Podcast
Questions and Answers
What is the typical chronic response in clients with CHF during exercise?
What is the typical chronic response in clients with CHF during exercise?
- No change in HR
- Increase in HR
- Lower peak HR and failure to meet >85% maximum HR (correct)
- Decrease in HR
Clients with stable CHF cannot undergo symptom-limited maximum cardiopulmonary exercise testing.
Clients with stable CHF cannot undergo symptom-limited maximum cardiopulmonary exercise testing.
False (B)
What is the purpose of functional tests for musculoskeletal strength and endurance?
What is the purpose of functional tests for musculoskeletal strength and endurance?
planning and evaluating exercise programs
Blood lactate concentration can be identified at the ______________.
Blood lactate concentration can be identified at the ______________.
Match the following medications with their effect on aerobic capacity in clients with CHF:
Match the following medications with their effect on aerobic capacity in clients with CHF:
What is an absolute contraindication for exercise in clients with CHF?
What is an absolute contraindication for exercise in clients with CHF?
Clients with CHF do not need to undergo ECG monitoring and pulse oximetry during early exercise sessions.
Clients with CHF do not need to undergo ECG monitoring and pulse oximetry during early exercise sessions.
What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?
What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?
Clients with stable CHF, with medical clearance, are able to undertake an exercise program with the goal of improving ______________.
Clients with stable CHF, with medical clearance, are able to undertake an exercise program with the goal of improving ______________.
Which of the following is a consideration for exercise testing in clients with CHF?
Which of the following is a consideration for exercise testing in clients with CHF?
What is the primary consideration when performing resistance training with a client who has a pacemaker?
What is the primary consideration when performing resistance training with a client who has a pacemaker?
Clients with a fixed-rate pacemaker should exceed the intensity in which BP begins to plateau with increased workload.
Clients with a fixed-rate pacemaker should exceed the intensity in which BP begins to plateau with increased workload.
What is the recommended frequency for aerobic exercise?
What is the recommended frequency for aerobic exercise?
The recommended intensity range for exercise is ______________% VO2peak.
The recommended intensity range for exercise is ______________% VO2peak.
What is the significance of a second degree type I (Wenckebach) block during exercise?
What is the significance of a second degree type I (Wenckebach) block during exercise?
Clients with a pacemaker should avoid contact sports during exercise.
Clients with a pacemaker should avoid contact sports during exercise.
What is the recommended duration for aerobic exercise?
What is the recommended duration for aerobic exercise?
What is the purpose of using RPE and METs in client's with a pacemaker?
What is the purpose of using RPE and METs in client's with a pacemaker?
The recommended weekly energy expenditure for aerobic exercise is greater than ______________ kcal.
The recommended weekly energy expenditure for aerobic exercise is greater than ______________ kcal.
Match the following types of pacemakers with their exercise intensity considerations:
Match the following types of pacemakers with their exercise intensity considerations:
What is the main goal of exercise interventions for individuals with pulmonary conditions?
What is the main goal of exercise interventions for individuals with pulmonary conditions?
Clients with pulmonary conditions can undergo exercise testing without any precautions.
Clients with pulmonary conditions can undergo exercise testing without any precautions.
What are the learning outcomes for exercise physiology in relation to pulmonary conditions?
What are the learning outcomes for exercise physiology in relation to pulmonary conditions?
The pulmonary system is responsible for exchanging ______________ and carbon dioxide.
The pulmonary system is responsible for exchanging ______________ and carbon dioxide.
Match the following components of the pulmonary system with their functions:
Match the following components of the pulmonary system with their functions:
What happens to the intrapleural pressure during inspiration?
What happens to the intrapleural pressure during inspiration?
The diaphragm rises during inspiration.
The diaphragm rises during inspiration.
What is the final temperature of inhaled air when it reaches the alveoli?
What is the final temperature of inhaled air when it reaches the alveoli?
According to Charles's law, the volume of a gas is directly proportional to its _______________________ temperature.
According to Charles's law, the volume of a gas is directly proportional to its _______________________ temperature.
What is the purpose of the conducting zone in the respiratory system?
What is the purpose of the conducting zone in the respiratory system?
The flow of a fluid is directly proportional to the resistance.
The flow of a fluid is directly proportional to the resistance.
What is the relationship between the pressure of a given quantity of gas and its volume according to Boyle's Law?
What is the relationship between the pressure of a given quantity of gas and its volume according to Boyle's Law?
Atmospheric pressure is typically measured in units of ______________ mm Hg at sea level.
Atmospheric pressure is typically measured in units of ______________ mm Hg at sea level.
Match the following components of the respiratory system with their functions:
Match the following components of the respiratory system with their functions:
What percentage of CO2 is transported in the blood as carbamino compounds?
What percentage of CO2 is transported in the blood as carbamino compounds?
Oxyhemoglobin is formed when O2 reacts with HHb in the blood.
Oxyhemoglobin is formed when O2 reacts with HHb in the blood.
What is the enzyme that helps in the conversion of CO2 to H2CO3?
What is the enzyme that helps in the conversion of CO2 to H2CO3?
The majority of CO2 in the blood is transported as ______________.
The majority of CO2 in the blood is transported as ______________.
Match the following terms with their definitions:
Match the following terms with their definitions:
Which measurement is most directly relevant to the body's ability to get oxygen to the tissues and dispose of carbon dioxide?
Which measurement is most directly relevant to the body's ability to get oxygen to the tissues and dispose of carbon dioxide?
The exact mechanism for setting the rhythm of respiration is fully understood.
The exact mechanism for setting the rhythm of respiration is fully understood.
Where does voluntary control over breathing originate?
Where does voluntary control over breathing originate?
The ______________ respiratory group produces a respiratory rhythm of 12 breaths per minute.
The ______________ respiratory group produces a respiratory rhythm of 12 breaths per minute.
Match the following brain regions with their functions in controlling breathing:
Match the following brain regions with their functions in controlling breathing:
What is the name of the test used to assist in asthma diagnosis to assess sensitivity of the airways?
What is the name of the test used to assist in asthma diagnosis to assess sensitivity of the airways?
Malnutrition or nutritional depletion is a rare issue for COPD clients.
Malnutrition or nutritional depletion is a rare issue for COPD clients.
What is the significance of a higher chlorine concentration in clients with cystic fibrosis?
What is the significance of a higher chlorine concentration in clients with cystic fibrosis?
The primary metabolic alkalosis is compensated by _______________________.
The primary metabolic alkalosis is compensated by _______________________.
Match the following tests with their purposes:
Match the following tests with their purposes:
The diaphragm rises during expiration.
The diaphragm rises during expiration.
What is the name of the imaging test used to differentiate between emphysema and chronic bronchitis?
What is the name of the imaging test used to differentiate between emphysema and chronic bronchitis?
What is the significance of malnutrition and associated weight loss in COPD clients?
What is the significance of malnutrition and associated weight loss in COPD clients?
Malnutrition or nutritional depletion may be an issue for up to _________% of COPD clients.
Malnutrition or nutritional depletion may be an issue for up to _________% of COPD clients.
What percentage of Australians had asthma in 2022?
What percentage of Australians had asthma in 2022?
The prevalence of asthma is higher for people living in disadvantaged areas.
The prevalence of asthma is higher for people living in disadvantaged areas.
What percentage of people aged 65 years and over had COPD in 2022?
What percentage of people aged 65 years and over had COPD in 2022?
Of all people with COPD in 2022, ______________% had two or more chronic conditions.
Of all people with COPD in 2022, ______________% had two or more chronic conditions.
Match the following demographics with their corresponding asthma prevalence rates in 2022:
Match the following demographics with their corresponding asthma prevalence rates in 2022:
What percentage of First Nations people had asthma in 2022?
What percentage of First Nations people had asthma in 2022?
The prevalence of COPD has decreased in the last decade.
The prevalence of COPD has decreased in the last decade.
How many deaths in Australia were related to asthma in 2022?
How many deaths in Australia were related to asthma in 2022?
What percentage of adults who experienced severe or very severe bodily pain in the 4-weeks prior to interview had COPD?
What percentage of adults who experienced severe or very severe bodily pain in the 4-weeks prior to interview had COPD?
A primary process is followed by a compensatory process in respiratory acidosis.
A primary process is followed by a compensatory process in respiratory acidosis.
What is the purpose of spirometry?
What is the purpose of spirometry?
The FEV1/FVC ratio of ≥80% is normal for ______________ individuals.
The FEV1/FVC ratio of ≥80% is normal for ______________ individuals.
Match the following spirometric tests with their descriptions:
Match the following spirometric tests with their descriptions:
Arterial blood gases contribute to the diagnosis and determine the need for oxygen therapy.
Arterial blood gases contribute to the diagnosis and determine the need for oxygen therapy.
What is the primary respiratory acidosis compensatory process?
What is the primary respiratory acidosis compensatory process?
The pulmonary system is responsible for exchanging ______________ and carbon dioxide.
The pulmonary system is responsible for exchanging ______________ and carbon dioxide.
What is the primary function of the conducting zone in the respiratory system?
What is the primary function of the conducting zone in the respiratory system?
The diaphragm falls during inspiration.
The diaphragm falls during inspiration.
What is the main goal of exercise interventions for individuals with pulmonary conditions?
What is the main goal of exercise interventions for individuals with pulmonary conditions?
The pulmonary system is responsible for exchanging _________ and carbon dioxide.
The pulmonary system is responsible for exchanging _________ and carbon dioxide.
Match the following components of the respiratory system with their functions:
Match the following components of the respiratory system with their functions:
What is the effect of oxidative stress on antiproteases?
What is the effect of oxidative stress on antiproteases?
Protease and anti-tease imbalance is a characteristic of COPD.
Protease and anti-tease imbalance is a characteristic of COPD.
What is the effect of transforming growth factor β on the airways?
What is the effect of transforming growth factor β on the airways?
Cigarette smoke and inflammation itself produce _______________________, which primes several inflammatory cells to release a combination of proteases and inactivates several antiproteases.
Cigarette smoke and inflammation itself produce _______________________, which primes several inflammatory cells to release a combination of proteases and inactivates several antiproteases.
Match the following components with their effects:
Match the following components with their effects:
What is a characteristic of COPD exacerbations?
What is a characteristic of COPD exacerbations?
Most clients with COPD experience significant reversibility/symptom-free periods.
Most clients with COPD experience significant reversibility/symptom-free periods.
What is the diagnosis given to patients experiencing recurrent airflow obstruction with a combination of asthma and COPD features?
What is the diagnosis given to patients experiencing recurrent airflow obstruction with a combination of asthma and COPD features?
Inflammation in COPD is present in all areas of the lungs as a ______________ response to inhaled toxins.
Inflammation in COPD is present in all areas of the lungs as a ______________ response to inhaled toxins.
Match the following factors with their influence on COPD progression:
Match the following factors with their influence on COPD progression:
What is the primary risk factor for developing COPD?
What is the primary risk factor for developing COPD?
The main site of airflow obstruction in COPD occurs in the large conducting airways.
The main site of airflow obstruction in COPD occurs in the large conducting airways.
What happens to the alveoli walls in COPD?
What happens to the alveoli walls in COPD?
In COPD, the bronchi are affected by enlarged _______________________ glands and dilated gland ducts.
In COPD, the bronchi are affected by enlarged _______________________ glands and dilated gland ducts.
Match the following COPD effects with their corresponding sites:
Match the following COPD effects with their corresponding sites:
What is the definition of Chronic Obstructive Pulmonary Disorder (COPD)?
What is the definition of Chronic Obstructive Pulmonary Disorder (COPD)?
All individuals with COPD have a non-fully reversible airflow limitation (FEV1/FVC < 0.7) measured by spirometry.
All individuals with COPD have a non-fully reversible airflow limitation (FEV1/FVC < 0.7) measured by spirometry.
What are the major risk factors for COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)?
What are the major risk factors for COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)?
The diagnosis of COPD is based on the presence of non-fully reversible airflow limitation, measured by _______________________.
The diagnosis of COPD is based on the presence of non-fully reversible airflow limitation, measured by _______________________.
Match the following symptoms with their characteristic feature in COPD:
Match the following symptoms with their characteristic feature in COPD:
What is the goal of ventilatory muscle training for COPD patients?
What is the goal of ventilatory muscle training for COPD patients?
Inspiratory Resistive Loading is a technique used in ventilatory muscle training.
Inspiratory Resistive Loading is a technique used in ventilatory muscle training.
What is the purpose of Voluntary Isocapnic Hyperpnea in ventilatory muscle training?
What is the purpose of Voluntary Isocapnic Hyperpnea in ventilatory muscle training?
Inspiratory Threshold Loading devices permit air to flow through them only after a critical ___________ pressure has been reached.
Inspiratory Threshold Loading devices permit air to flow through them only after a critical ___________ pressure has been reached.
Match the following ventilatory muscle training techniques with their descriptions:
Match the following ventilatory muscle training techniques with their descriptions:
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
The diaphragm descends during inspiration.
The diaphragm descends during inspiration.
What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?
What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?
The _______________________ muscles are activated during exercise in clients with pulmonary conditions.
The _______________________ muscles are activated during exercise in clients with pulmonary conditions.
Match the following components of resistance training with their goals:
Match the following components of resistance training with their goals:
What is the primary method used to establish an initial diagnosis of COPD?
What is the primary method used to establish an initial diagnosis of COPD?
In clients with COPD, exercise testing is only important for those with severe disease.
In clients with COPD, exercise testing is only important for those with severe disease.
What are some common signs and symptoms of COPD?
What are some common signs and symptoms of COPD?
The ______ barked
The ______ barked
Match the following components of the diagnostic process for COPD with their descriptions:
Match the following components of the diagnostic process for COPD with their descriptions:
What is the purpose of exercise testing in clients with COPD?
What is the purpose of exercise testing in clients with COPD?
Arm ergometer testing results in decreased dyspnea in clients with COPD.
Arm ergometer testing results in decreased dyspnea in clients with COPD.
What is the name of the test used to assess the exercise capacity of clients with COPD?
What is the name of the test used to assess the exercise capacity of clients with COPD?
In clients with COPD, reduced exercise capacity is due to reduced _______________________ capacity compared to demand.
In clients with COPD, reduced exercise capacity is due to reduced _______________________ capacity compared to demand.
Match the following exercise tests with their characteristics:
Match the following exercise tests with their characteristics:
What is the recommended intensity of the training load for ventilatory muscle training according to ACSM?
What is the recommended intensity of the training load for ventilatory muscle training according to ACSM?
There is a demonstrated superiority of one method of inspiratory muscle training over another.
There is a demonstrated superiority of one method of inspiratory muscle training over another.
What is the frequency of inspiratory muscle training recommended by AACVPR?
What is the frequency of inspiratory muscle training recommended by AACVPR?
The AACVPR recommends inspiratory muscle training sessions of two 15 min sessions per day or one ______________ min session per day.
The AACVPR recommends inspiratory muscle training sessions of two 15 min sessions per day or one ______________ min session per day.
Match the following types of inspiratory muscle training with their descriptions:
Match the following types of inspiratory muscle training with their descriptions:
What is the primary contributing factor to asthma?
What is the primary contributing factor to asthma?
Inflammation in asthma is primarily in the small sized bronchi.
Inflammation in asthma is primarily in the small sized bronchi.
What is the percentage of adults with recently diagnosed asthma who may experience clinical remission within 5 years?
What is the percentage of adults with recently diagnosed asthma who may experience clinical remission within 5 years?
Inflammation in asthma promotes ______________ and structural changes in the airways.
Inflammation in asthma promotes ______________ and structural changes in the airways.
Match the following factors with their relationship to asthma:
Match the following factors with their relationship to asthma:
What percentage of CF patients have exocrine pancreatic insufficiency?
What percentage of CF patients have exocrine pancreatic insufficiency?
Malnutrition is a rare issue for CF patients.
Malnutrition is a rare issue for CF patients.
What is the correlation between ideal body mass and the effects on the respiratory system?
What is the correlation between ideal body mass and the effects on the respiratory system?
CF-related diabetes is more common in adults over ______ years.
CF-related diabetes is more common in adults over ______ years.
Match the following effects on the body with their corresponding systems:
Match the following effects on the body with their corresponding systems:
What is the primary characteristic of asthma?
What is the primary characteristic of asthma?
Asthma is a homogeneous disease.
Asthma is a homogeneous disease.
What is the typical pattern of symptoms in individuals with asthma?
What is the typical pattern of symptoms in individuals with asthma?
Asthma is defined by the history of respiratory symptoms, such as _______________________, that vary over time and in intensity.
Asthma is defined by the history of respiratory symptoms, such as _______________________, that vary over time and in intensity.
Match the following characteristics of asthma with their definitions:
Match the following characteristics of asthma with their definitions:
What percentage of Australians had asthma in 2020-21 according to the ABS?
What percentage of Australians had asthma in 2020-21 according to the ABS?
Pathology may be present even when symptoms are present.
Pathology may be present even when symptoms are present.
What is the name of the asthma phenotype that is particularly common in women who present for the first time in adulthood?
What is the name of the asthma phenotype that is particularly common in women who present for the first time in adulthood?
First Nations people were ______________ times as likely to report having asthma as non-Indigenous Australians.
First Nations people were ______________ times as likely to report having asthma as non-Indigenous Australians.
Match the following asthma phenotypes with their characteristics:
Match the following asthma phenotypes with their characteristics:
What is the characteristic of lung function in individuals with asthma?
What is the characteristic of lung function in individuals with asthma?
Allergy tests are specific for asthma and are present in all phenotypes.
Allergy tests are specific for asthma and are present in all phenotypes.
What is the significance of a reduced FEV1/FVC ratio in diagnosing asthma?
What is the significance of a reduced FEV1/FVC ratio in diagnosing asthma?
Inhaled ____________ are used in bronchial provocation tests to diagnose asthma.
Inhaled ____________ are used in bronchial provocation tests to diagnose asthma.
Match the following tests with their purposes in diagnosing asthma:
Match the following tests with their purposes in diagnosing asthma:
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
Clients with stable CHF can undergo symptom-limited maximum cardiopulmonary exercise testing without medical clearance.
Clients with stable CHF can undergo symptom-limited maximum cardiopulmonary exercise testing without medical clearance.
What is the purpose of conducting exercise/fitness/functional tests on individuals with asthma and cystic fibrosis?
What is the purpose of conducting exercise/fitness/functional tests on individuals with asthma and cystic fibrosis?
According to Boyle's Law, the volume of a gas is directly proportional to its _______________________ temperature.
According to Boyle's Law, the volume of a gas is directly proportional to its _______________________ temperature.
Match the following terms with their definitions:
Match the following terms with their definitions:
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
What is the primary goal of exercise interventions for individuals with pulmonary conditions?
Teens with pulmonary conditions should undergo 60 minutes of daily physical activity.
Teens with pulmonary conditions should undergo 60 minutes of daily physical activity.
What is the recommended frequency for aerobic exercise in individuals with pulmonary conditions?
What is the recommended frequency for aerobic exercise in individuals with pulmonary conditions?
Young children with pulmonary conditions should engage in __________ minutes of physical activity per day.
Young children with pulmonary conditions should engage in __________ minutes of physical activity per day.
Match the following age groups with their recommended exercise frequency and duration:
Match the following age groups with their recommended exercise frequency and duration:
What is the primary reason for conducting an exercise test in clients with asthma?
What is the primary reason for conducting an exercise test in clients with asthma?
Clients with asthma should avoid exercise if they experience acute bronchospasm.
Clients with asthma should avoid exercise if they experience acute bronchospasm.
What is the typical duration of bronchoconstriction after exercise in clients with exercise-induced bronchospasm?
What is the typical duration of bronchoconstriction after exercise in clients with exercise-induced bronchospasm?
Exercise-induced bronchospasm is related more to the ______________________ of air during exercise.
Exercise-induced bronchospasm is related more to the ______________________ of air during exercise.
Match the following symptoms with exercise-induced bronchospasm:
Match the following symptoms with exercise-induced bronchospasm:
What is the recommended weekly duration of enjoyed activities for children with cystic fibrosis?
What is the recommended weekly duration of enjoyed activities for children with cystic fibrosis?
Resistance training can improve muscular strength and endurance in clients with cystic fibrosis.
Resistance training can improve muscular strength and endurance in clients with cystic fibrosis.
What is the benefit of exercise training on dynamic lung function in clients with cystic fibrosis?
What is the benefit of exercise training on dynamic lung function in clients with cystic fibrosis?
Exercise training can improve ______________ in clients with cystic fibrosis.
Exercise training can improve ______________ in clients with cystic fibrosis.
Match the following benefits of exercise training with their descriptions:
Match the following benefits of exercise training with their descriptions:
What is the primary purpose of bronchoprovocation challenge with pre and post spirometry testing?
What is the primary purpose of bronchoprovocation challenge with pre and post spirometry testing?
According to the ACSM recommendations, avoidance of triggers resulting in bronchoconstriction is not necessary for clients with asthma.
According to the ACSM recommendations, avoidance of triggers resulting in bronchoconstriction is not necessary for clients with asthma.
What is the significance of a 15-minute pre-exercise warm-up in reducing the risk of EIB?
What is the significance of a 15-minute pre-exercise warm-up in reducing the risk of EIB?
The protocol for exercise testing in clients with cystic fibrosis involves monitoring and management of the client's _______________________.
The protocol for exercise testing in clients with cystic fibrosis involves monitoring and management of the client's _______________________.
Match the following components with their purposes in managing exercise-induced bronchoconstriction (EIB):
Match the following components with their purposes in managing exercise-induced bronchoconstriction (EIB):
Study Notes
Revascularisation
- Restoration of perfusion to a body part or organ
- Myocardium = CABG (Coronary Artery Bypass Grafting) and PCI/PTCA (Percutaneous Coronary Intervention/Percutaneous Transluminal Coronary Angioplasty)
Exercise in Patients with CAD
- Common for clients with CAD and associated pathologies to experience angina
- Angina symptoms are a cascade of events referred to as the ischemic cascade:
- Increased plaque, leading to an imbalance between O2 supply and demand in the myocardium
- Abnormal diastolic function (ventricular compliance and impaired filling)
- Systolic abnormalities (effecting preload, afterload, ejection fraction, cardiac output, etc.)
- ECG changes – ST segment depression
- Angina
Considerations - Medications
- Cardiac rehabilitation (CR) reduces the risk of future events
- International guidelines recommend patients have access to, and participate in, CR (for secondary prevention)
- Modern CR is multidisciplinary, including patient assessments, risk profiles, dietary advice, psychosocial support, individualised exercise prescription, and physical activity counselling
Contraindications to Exercise (Cardiac Rehab)
- Specific contraindications to exercise testing following revascularisation
- Stress testing following revascularisation:
- Benefits and limitations of different test types (cardiorespiratory, strength, and ROM)
- Special considerations for CABG and PTCA-stent
Exercise Prescription
- Inpatient (2-5 days for CABG, 1-2 days for PTCA-stent) and outpatient programs (supervised and unsupervised, at-home)
- Mode, frequency, intensity, and duration of exercise prescription
- Progression of exercise prescription from inpatient to outpatient
Chronic Heart Failure (CHF)
- Exercise testing is vital for CHF clients due to high mortality risk and response to medication and appropriate exercise prescription
- Testing protocols are similar to those with CAD
- Symptom-limited stress test with small workload increments
- Functional capacity, including work rates and HR responses, is crucial
- ECG monitoring and pulse oximetry during early exercise sessions
Accurate Assessment of Functional Capacity
- Recommended use of a metabolic cart
- Key measures: VE-VCO2, VO2peak, and % predicted
- VO2peak, ventilatory-derived lactate threshold (V-LT) using the V-slope method
- Functional tests for musculoskeletal strength and endurance are useful for planning and evaluating exercise programs
Contraindications
- Clients with stable HF routinely undergo symptom-limited maximum cardiopulmonary exercise testing to evaluate cardiorespiratory function
- Arrhythmias are common for clients with CHF
- If testing for ischemia, stress testing may be problematic due to ECG anomalies at rest
- Impaired thermoregulatory responses to heat exposure
Considerations - Medications
- Medications that tend to improve aerobic capacity: ACE inhibitors, ARBs, digoxin, diuretics, nitrates
- Medications that have little effect: calcium channel blockers, statins, anti-arrhythmics, and anti-thrombotics
- Chronic beta-adrenergic blockade has significant benefits on mortality and functional capacity
- Beta-blockers are mandatory in the treatment of CHF and blunt HR responses
Typical Chronotropic Responses
- Lower peak HR and failure to meet >85% maximum HR (20% decrease)
- HR responses: tachycardia at rest, absolute contraindication
- Body mass: increase of more than 1-2 kg compared to previous few days, likely due to fluid retention
- Questions relating to chest pain, worsening orthopnoea, exercise-induced dyspnoea, changes in physical and mental health and wellbeing
Exercise Prescription for CHF
- Clients with stable CHF, with medical clearance, are able to undertake an exercise program
Pacemaker Implantation
- 9782 pacemakers were inserted in Western Australia between 1995-2009, with a prevalence of 1 in 50 in people aged >75 years.
- Dual chamber and triple chamber pacing prevalence also increased during this period.
Pathophysiology
- Sick sinus syndrome refers to rhythm disorders involving the SA node, including the inability to generate a heartbeat or increase heart rate in response to changing circulatory demands.
- Symptoms of SA node dysfunction include fatigue, light-headedness, exercise intolerance, and syncope.
- AV conduction failure (AV block) occurs when impulses are blocked by the AV node, and ventricular activation is dependent on activation below the block.
Pacemaker Function
- A pacemaker may replace SA node signals that are slowed or blocked, or maintain normal timing between the upper and lower chambers.
- A pacemaker consists of separate but integrated components that stimulate the heart with precise timing.
Types of Pacemakers
- Pacemakers can be temporary or permanent, and may be single-chamber, dual-chamber, or triple-chamber.
Physiological Pacing
- Physiological pacing maintains the normal sequence and timing of contractions of both the atrium and ventricles.
- AV synchrony produces higher cardiac output without increasing myocardial O2 uptake.
- Dual-chamber pacemakers can improve efficiency, augment ventricular filling, and improve hemodynamic responses.
Rate-Responsive Pacing
- Rate-responsive pacing is used when the native SA node cannot increase heart rate to meet metabolic needs (e.g., during exercise).
- Sensors in the pacemaker sense exercise-induced changes and generate impulses to pace the heart.
Implantable Cardioverter Defibrillators (ICDs)
- ICDs are designed to detect and terminate lethal arrhythmias with an electrical shock.
- Combined pacemaker implementation and ICD therapy can reduce mortality by 40% compared to pacemaker alone.
Loop Recorders
- Loop recorders are implanted diagnostic tools used to monitor for cardiac arrhythmias, particularly in cases of unexplained syncope or palpitations.
Exercise Testing and Prescription
- Clients with pacemakers should undergo exercise testing to provide appropriate rate responses.
- Pacemaker settings can be adjusted to optimize responses during testing.
- Informal and formal exercise testing can be used to establish an upper rate limit, angina threshold, and ischemic threshold.
Exercise Prescription
- The sensor-driven heart rate increase rate follows pacemaker algorithms, with key parameters including the slope of the heart rate increase/decline and sensor sensitivity.
- Resistance training is safe, but clients should avoid activities that have direct contact with the pacemaker.
- Frequency, intensity, and duration of exercise will vary depending on the client's goals and co-morbidities.
Pulmonary System
- The pulmonary system has two main parts: pulmonary respiration (ventilation and gas exchange in the lungs) and cellular respiration (O2 utilization and CO2 production by the tissues)
- The respiratory system's purposes during exercise include gas exchange between the environment and the body, and regulation of acid-base balance
Conducting Zone
- Conducts air to the respiratory zone
- Humidifies, warms, and filters air
- Components: trachea, bronchial tree, bronchioles
Respiratory Zone
- Exchanges gases between air and blood
- Components: respiratory bronchioles, alveolar sacs
- Surfactant prevents alveolar collapse
Muscles Associated with Respiration
- (Not specified in the text)
Pulmonary Ventilation
- Respiratory airflow is governed by the same principles as blood flow: flow, pressure, and resistance
- Atmospheric pressure drives respiration: 760 mm Hg at sea level, lower at higher elevations
- Boyle's Law: at a given temperature, the pressure of a given quantity of gas is inversely proportional to its volume
Gas Exchange
- CO2 transport: 7% dissolved, 23% carbamino compounds, 70% bicarbonate
- O2 transport: 98.5% bound to Hb, 1.5% dissolved
Introduction to the Pulmonary System
- Overview of the pulmonary system, common diagnostic procedures, and nutritional considerations
- Learning outcomes: explain the pathophysiology of pulmonary conditions, outline risk factors and complications, explain diagnostic techniques and treatment procedures, demonstrate exercise/fitness/functional tests, and prescribe exercise as a therapeutic modality
Neural Control of Breathing
- Exact mechanism for setting the rhythm of respiration remains unknown
- Breathing depends on repetitive stimuli of skeletal muscles from the brain
- Controlled by 2 regions of the brain: cerebral and conscious, and automatic and unconscious (medulla oblongata and pons)
- Voluntary control over breathing originates in the motor cortex of the frontal lobe of the cerebrum
- Involuntary control involves respiratory nuclei in the medulla, dorsal respiratory group, and pons
Asthma in Australia
- 467 deaths in Australia related to asthma in 2022, with 299 female and 168 male deaths
- 2.8 million (11%) Australians had asthma in 2022, an increase from 10.2% in 2011-12
- Females had higher rates of asthma than males (12.2% compared to 9.4%), but boys aged 0-14 had higher rates than girls (10.1% compared to 6.2%)
- The prevalence of asthma was higher for people living in disadvantaged areas (13.2% compared to 10.2%) and those living with a disability (17.0% compared to 8.0%)
- 16% of First Nations people had asthma, a decrease from 18% in 2012-13
COPD in Australia
- 2.5% of Australians had COPD in 2022, a steady rate over the last decade
- The prevalence of COPD was similar between males and females (2.4% and 2.6%)
- 7.0% of people aged 65 years and over had COPD
- Current daily smokers were more likely to have COPD than ex-smokers or those who had never smoked
- 86.6% of people with COPD had two or more chronic conditions
- 1 in 10 adults who experienced severe or very severe bodily pain in the 4 weeks prior to the interview had COPD
Diagnostic Procedures
Spirometry
- Measures pulmonary volumes and rate of expired airflow
- Useful for diagnosing lung diseases and monitoring improvement or deterioration
- Spirometric tests include:
- Vital capacity (VC)
- Forced expiratory volume in 1 second (FEV1)
- FEV1/FVC ratio
- Key differences between an obstructive and restrictive pattern:
- Obstructive: both FEV1 and FEV1% are decreased
- Restrictive: FEV1 is decreased, but FEV1% is normal or increased
Arterial Blood Gases
- Determine pH levels, bicarbonate (HCO3-), and partial pressures of O2 and CO2 in arterial blood
- Contribute to diagnosis and determine the need for oxygen therapy
Compensatory Processes
- Primary process is followed by a compensatory process
- Examples:
- Primary respiratory acidosis (high PCO2) / acidemia: compensatory process = metabolic alkalosis (rise in serum bicarbonate)
- Primary metabolic acidosis (low bicarbonate) / academia: compensatory process = respiratory alkalosis (low PCO2)
Imaging
- Chest roentgenogram (X-ray) is often used to differentiate between emphysema and chronic bronchitis
- Computed tomography (CT) scan has greater sensitivity
- Emphysema is characterized by large lung volumes, hyperinflation, flattened diaphragm, and vascular weakening
Bronchoscopy
- Involves insertion of a bronchoscope through the nose or mouth into the lungs to identify pathologies, remove foreign objects, or obtain a sample
- Typically performed after a CT or chest X-ray
Bronchial Provocation Test
- Assists in asthma diagnosis to assess sensitivity of the airways
- Involves inhalation of methacholine followed by spirometry assessments
Sweat Chloride
- Used for diagnosis of cystic fibrosis, considered the gold standard
- Higher chlorine concentrations in clients with CF
- Gene mutation testing determines if someone is a CF carrier or establishes diagnosis
Nutritional Considerations
COPD
- Malnutrition or nutritional depletion may be an issue for up to 25% of COPD clients
- Increased prevalence with severity of disease
- Malnutrition and associated weight loss have been identified as a predictor of mortality
- Causes of malnutrition are not well known, including reduced energy intake and increased caloric demand (higher BMR)
- Affects diaphragm contractile force
Pathophysiology of COPD
- Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms, airflow obstruction, and abnormalities of the airways and/or alveoli.
- GOLD report 2023 outlines major risk factors: exposure to noxious particles, genetic syndromes, abnormal lung development, and oxidative stress-induced accelerated aging.
Clinical Presentation and Diagnostic Criteria
- Typical COPD symptoms include dyspnea, wheezing, chest tightness, fatigue, activity limitation, and/or cough with or without sputum production.
- Diagnosis is based on the presence of non-fully reversible airflow limitation (FEV1/FVC < 0.7 post-bronchodilation) measured by spirometry.
- Some individuals may have structural lung lesions (e.g., emphysema) and/or physiological abnormalities (low-normal FEV1, gas trapping, hyperinflation) with an FEV1/FVC ratio ≥ 0.7 post-bronchodilation, classified as 'Pre-COPD' or 'PRISm'.
COPD vs Asthma
- COPD is characterized by chronic airway inflammation and hyper-responsiveness of the tracheobronchial tree, whereas asthma is characterized by recurrent airflow obstruction with symptom-free periods.
- Patients experiencing a combination of asthma and COPD features are diagnosed with asthma and COPD overlap syndrome.
Factors that Influence COPD Progression
- Genetic factors, age >45 years, gender, race, lung growth and development, exposure to particles, socioeconomic status, asthma, airway hyper-reactivity, chronic bronchitis, and infections can influence COPD progression.
Pathology, Pathogenesis, and Pathophysiology
- Pathology: chronic inflammation, structural changes
- Pathogenesis: oxidative stress, protease-antiprotease imbalance, inflammatory cells, inflammatory mediators, peribronchiolar and interstitial fibrosis
- Pathophysiology: airflow limitation and gas trapping, gas exchange abnormalities, mucus hypersecretion, pulmonary hypertension
Pathogenesis of COPD - Inflammation
- Inflammation is present in all areas of the lungs as a protective response to inhaled toxins, leading to tissue destruction, impairment of defense mechanisms, and disruption to repair mechanisms.
- Smoking and associated inflammation contribute to an imbalance between oxidants and antioxidants, creating an environment of oxidative stress in the lung.
Inflammatory Markers and COPD
- Increased numbers of neutrophils, macrophages, T lymphocytes, and release of cytokines and mediators, such as leukotriene B4, chemotactic factors, pro-inflammatory cytokines, and growth factors, reflect the degree of airflow obstruction.
Protease and Anti-Protease Imbalance
- Protease: enzymes that break down proteins and peptides
- Up-regulation of proteases and inactivation of anti-proteases lead to an imbalance, which is exacerbated by cigarette smoke and inflammation.
Oxidative Stress
- Sources of oxidants include cigarette smoke and reactive oxygen and nitrogen species released from inflammatory cells, leading to an imbalance in oxidants and antioxidants.
- Markers of oxidative stress are increased in stable COPD and are further increased in exacerbations.
Pathophysiology of COPD
- Primary risk factor for developing COPD: tobacco smoke
- Secondary effects on skeletal muscle
- Specifically, sites affected by COPD include:
- Bronchi: enlarged mucus glands and dilated gland ducts
- Bronchioles: mucus plugging, inflammation, increased airway smooth muscle tone
- Pulmonary parenchyma and vasculature: loss of alveoli wall support, diminished elastic recoil, and increased work by respiratory muscles to meet ventilatory demands.
COPD and Exercise
- COPD patients who demonstrate less dynamic hyperinflation, desaturate less, and are less breathless tend to perform greater amounts of work.
- One-leg cycling can have benefits similar to conventional cycling.
Resistance Training for COPD Clients
- Use free weights or machines, with an emphasis on functional activities.
- Frequency: 2-3 times a week, with 1-4 sets per exercise.
- Progression: Gradually increase resistance and reps as strength increases.
- Goals: Improve respiratory muscle strength and endurance, and reduce dyspnea.
Considerations for Clients with COPD
- Signs and symptoms: dyspnea, cough, sputum production, wheezing, chest tightness, and occasional fever.
- Diagnosis is based on medical history, physical examination, and laboratory results (spirometry, CT scan, and x-ray).
- GOLD recommendations include comprehensive medical history, physical examination, and laboratory results.
Exercise Testing for COPD
- Important for clients with COPD, even mild-to-moderate, as symptoms often do not present until increased demand is placed on the respiratory system.
- Exercise testing is used to track the progression of disease, detect exercise hypoxemia, and determine the need for supplemental oxygen during exercise training.
Modes of Exercise Testing
- Treadmill testing: constant work rate protocols, with incremental increases in workload and slow progression.
- Cycle ergometer testing: unloaded cycling for 3 minutes, followed by ramped protocol.
- 6-minute walk test: field walking test, either self-paced or externally paced, over a predetermined time or distance.
Special Considerations
- Arm ergometer testing may limit the intensity and duration of exercise due to increased dyspnea.
Flexibility and Stretching for COPD
- Mode: balance, stretching, Tai Chi, and modified yoga.
- Intensity: stretch to the point of tightness, not pain.
- Frequency: >2 times a week, with 10-60 seconds of stretching.
- Goals: increase range of motion, improve gait and balance, and improve breathing efficiency.
Ventilatory Muscle Training
- Recommended for COPD patients to increase ventilatory muscle strength and endurance, alleviate dyspnea, and improve health-related quality of life.
- Techniques:
- Voluntary isocapnic hyperpnea
- Inspiratory resistive loading
- Inspiratory threshold loading
- Guidelines: 4-5 times a week, 2-4 sets per exercise, with an intensity of ≥30% maximal inspiratory pressure.
Benefits of Training for COPD Clients
- Improved exercise capacity
- Reduced dyspnea
- Improved health-related quality of life
Pathophysiology of Asthma
- Asthma is a heterogeneous disease characterized by chronic airway inflammation, defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness, and cough, that vary over time and in intensity, together with variable expiratory airflow limitation.
- Hyperresponsiveness of the airway to direct and indirect stimuli and can involve chronic inflammation.
- Symptoms typically resolve (transient) with experiences of flare-ups, but pathology may be present even when symptoms are not present.
- Around 2.7 million Australians had asthma in 2017-18, with a prevalence of 11% in 2020-21, which is higher for females over the age of 15.
Asthma Phenotypes
- Allergic asthma: easily recognized, often commences in childhood, associated with a past and/or family history of allergic disease, and sputum examination shows airway inflammation.
- Non-allergic asthma: the cellular profile of the sputum may be neutrophilic, eosinophilic, or contain only a few inflammatory cells, and demonstrate a lesser short-term response to ICS.
- Adult-onset (late-onset) asthma: particularly women, present for the first time in adulthood, mostly non-allergic, and often require higher doses of ICS or relatively refractory to corticosteroid treatment.
- Asthma with persistent airflow limitation: some with long-standing asthma develop airflow limitation that is persistent or incompletely reversible (from airway wall remodeling).
- Asthma with obesity: some obese patients with asthma have prominent respiratory symptoms and little eosinophilic airway inflammation.
Environmental Factors
- Pathophysiology: 3 components to asthma, including airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness.
- Environmental factors: allergens (indoor and outdoor), infections, smoking, diet, and medications.
- Host factors: genetics, obesity, and gender.
Airway Inflammation
- Can be episodic and variable, but airway inflammation is persistent.
- Inflammation, and thus obstruction, is primarily in the medium-sized bronchi.
- CD4 lymphocyte promotes inflammation through immunoglobulin E, eosinophils, basophils, and mast cells.
- Inflammation promotes oedema, structural changes (remodeling of airways), hypertrophy, and hyperplasia of airway wall, and angiogenesis and increased submucosal gland size.
Diagnosis
- Lung function testing to document variable expiratory airflow limitation.
- Bronchial provocation tests: inhaled methacholine, histamine, and moderately sensitive for a diagnosis of asthma but have limited specificity.
- Allergy tests: atopy increases the probability of allergic asthma, but is not specific for asthma or present in all phenotypes.
Diagnostic Criteria for Asthma
- Chest radiographs: identify changes such as bronchiectasis (irregular and dilated airways).
- Spirometry assessments: reduced FEV1 and forced expiratory flow, and hyperinflation.
- Lower the FEV1, the more severe the disease.
Cystic Fibrosis
- Effects on the gastrointestinal system: exocrine pancreatic insufficiency, malabsorption of nutrients, and increased need for higher caloric intake and poor utilization.
- Effects on the metabolic system: cystic-fibrosis-related diabetes, pancreatic scarring, and insulin secretion.
Effects of Cystic Fibrosis
- Correlation between ideal body mass and effects on respiratory system.
- Gastrointestinal tube may be required for advanced nutritional issues.
- Other common conditions included liver disease, endocrine pancreatic insufficiency, and gallbladder disease.
Exercise Testing and Prescription for Asthma and Cystic Fibrosis
Asthma
- Exercise testing is not generally required for individuals with asthma, unless exercise tolerance is reduced disproportionately to symptoms or air-flow limitations.
- A symptom-limited incremental test is completed, including assessments of oxyhemoglobin saturation and ECG, with optional respiratory gas analysis and anaerobic threshold.
- Contraindications to consider include acute bronchospasm, chest discomfort, increased shortness of breath, and severe deconditioning or co-morbidities.
Exercise-Induced Bronchospasm (EIB or EIA)
- Pathophysiology: related to the consequences of heating and humidifying large volumes of air during exercise, leading to mast cell degranulation, eosinophil activation, and bronchoconstriction.
- Symptoms: dyspnea, cough, tightness in the chest, wheezing, and sputum production.
- Development of EIB is related more to water content than temperature.
- Diagnosis requires bronchoprovocation challenge with pre- and post-spirometry testing, with a protocol involving rapid increase in intensity of 2-4 minutes, breathing dry air.
- Two most important determinants of EIB are sustained high-level ventilation during exercise and water content.
- Pre-exercise warm-up is important to reduce the risk of EIB.
- Bronchodilator, anti-inflammatory, or leukotriene modifier therapy should be delivered 15 minutes prior to exercise.
Exercise Prescription for Asthma
- Variety of exercise prescription reflects the vast range of symptoms, severity, and limitations to airflow.
- Mode and intensity should reflect training status, interests, and goals.
- Exposure to cold air, low humidity, and air pollutants should be minimized.
- GXT is performed, starting below VT, with an intensity of 50-85% HHR.
- If maximal test was completed, initial exercise intensity should be just below AT.
- ACSM recommendations include avoiding triggers resulting in bronchoconstriction, adequate warm-up, and use of bronchodilators prior to exercise.
Cystic Fibrosis
- Exercise testing is important for monitoring and managing clinical status, pre-transplant assessment, counseling, and education.
- Testing should include a standardized GXT to maximum using a treadmill or cycle ergometer, with monitoring of data pre-, during, and post-GXT, utilizing ECG and pulse oximetry.
Exercise Prescription for Cystic Fibrosis
- Aerobic exercise: daily, moderate to vigorous intensity, 30-60 minutes, with progression of 10% every 2 weeks.
- Resistance training: 2-3 times a week, 1-3 sets, 8-12 reps, with mild progression.
- Flexibility: daily, 10-30 seconds per stretch, pain-free, with natural progression.
- Daily physical activity: 60 minutes a day for young children and children, with an emphasis on airway clearance, coughing, and huffing.
Benefits of Aerobic Exercise Training
- Improvements in FEV1 when aerobic and resistance training are utilized.
- Improvements in dynamic lung function, including lower RHR, increased Hrmax, improved VO2max, and increased work capacity.
- Greater training effects with higher intensity programs.
- Exercise training during hospitalizations is also useful with chest physiotherapy and bronchial drainage.
Benefits of Muscular Strength and Endurance
- Benefits of anaerobic function have mixed results.
- Resistance training + home cycling has been shown to increase muscular strength, vertical jump, flexibility, and balance.
- Muscle limitations include decreased muscle size and metabolic abnormalities leading to reduced strength.
- Longer rest periods may be required, and muscle wastage may occur due to medications for CF clients post-lung transplant.
Benefits for Body Composition, Nutrition, and Mental Health
- Exercise limitations occur independent of nutritional concerns.
- Exercise can increase body mass independent of caloric needs.
- Nutritional supplementation can support improved aerobic capacity and tolerance, and respiratory muscle strength.
- Exercise can improve wellbeing, reduce rates of depression and anxiety.
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Description
This quiz covers considerations and contraindications of exercise testing and prescription, specifically focusing on Week 9 of the EHR519 course.