Term
| what are the goals for inpatient rehabilitation programs? |
|
Definition
-identify significant cardiovascular, physical, or cognitive impairments that may influence exercise performance
-offset the deleterious physiologic and psycho effects of bed rest
-provide additional medical surveillance of patients and their responses to physical activity
-evaluate and begin to enable patients to safety return to ADL within limits of impose CVD
-prepare the patient and support system to optimize recovery
-facilitate physician referral and patient entry into an outpatient cardiac rehabilitation program |
|
|
Term
| define acute coronary syndromes. |
|
Definition
| the manifestation of coronary artery disease as increasing symptoms of angina pectoris, MI, or sudden death |
|
|
Term
|
Definition
| diseases that involve the heart and/or blood vessels; includes hypertension, CAD, peripheral artery disease; includes but not limited to atherosclerosis |
|
|
Term
|
Definition
| diseases of the blood vessels that supple the brain |
|
|
Term
|
Definition
| disease of the arteries of the heart |
|
|
Term
| define myocardial ischemia. |
|
Definition
| temporary lack of adequate coronary blood flow relative to myocardial oxygen demands; it is often manifested as angina pectoris |
|
|
Term
|
Definition
| injury/death of the muscular tissue of the heart |
|
|
Term
| define peripheral arterial disease. |
|
Definition
| diseases of arterial blood vessels outside the heart and brain |
|
|
Term
| activities and programs during the early recovery period depend on what? |
|
Definition
| the size of the MI and the occurrence of any complications and include self-care activities, arm and leg ROM, and postural changes |
|
|
Term
| what causes much of the exercise deterioration after an acute cardiac event? |
|
Definition
| intermittent sitting or standing, gravitational stress |
|
|
Term
| what are the indications for inpatient and outpatient cardiac rehabilitation? |
|
Definition
medically stable post-MI
stable angina
CABG surgery
PTCA
stable heart failure by either systolic or diastolic function
heart transplantation
valvular heart surgery
PAD
at risk for CAD |
|
|
Term
| what are the contradictions for inpatient and outpatient cardiac rehabilitation? |
|
Definition
unstable angina
uncontrolled hypertension
orthostatic drop in BP of >20mmHg
significant aortic stenosis
uncontrolled atrial or ventricle arrhythmias
uncontrolled sinus tachycardia
uncompensated heart failure
3rd degree AV block without pacemaker
active myocarditis
recent embolism
actue thrombophlebitis
acute systemic illness or fever |
|
|
Term
| T/F although not all patients may be suitable candidates for inpatient exercise, virtually all benefit from some level of inpatient intervention. |
|
Definition
|
|
Term
| what are the principles for designing an inpatient exercise Rx? |
|
Definition
frequency
intensity
time
type
progression |
|
|
Term
| define frequency for inpatient exercise Rx. |
|
Definition
| mobilization two to four times per day for the first 3 days of the hospital stay |
|
|
Term
| define intensity for inpatient exercise Rx. |
|
Definition
seated or standing resting heart rate +20bpm for patients with an MI and +30bpm for patients recovering from heart surgery
upper limit <120bpm |
|
|
Term
define time for inpatient exercise Rx.
what should you attempt to achieve? |
|
Definition
begin with intermittent walking bouts lasting 3-5 minutes as tolerated with exercise bouts of progressively increasing duration. The rest may be a slower walk that is shorted than the duration of the exercise bout
2:1 ratios of exercise to rest |
|
|
Term
| define type of exercise for inpatient exercise Rx. |
|
Definition
|
|
Term
| define progression for inpatient exercise Rx. |
|
Definition
| when continuous exercise duration reaches 10-15 minutes increase intensity as tolerated within the recommended RPE and HR limits |
|
|
Term
| what should patients understand by time of discharge? |
|
Definition
| an understanding of physical activities that may e inappropriate or excessing. |
|
|
Term
| when the patient is discharged what should they leave with? |
|
Definition
| a safe, progressive plan of exercise |
|
|
Term
| T/F Outpatient rehabilitation programs can being when the patient is still in the hospital. |
|
Definition
false
immediately after discharge |
|
|
Term
| what should be assessed at outpatient program entry? |
|
Definition
-medical and surgical history including the most recent cardiovascular event, comorbidities and other pertinent medical history
-phsyical examination with an emphasis on the cardiopulmonary and musculoskeletal systems
-review of recent cardiovascular tests and procedures including ECG, coronary angiogram, echocardiogram, stress test
-current medications
CVD risk factors |
|
|
Term
| what are the goals for outpatient cardiac rehabilitation? |
|
Definition
1)develop and assist the patient to implement a safe and effective formal exercise and lifestyle physical activity program
2)provide appropriate ongoing surveillance data to the patient's health care providers in order to enhance medical management
3)return the patient to vocational and recreational activities or modify theses activities based on the patient's clinical status
4)provide patient and spouse/partner/family education to optimize secondary prevention through aggressive lifestyle management and judicious use of cardiaprotective medications |
|
|
Term
for outpatient rehabilitation what should be performed before, during, and after each session?
which should include what? |
|
Definition
routine preexercise assessment of risk for exercise
HR and BP
body weight
symptoms or evidence of change in clinical status not necessarily related to activity
symptoms and evidence of exercise intolerance
change in medications
considerations of ECG |
|
|
Term
| what does the ACC/AHA say is essential for the development of an Ex Rx for patients who suffered from MI with or with out revascularization? |
|
Definition
|
|
Term
| T/F if you are testing a patient with cardiac problems, the test should be performed off of the normal medications. |
|
Definition
false
you would want the patient on the medications in order to see how they will reposed to exercise |
|
|
Term
| what variables should be considered when creating an exercise Rx for patients with CVD? |
|
Definition
1)safety factors including clinical status, risk stratification category, exercise capacity, ischemic.anginal threshold, musculoskeletal limitations, and cognitive/psychological impairments
2)associated factors including premorbid activity level, vocational and avocational requirements and personal health and fitness goals |
|
|
Term
define frequency for outpatient programs.
what does it depend on? |
|
Definition
exercise should be perfumed at least 3 days but preferable most days of the week.
baseline exercise tolerance, exercise intensity, fitness and other health goals, |
|
|
Term
| define intensity for outpatient programs. |
|
Definition
40-80% HRR
11-16 RPE
take their medications at their usual time |
|
|
Term
| people who take a beta-blocker might have what during exercise? |
|
Definition
| attenuated HR response to exercise and an increase or altered after an exercise test or during the course of rehabilitation |
|
|
Term
| when should you monitor signs and symptoms of exercise intensity? |
|
Definition
| when beta blocker dose is altered without a new exercise test |
|
|
Term
define time for outpatient programs.
how long is the warm up and cool down?
what is the goal duration?
following a cardiac related event? |
|
Definition
warm-up and cool-down activities should be 5-10 minutes including static stretch and ROM and light intensity
goal duration 20-60 minutes
start with as little as 5-10 minute aerobic conditioning with a gradual increase 10-20% per week |
|
|
Term
| what is the recommended time increase for patients with a recent cardiac related event? |
|
Definition
|
|
Term
define type for outpatient programs.
what does it include?
what equipment? |
|
Definition
rhythmic aerobic, large muscle group activities with an emphasis on increase caloric expenditure
arm ergometer
combination of upper and lower cycle ergometer
upright and recumbent cycle ergometer
rower
elliptical
stair climber |
|
|
Term
| define progression for outpatient programs. |
|
Definition
| there is no standard former for the rate of progression in exercise session duration, but should be individualized to patient tolerance |
|
|
Term
| when can low risk patients begin intermittent ECG monitoring? |
|
Definition
| after 6 exercise sessions |
|
|
Term
| when can moderate risk patients begin intermittent ECG monitoring? |
|
Definition
| after 12 exercise sessions |
|
|
Term
| when can high risk patients begin intermittent ECG monitoring? |
|
Definition
| after 18 exercise sessions |
|
|
Term
| what are the three reasons for No Available Preparticipation Exercise Test? |
|
Definition
-extreme deconditioning
-ortho limitations
-recent successful percutaneous intervention or revascularization surgery without residual obstructive coronary artery disease |
|
|
Term
| exercise prescription procedures for recent MI patients can be based on what? |
|
Definition
| recommendations and what happened during inpatient phase, home exercise activities and RPE |
|
|
Term
| in addition to formal exercise sessions following an MI or revascularization surgery patients should be encouraged to return to _____. |
|
Definition
|
|
Term
walking for 30 min each day is the equivalent of how many steps? one mile?
what is recommended as beneficial? |
|
Definition
3,000-4,000 steps
~2,000 steps
5,400-7,000 per day |
|
|
Term
| outpatient programs after a cardiac event represents guideline based care which goals are to what? |
|
Definition
reduce the risk for experiencing a second event
improve exercise tolerance
manage symptoms
facilitate a healthier lifestyle |
|
|
Term
| why might someone not be able to participate in an outpatient cardiac rehabilitation program? |
|
Definition
location and accessibility
transportation
work or personal schedule |
|
|
Term
| the rehabilitation team should prepare a program that. |
|
Definition
| prepares the patient for eventual transfer to unsupervised exercise |
|
|
Term
| what issues should be considered in the determination of appropriateness for independent exercise? |
|
Definition
cardiac symptoms that are stable or absent
appropriate HR, BP, and rhythm
demonstrated knowledge of proper exercise principles and awareness of abnormal symptoms
motivation to continue to exercise regularly without supervision |
|
|
Term
| what are the major risk factors of PAD? |
|
Definition
diabetes
hypertension
smoking
dylipidemia
hyperhomocysteinemia
non-white race
high levels of C-reactive protein
renal insufficiency |
|
|
Term
| what is intermittent claudication? |
|
Definition
| a reproducible aching or cramping sensation in one or both legs that typically is triggered by weight bearing exercise |
|
|
Term
| T/F patients with any description of leg pain should be considered to have intermittent claudication until proven otherwise. |
|
Definition
|
|
Term
|
Definition
| the development of atherosclerotic plaque in systemic arteries that leads to significant stenosis, resulting in reduction of blood flow to regions distal to the area of occlusion |
|
|
Term
| why is exercise testing performed in patients with PAD? |
|
Definition
to determine the time of onset of claudication pain pre therapeutic and post therapeutic intervention
to measure the post exercise ABI
to diagnose the presence of CVD |
|
|
Term
| T/F patients with PAD high risk don't need to be supervised during exercise testing. and medicine should not be taken |
|
Definition
false
under medical supervision and dose should be noted and repeated in the identical manner on the subsequent test |
|
|
Term
| what is the frequency recommendation for patients with PAD? |
|
Definition
weight-bearing exercise 3-5 days per week
weight lifting at least 2 days a week |
|
|
Term
| what is the intensity recommendation for patients with PAD? |
|
Definition
| moderate intensity 40-60% VO2R that allow patient to walk until a pain score of 3 is reached |
|
|
Term
| what is the time recommendation for patients with PAD? |
|
Definition
| 30-60 min per day, but may being with 10 minute bouts to total that. may also being with 15 mina day to gradually increase 5 min a day bi weekly |
|
|
Term
| what is the type recommendation for patients with PAD? |
|
Definition
weight-bearing aerobic exercise and non-weight-bearing aerobic exercise
cycling can be used in the warm up but should not be primary
resistance training is recommended |
|
|
Term
| what are other considerations for patients with PAD? |
|
Definition
no optimal work to rest ratio
cold environment may aggravate the symptoms of intermittent claudication
encourage patients to stop smoking
should participate in supervised exercise for at least 6 mo |
|
|
Term
| what are the exercise considerations for patients with pacemakers? |
|
Definition
programmed pacemaker modes, HR limits
exercise testing should be used to evaluate HR and rhythm |
|
|
Term
| in patients with heart failure, resistance training has been shown to what? |
|
Definition
increase muscle strength and endurance
reduce symptoms
improve quality of life |
|
|
Term
| patients with cardiac transplantation, rehabilitation should be aware of what hemodynamic alterations that are commonly present? |
|
Definition
resting HR is elevated
HR response to exercise is abnormal such as increase HR is delayed and HR is below normal |
|
|
Term
| what are the purposes of resistance training for patients with cardiac disease? |
|
Definition
improve muscular strength and endurance
decrease cardiac demands of muscular work
prevent and treat other diseases and conditions
improve self confidence
maintain independence |
|
|
Term
| an exercise program consists of what three components? |
|
Definition
warm up
conditioning
cool down |
|
|
Term
| how long does the warm up usually last according to the article? |
|
Definition
|
|
Term
| T/F people with above average ROMs may actually be at an increased risk for injury if the musculature to stabilize the joint is inadequate. |
|
Definition
|
|
Term
| what is the conditioning period designed to do? |
|
Definition
increase caloric expenditure to aid with weight management
improve overall FC
delay the onset of symptoms
maintain current functional ability |
|
|
Term
| what are the five components of the conditioning phase? |
|
Definition
frequency
intensity
time
type
progression |
|
|
Term
what is the standard recommendation for frequency, according to the article?
what is recommended for the average rehabilitation program? |
|
Definition
3-5 time per week
3 times per week for the first 6 mo |
|
|
Term
what is the recommendation for intensity, according to the article?
explain the sliding scale. |
|
Definition
40-50% of FC
training intensity is a baseline of 60% plus the max METs of they individual, but for patients who are high risk or have low FC the base is 40% and add twice the FC |
|
|
Term
| T/F exercise intensity is static. |
|
Definition
|
|
Term
| if patients use the handrail what is the percent error of the test increased by? |
|
Definition
|
|
Term
| what can alter a patients FC? |
|
Definition
|
|
Term
| what are ways to measure exercise intensity? |
|
Definition
METs
HR
RPE
onset of symptoms |
|
|
Term
| is using the onset of symptoms for exercise intensity what is a good indicator of the ischemic threshold? |
|
Definition
|
|
Term
| what is the recommended duration of exercise session, according to the article? |
|
Definition
|
|
Term
| what is the goal for most patients in the duration of the session? |
|
Definition
| to achieve continuous activity |
|
|
Term
| what is the recommendations for mode,according to the article to improve FC? |
|
Definition
| large muscle group rhythmic and repetitive exercise |
|
|
Term
| T/F cycling is like to result in greater total muscle fatigue. |
|
Definition
|
|
Term
| T/F it is important to train specifically in cardiac rehab |
|
Definition
|
|
Term
| T/F cycle ergometry only yields a FC that is 85% that which is obtain on a treadmill. |
|
Definition
|
|
Term
| what type of resistance training is recommended for cardiac rehab patients, according to the article? |
|
Definition
|
|
Term
| how long should you wait to increase weight? |
|
Definition
|
|
Term
| what is the weight loss goal per week? |
|
Definition
|
|
Term
| what are the guidelines for weight loss? |
|
Definition
1)caloric intake should be balanced and not lower than 1200 kcal per day
2)a negative caloric behavior should not exceed 500-1000 kcal per day
3)the use of behavior modification should be included to identify and eliminate diet habits
4)exercise programs that provide daily calorie expenditures of more than or equal to 300 kcal per day should be included
5)the weight loos program should be structured to show how new eating habits, exercise habits, and associated weight loss can be maintained |
|
|
Term
| how long does the cool down last, according to the article? |
|
Definition
|
|
Term
| what should be performed in the cool down? |
|
Definition
| low-level, rhythmic, aerobic exercise |
|
|
