Transcript Chapter 7 Aerobic Exercise - PHT 1228c Therapeutic Exercise II

Principles of Aerobic Exercise
Chapter 7
Part II: Applied Science of Exercise and
Techniques
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Key Terms and Concepts
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Physical Activity
Exercise
Physical Fitness
Maximum Oxygen
Consumption
 Endurance
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 Aerobic Exercise
Training (Conditioning)
 Adaptation
 Myocardial Oxygen
Consumption
 Deconditioning
Energy Systems, Energy
Expenditure, and Efficiency
 Energy Systems
– Phosphagen, or ATP-PC system
– Anaerobic glycolytic system
– Aerobic system
– Recruitment of motor units
– Functional implications
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Energy Systems, Energy
Expenditure, and Efficiency (cont'd)
 Energy Expenditure
– Quantification of energy expenditure
– Classification of activities
 Efficiency
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Physiological Response to Aerobic
Exercise
 Cardiovascular Response to Exercise
– Exercise pressor response
– Cardiac effects
– Peripheral effects
• Net reduction in total peripheral resistance
• Increased cardiac output
• Increase in systolic blood pressure
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Physiological Response to Aerobic
Exercise (cont'd)
 Respiratory Response to Exercise
 Responses Providing Additional Oxygen to
Muscle
– Increased blood flow
– Increased oxygen extraction
– Oxygen consumption
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Signs & Symptoms of Excessive
Effort
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Persistent dyspnea
Dizziness/confusion
Pain
Severe leg claudication
Excessive fatigue
Pallor, cold sweat
Ataxia
Pulmonary rales
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 Lack of SBP increase
 Hypertensive BP >
200/110
 Progressive fall in SBP by
10-15mmHg
 Change in rhythm
Delayed Responses:
Prolonged fatigue
Insomnia
Sudden weight gain due to
fluid
Testing as a Basis for Exercise
Programs
 Fitness Testing of Healthy Subjects
 Stress Testing for Convalescing Individuals and
Individuals at Risk
– Principles of stress testing
– Purpose of stress testing
– Preparation for stress testing
– Termination of stress testing
 Multistage Testing
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Determinants of an Exercise
Program
 Frequency
 Intensity
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Overload principle
Individuals at risk
Variables
Specificity principle
 Time (Duration)
 Type (Mode)
– Reversibility principle
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General Recommendations for
Aerobic Physical Activity
 ACSM, AHA, CDC, Surgeon General
– Children: Age 6–17
– Adults: Age 18–65
– Older adults: Age 65 or older
– Adults age 50–65 with chronic health conditions
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Exercise Program
 Warm-Up Period
 Aerobic Exercise Period
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Continuous training
Interval training
Circuit training
Circuit-interval training
 Cool-Down Period
 Application
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Physiological Changes That Occur
With Training
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Cardiovascular
Respiratory
Metabolic
Other Systems
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Application of Principles of an
Aerobic Conditioning Program
 For the Patient With Coronary Disease
– Inpatient phase (Phase I)
– Outpatient phase (Phase II)
– Outpatient program (Phase III)
– Special considerations
– Adaptive changes
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Applications of Aerobic Training
 For the Deconditioned Individual and the
Patient With Chronic Illness
– Deconditioning
– Reversal of deconditioning
– Adaptations for participation restrictions
(disabilities), activity restrictions (functional
limitations), and deconditioning
– Impairments, goals, and plan of care
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Age Differences
 Children
 Young Adults
 Older Adults
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Heart Rate
Stroke Volume
Cardiac Output
Arteriovenous Oxygen
Difference
Maximum Oxygen Uptake
Blood Pressure
Respiration
Muscle Mass and Strength
Anaerobic Ability
Hypertension
 Prehypertensive
 Stage I
 Stage II
 Stage II
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 SBP 120-130; DBP 80-89
 SBP 130-140; DBP 90100
 SBP 140-160; DBP 100110
 SBP > 160; DBP >110
PT Intervention for Pts with CAD
 General Goals of PT intervention
– Increase aerobic capacity
– Increase ability to perform physical tasks related
to self care, home management, community &
work integration & leisure activities
– Improve physiological response to increased O2
demand
– Increased strength, power & endurance
– Decreased symptoms associated with increased
O2 demand
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PT Intervention - continued
 Increase ability to recognize recurrence &
intervention is sought sooner
 Reduce risk of recurrence
 Acquire behaviors that foster healthy habits,
wellness, & prevention
 Enhance decision making regarding health,
use of health care resources by pt, family,
caregivers, etc.
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Contraindications to Aerobic
Exercise
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Unstable Angina
Symptomatic heart failure
Uncontrolled arrythmias
Moderate to severe aortic stenosis
Uncontrolled diabetes
Acute systemic illness/fever
Uncontrolled tachycarida (HR >100 bpm)
Resting SBP > 200 mmHG; DBP >110 mmHg
Thromophlebitis
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Clinical Signs & Symptoms
CAD/CHF
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Chest pressure
Dyspnea
Fatigue
Syncope
Palpitations
Edema – pulmonary/Peripheral – CHF
Fluid weight gain – CHF
S3 Heart Sound – CHF
Renal dysfunction - CHF
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PT Intervention for CHF - Goals
 Improve physiological reponse to increased O2
demand
 Improvement of self management of symptoms
 Increased ability to perform physical tasks
 Acquire behaviors that foster healthy habits, wellness
& prevention
 Reduction of disability associated with acute or chronic
illness
 Reduction of secondary impairments
 Improved awareness & use of community resources
 Increased performance of & independence with ADL’s
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Pt Education for Pts with CHD
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Activity Guidelines
Self Monitoring – pulse; RPE
Symptom recognition & response
Nutrition
Medications – prescription & OTC
Lifestyle issues
Psychological/Social Issues
Other
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