA for communities?

-school policies/practices

-access to indoor/outdoor recreation facilities

-community wide programs

What is the "Move your way campaign"?

consumer-focused campaign to promote PA recommendations

-purpose = raise awareness of recommendations and change behavior among consumers

-targeting those who are contemplating exercise, or those not meeting recommendations

What is "Bridging the gap"?

a toolkit for PTs to use to link PT and lifelong physical activity and exercise in people with neurological conditions

What are the 4 objectives of "Bridging the gap toolkit"?

1. understand duration & scope of PT for maximizing recovery and planning for lifelong PA & exercise

2. outline recommendations of long-term relationship with PT, including re-assessments and reasons to re-initiate care

3. describe reasons for lifelong exercise after PT; include continued recovery of physical function & maintenance

4. provide recommendations for setting & achieving goals for physical activity

According to objective 1 of "Bridging the Gap Toolkit", during a PT episode of care, people with a neuro condition may undergo tx to address what areas?

-maximize motor function

-improve ability and independence with functional activities and walking

-return to previous home & community roles, as well as leisure physical activity participation

-minimize risk of future injury

-maximize health, wellness, and adjustment to change in abilities

T or F: Prior to discharge, it is important to discuss with a pt the role of a long-term relationship with PT

True

According to objective 2 of "Bridging the Gap Toolkit", pts may have a long-term relationship with PT, beyond their initial bout of care, for what reasons?

-additional bouts of care after the initial d/c

-annual or semi-annual reassessments

-consult for a second opinion

Why might a pt receive additional bouts of care after the initial PT d/c?

changes in the pt's ability to address specific problems that arise, or to upgrade the person's functional activities / exercise program

When might reassessments be indicated for a pt after a PT initial d/c?

-determine progression or decline

-determine need for further PT care

-modify functional mobility strategies

-equipment assessment and modification

-review/modify PA and exercise programs

What are some areas that could be addressed in a PT consultation?

might be getting a second PT opinion in order to address...

-appropriateness of current rehab POC (content, duration, frequency)

-any additional interventions that may be beneficial

-equipment recommendations

-prognosis for further recovery

-recommendations related to return to daily life functions & ADLs

How can PTs play a role in promoting lifelong PA and exercise after PT?

-help with transition to community-based fitness & wellness programs

-help client set goals

-optimize physical & mental health & wellness throughout lifespan

-develop & maintain social support

-consider referral to mental health professionals

How can PTs recommend a setting and achievement of goals after an initial bout of PT?

-PT can determine medical guidelines or limits including: vital targets/limits, WB precautions, appropriateness of exercise, response to medical emergencies

-recommendations for specific parameters for exercise

To optimize goal setting and goal achievement, to ultimately establish an action plan for lifelong exercise, what steps are recommended for neuro condition pts?

1. known one's values

2. set SMART goals

3. make an action plan

What does it mean when a pt should know their values prior to setting goals?

-clarify what matters most to the individual

-family, health, independence, growth, wealth, etc,

T or F: When values and goals match, action and success will follow

True

T or F: The 3 steps that are recommended for pts with neuro conditions, in order to establish goals are as follows:

1. set a SMART goal

2. make an action plan

3. know values

False!!!

1. know values

2. set SMART goal

3. action plan

What do SMART goals encompass?

specific, measurable, achievable, realistic, time-based

How should an action plan be made when thinking about a pt's goal achievement in continuing lifelong exercise?

action plan should match the SMART goal and specifically include:

-WHAT the client will specifically do (FITT principles)

-WHEN the pt will do it

-WHERE they will do it

-how the pt will monitor what they will do, overcome obstacles, and celebrate success