PE400 Test 2

Chapter 8

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• Physical health domain includes the following:​

  • Health-related components​

    • Cardiorespiratory, muscular strength and endurance, body composition, and flexibility​

  • Skill-related components​

    • Agility, balance, coordination, power, speed, and reaction time​

  • Medical-related components​

    • Integumentary, musculoskeletal, cardiovascular/lymphatic, respiratory, neurologic, endocrine, digestive/excretory/urinary, immune, and reproductive

Percentage of age-predicted maximal heart rate (APMHR)​

• 207 - (0.7 X age), provide desired intensity percentages

Aerobic exercises are categorized by intensity and skill demands (Table 8.3).​

• Type A exercises: recommended for all adults; little skill is needed, and the intensity is easily modified.

• Type B exercises: typically performed at vigorous intensities, recommended for those with average physical fitness who have been exercising on a regular basis

• Type C exercises: require skill to perform; best for individuals with reasonable motor skills and physical fitness

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• Type D exercises: recreational sports, generally recommended as ancillary physical activities, only recommended for those with motor skills and physical fitness adequate to perform safely

Aerobic exercise volume is the product of frequency, intensity, and time.

Aerobic exercise progression may consist of increasing any of the components of the FITT principle.​

• Rate of exercise progression depends on:​

• Health status​

• Physical fitness​

• Training responses​

• Program goals

  When initiating an exercise program:​

• Light-to-moderate intensity and then increasing exercise time as tolerated is recommended.​

• 5–10 minutes every 1–2 weeks for the first 4–6 weeks

Chapter 9

Pregnancy

• Primarily distributed in the abdominal region​

• Weight gain can lead to:​

• Translation of the center of gravity​

• Increases the risk for balance complications ​

• Functional imbalance between hip flexors and hip extensors​

• Altered glenohumeral and cervical spine mechanics

Special Considerations

Body position​

• Supine position​

• Contraindicated after 16th week of gestation ​

• Can impact uterine blood flow and maternal venous return ​

• Prone position ​

• i.e., Lying on stomach​

• Avoid after 1st trimester

Chapter 10: Chronic Stable Angina and Coronary Artery Bypass Graft Surgery

For individuals with coronary heart disease (CHD), exercise is a critical intervention and should be prioritized.​

• Slows the progression of disease​

• Prevents or reverses physical deconditioning

Angina is chest pain, pressure, discomfort, or fullness that is the manifestation of diminished blood flow resulting in inadequate oxygen delivery to the myocardium.​

• Brought on by exertion or psychological stress ​

• Resolved with rest or medications ​

• Management of symptoms is of paramount importance.

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• Unstable angina: worsening angina, sudden-onset angina at rest, and angina lasting more than 15 minutes​

• Chronic angina: usually related to myocardial ischemia, typically presents with the initiation of physical activity, and symptoms are typically nonexistent at rest

CABGS is an invasive methods that involves harvesting and surgically grafting a blood vessel.​

• Bypasses an area of the coronary artery that has restricted blood flow as a result of atherosclerosis

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• Recovery time is typically 6–8 weeks for sternum-splitting incision and 2–4 weeks for minimally invasive surgeries.

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• Upper body weight restrictions are typically in place for 5–8 weeks.

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• Lower intensity, lower body, and aerobic exercise can begin as early as 2 weeks postsurgery.​

Chapter 11:
Ventricular Assist Devices, Total Artificial Heart, and Heart Transplantation

LVAD is a battery-powered pump surgically implanted in the upper abdomen that provides circulatory support by pulling blood from the left ventricle and pumping it to the aorta.
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• Commonly used for:

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• Maintaining patient viability while waiting for a heart transplant

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• Permanent solution for patients deemed not suitable for transplantation

Heart Transplant

• Orthotopic transplantation: excision of diseased heart and anastomosis of the donor heart to the great vessels and atria of the recipient​

  1. More common surgical technique​

• Heterotopic transplantation: Diseased heart is left intact, and donor heart is sewn in parallel.

There are four types of rejection:​

• Hyperacute: caused by preformed antibodies to the donor heart.

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• Acute cellular: caused by T-lymphocyte and macrophage infiltration of the myocardium.

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• Acute humoral (vascular): initiated by antibodies which can impair coronary vasodilatory reserve resulting in ventricular dysfunction.

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• Chronic: an unusually accelerated form of coronary artery disease affecting epicardial and intramyocardial coronary arteries and veins

Responses to acute exercise in transplant patients are unique and related to the following factors:
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• Donor heart does not receive direct input from autonomic nervous system or provide direct afferent signals to the central nervous system.

Heart rate​

Resting HR is elevated.​

1. Exercising HR will elevate more gradually and peak HR will be lower than normal, highest HR typically during recovery.

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Blood pressure ​

Cardiac output​
Impaired due to lower stroke volume and HR responses

Chapter 12
Cardiovascular Disease: Heart Failure

Symptom-limited exercise test using a low-intensity protocol should be performed prior to exercise prescription.
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Exercise testing considerations include the following:​

• Monitoring postexercise symptoms closely

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  • Hypotension, arrhythmias, or disproportionate dyspnea

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• Low-intensity protocols with small, 1-MET increases between stages should be used.

  Modified Naughton or ramp protocols

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• Six-minute walk test may be used as an alternative in this population.

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• Test termination criteria should be focused on symptoms instead of target HR.

HF is associated with skeletal muscle abnormalities resulting in decreased exercise tolerance and function.​

The importance of resistance training cannot be underestimated.​

Resistance training recommendations​

• At least 1–2 nonconsecutive days per week

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• 1–2 sets, 10–15 repetitions; begin 40% 1-RM for lower body and 50% 1–RM for upper body

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• May progress to 70% 1-RM as tolerated

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• Power training is also essential.

Chapter 13
Valvular Heart Disease and Peripheral Artery Disease​

Valvular heart disease (VHD) is any disease of a single heart valve or any combination of the four valves.

• Aortic and mitral valve diseases are most prevalent due to higher pressure on the left side of the heart

Exercise prescription and progression depends on:​

• Severity of disease​

• Presence of symptoms​

• Type of treatment​

• Patients with asymptomatic VHD can participate in competitive sports and vigorous activity.​

• Patients with more than mild VHD or additional limitations, like anticoagulant therapy, should avoid competitive sports and/or vigorous activities.

Chapter 14
Special Considerations for Type 1 and Type 2 Diabetes Mellitus

Glycemic control is assessed by measuring HbA1C.​

1. Time-averaged blood glucose concentration over the previous 2–3 months.​

HbA1C goal = <7.0%, measured every 3–4 months​

Exercise facilitates improved blood glucose control for T2DM but does not uniformly provide glycemic control for T1DM.
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Exercise also assists with:​

1. Risk of CVD in patients with diabetes

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2. Reductions in BP

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3. Exercise-related risks associated with diabetes

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4. Hypoglycemia

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5. Hyperglycemia

Chapter 15
Metabolic Syndrome, Hypertension, and Dyslipidemia