EHR519 Weeks 9 - 13
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Questions and Answers

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.

    False (B)

    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 ______________.

    <p>VT</p> Signup and view all the answers

    Match the following medications with their effect on aerobic capacity in clients with CHF:

    <p>Angiotensin converting enzyme inhibitors = improve aerobic capacity Beta-blockers = blunt HR responses Calcium channel blockers = little effect Digoxin = improve aerobic capacity</p> Signup and view all the answers

    What is an absolute contraindication for exercise in clients with CHF?

    <p>All of the above (D)</p> Signup and view all the answers

    Clients with CHF do not need to undergo ECG monitoring and pulse oximetry during early exercise sessions.

    <p>False (B)</p> Signup and view all the answers

    What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?

    <p>fluid retention that can lead to acute pulmonary oedema</p> Signup and view all the answers

    Clients with stable CHF, with medical clearance, are able to undertake an exercise program with the goal of improving ______________.

    <p>cardiorespiratory function</p> Signup and view all the answers

    Which of the following is a consideration for exercise testing in clients with CHF?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary consideration when performing resistance training with a client who has a pacemaker?

    <p>Avoiding direct contact with the pacemaker (A)</p> Signup and view all the answers

    Clients with a fixed-rate pacemaker should exceed the intensity in which BP begins to plateau with increased workload.

    <p>False (B)</p> Signup and view all the answers

    What is the recommended frequency for aerobic exercise?

    <p>3-5 days/week</p> Signup and view all the answers

    The recommended intensity range for exercise is ______________% VO2peak.

    <p>40-85</p> Signup and view all the answers

    What is the significance of a second degree type I (Wenckebach) block during exercise?

    <p>The sinus rate is exceeding the pacemaker's maximal tracking or sensor rate (D)</p> Signup and view all the answers

    Clients with a pacemaker should avoid contact sports during exercise.

    <p>True (A)</p> Signup and view all the answers

    What is the recommended duration for aerobic exercise?

    <p>20-60 minutes</p> Signup and view all the answers

    What is the purpose of using RPE and METs in client's with a pacemaker?

    <p>To determine the client's exercise intensity (C)</p> Signup and view all the answers

    The recommended weekly energy expenditure for aerobic exercise is greater than ______________ kcal.

    <p>1000</p> Signup and view all the answers

    Match the following types of pacemakers with their exercise intensity considerations:

    <p>Fixed-rate pacemaker = Should not exceed intensity in which BP begins to plateau with increased workload Rate-responsive pacemaker = Can use HR, but use with RPE and METs</p> Signup and view all the answers

    What is the main goal of exercise interventions for individuals with pulmonary conditions?

    <p>To prescribe exercise as a therapeutic modality (A)</p> Signup and view all the answers

    Clients with pulmonary conditions can undergo exercise testing without any precautions.

    <p>False (B)</p> Signup and view all the answers

    What are the learning outcomes for exercise physiology in relation to pulmonary conditions?

    <p>The learning outcomes include explaining the pathophysiology of pulmonary conditions, outlining risk factors and complications, explaining diagnostic techniques and treatment procedures, demonstrating the ability to conduct exercise tests, and prescribing exercise as a therapeutic modality.</p> Signup and view all the answers

    The pulmonary system is responsible for exchanging ______________ and carbon dioxide.

    <p>oxygen</p> Signup and view all the answers

    Match the following components of the pulmonary system with their functions:

    <p>Lungs = Gas exchange Trachea = Air transport Diaphragm = Breathing muscle Bronchi = Airway division</p> Signup and view all the answers

    What happens to the intrapleural pressure during inspiration?

    <p>Decreases by 6 mm Hg (C)</p> Signup and view all the answers

    The diaphragm rises during inspiration.

    <p>False (B)</p> Signup and view all the answers

    What is the final temperature of inhaled air when it reaches the alveoli?

    <p>37°C</p> Signup and view all the answers

    According to Charles's law, the volume of a gas is directly proportional to its _______________________ temperature.

    <p>absolute</p> Signup and view all the answers

    What is the purpose of the conducting zone in the respiratory system?

    <p>Humidifies, warms, and filters air (B)</p> Signup and view all the answers

    The flow of a fluid is directly proportional to the resistance.

    <p>False (B)</p> Signup and view all the answers

    What is the relationship between the pressure of a given quantity of gas and its volume according to Boyle's Law?

    <p>The pressure of a given quantity of gas is inversely proportional to its volume.</p> Signup and view all the answers

    Atmospheric pressure is typically measured in units of ______________ mm Hg at sea level.

    <p>760</p> Signup and view all the answers

    Match the following components of the respiratory system with their functions:

    <p>Trachea = Conducts air to respiratory zone Bronchioles = Exchange of gases between air and blood Alveolar sacs = Humidifies, warms, and filters air Respiratory bronchioles = Exchange of gases between air and blood</p> Signup and view all the answers

    What percentage of CO2 is transported in the blood as carbamino compounds?

    <p>23% (D)</p> Signup and view all the answers

    Oxyhemoglobin is formed when O2 reacts with HHb in the blood.

    <p>True (A)</p> Signup and view all the answers

    What is the enzyme that helps in the conversion of CO2 to H2CO3?

    <p>Carbonic anhydrase</p> Signup and view all the answers

    The majority of CO2 in the blood is transported as ______________.

    <p>HCO3-</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Hb = Deoxyhemoglobin HbCO2 = Carbaminohemoglobin HbO2 = Oxyhemoglobin HHb = Hemoglobin</p> Signup and view all the answers

    Which measurement is most directly relevant to the body's ability to get oxygen to the tissues and dispose of carbon dioxide?

    <p>Residual volume (C)</p> Signup and view all the answers

    The exact mechanism for setting the rhythm of respiration is fully understood.

    <p>False (B)</p> Signup and view all the answers

    Where does voluntary control over breathing originate?

    <p>Motor cortex of the frontal lobe of the cerebrum</p> Signup and view all the answers

    The ______________ respiratory group produces a respiratory rhythm of 12 breaths per minute.

    <p>Ventral</p> Signup and view all the answers

    Match the following brain regions with their functions in controlling breathing:

    <p>Cerebral = Conscious control over breathing Medulla oblongata = Automatic control over breathing Pons = Modifies rhythm of the VRG</p> Signup and view all the answers

    What is the name of the test used to assist in asthma diagnosis to assess sensitivity of the airways?

    <p>Bronchial provocation test (A)</p> Signup and view all the answers

    Malnutrition or nutritional depletion is a rare issue for COPD clients.

    <p>False (B)</p> Signup and view all the answers

    What is the significance of a higher chlorine concentration in clients with cystic fibrosis?

    <p>It is due to a mutation in two copies of the CFTR gene, allowing excess chlorine into the extracellular spaces.</p> Signup and view all the answers

    The primary metabolic alkalosis is compensated by _______________________.

    <p>respiratory acidosis</p> Signup and view all the answers

    Match the following tests with their purposes:

    <p>Chest roentgenogram = Differentiate between emphysema and chronic bronchitis Computed tomography (CT) scan = Greater sensitivity Bronchoscopy = Identify pathologies, remove foreign objects or obtain a sample Sweat chloride test = Diagnosis of cystic fibrosis</p> Signup and view all the answers

    The diaphragm rises during expiration.

    <p>False (B)</p> Signup and view all the answers

    What is the name of the imaging test used to differentiate between emphysema and chronic bronchitis?

    <p>Chest roentgenogram (C)</p> Signup and view all the answers

    What is the significance of malnutrition and associated weight loss in COPD clients?

    <p>It is a predictor of mortality.</p> Signup and view all the answers

    Malnutrition or nutritional depletion may be an issue for up to _________% of COPD clients.

    <p>25</p> Signup and view all the answers

    What percentage of Australians had asthma in 2022?

    <p>11% (D)</p> Signup and view all the answers

    The prevalence of asthma is higher for people living in disadvantaged areas.

    <p>True (A)</p> Signup and view all the answers

    What percentage of people aged 65 years and over had COPD in 2022?

    <p>7.0%</p> Signup and view all the answers

    Of all people with COPD in 2022, ______________% had two or more chronic conditions.

    <p>86.6</p> Signup and view all the answers

    Match the following demographics with their corresponding asthma prevalence rates in 2022:

    <p>Females = 12.2% Males = 9.4% 0-14 years old boys = 10.1% 0-14 years old girls = 6.2%</p> Signup and view all the answers

    What percentage of First Nations people had asthma in 2022?

    <p>16% (A)</p> Signup and view all the answers

    The prevalence of COPD has decreased in the last decade.

    <p>False (B)</p> Signup and view all the answers

    How many deaths in Australia were related to asthma in 2022?

    <p>467</p> Signup and view all the answers

    What percentage of adults who experienced severe or very severe bodily pain in the 4-weeks prior to interview had COPD?

    <p>9.3% (C)</p> Signup and view all the answers

    A primary process is followed by a compensatory process in respiratory acidosis.

    <p>True (A)</p> Signup and view all the answers

    What is the purpose of spirometry?

    <p>To diagnose lung diseases and monitor improvement or deterioration</p> Signup and view all the answers

    The FEV1/FVC ratio of ≥80% is normal for ______________ individuals.

    <p>healthy</p> Signup and view all the answers

    Match the following spirometric tests with their descriptions:

    <p>Vital capacity (VC) = Maximal volume of air that can be expired after maximal inspiration Forced expiratory volume in 1sec (FEV1) = Volume of air expired during 1 second during maximal expiration FEV1/FVC ratio = Ratio of lung function to determine lung health</p> Signup and view all the answers

    Arterial blood gases contribute to the diagnosis and determine the need for oxygen therapy.

    <p>True (A)</p> Signup and view all the answers

    What is the primary respiratory acidosis compensatory process?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    The pulmonary system is responsible for exchanging ______________ and carbon dioxide.

    <p>oxygen</p> Signup and view all the answers

    What is the primary function of the conducting zone in the respiratory system?

    <p>Warming, humidifying, and filtering the air (D)</p> Signup and view all the answers

    The diaphragm falls during inspiration.

    <p>False (B)</p> Signup and view all the answers

    What is the main goal of exercise interventions for individuals with pulmonary conditions?

    <p>To improve exercise capacity and overall health</p> Signup and view all the answers

    The pulmonary system is responsible for exchanging _________ and carbon dioxide.

    <p>oxygen</p> Signup and view all the answers

    Match the following components of the respiratory system with their functions:

    <p>Diaphragm = Separates the chest cavity from the abdominal cavity Bronchi = Warms, humidifies, and filters the air Alveoli = Gas exchange occurs here Trachea = Conducts air to and from the lungs</p> Signup and view all the answers

    What is the effect of oxidative stress on antiproteases?

    <p>Inactivates them (A)</p> Signup and view all the answers

    Protease and anti-tease imbalance is a characteristic of COPD.

    <p>True (A)</p> Signup and view all the answers

    What is the effect of transforming growth factor β on the airways?

    <p>Fibrosis</p> Signup and view all the answers

    Cigarette smoke and inflammation itself produce _______________________, which primes several inflammatory cells to release a combination of proteases and inactivates several antiproteases.

    <p>oxidative stress</p> Signup and view all the answers

    Match the following components with their effects:

    <p>TNF-α = Pro-inflammatory cytokine IL-1 = Pro-inflammatory cytokine Transforming growth factor β = Causes fibrosis Oxidative stress = Leads to inactivation of antiproteases</p> Signup and view all the answers

    What is a characteristic of COPD exacerbations?

    <p>Prolonged recovery times (B)</p> Signup and view all the answers

    Most clients with COPD experience significant reversibility/symptom-free periods.

    <p>False (B)</p> Signup and view all the answers

    What is the diagnosis given to patients experiencing recurrent airflow obstruction with a combination of asthma and COPD features?

    <p>Asthma-COPD overlap syndrome</p> Signup and view all the answers

    Inflammation in COPD is present in all areas of the lungs as a ______________ response to inhaled toxins.

    <p>protective</p> Signup and view all the answers

    Match the following factors with their influence on COPD progression:

    <p>Genetic factors = Age &gt;45yrs and gender (&gt; in women) Race (2.3 x higher in Indigenous) = Lung growth and development Exposure to particles = Socioeconomic status Asthma &amp; airway hyper-reactivity = Chronic bronchitis</p> Signup and view all the answers

    What is the primary risk factor for developing COPD?

    <p>Smoking (D)</p> Signup and view all the answers

    The main site of airflow obstruction in COPD occurs in the large conducting airways.

    <p>False (B)</p> Signup and view all the answers

    What happens to the alveoli walls in COPD?

    <p>Loss of alveoli wall support</p> Signup and view all the answers

    In COPD, the bronchi are affected by enlarged _______________________ glands and dilated gland ducts.

    <p>mucus</p> Signup and view all the answers

    Match the following COPD effects with their corresponding sites:

    <p>Bronchi = enlarged mucus glands and dilated gland ducts Bronchioles = mucus plugging, inflammation, and increased airway smooth muscle tone Pulmonary parenchyma and vasculature = loss of alveoli wall support and diminished elastic recoil</p> Signup and view all the answers

    What is the definition of Chronic Obstructive Pulmonary Disorder (COPD)?

    <p>A heterogeneous lung condition characterised by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli. (D)</p> Signup and view all the answers

    All individuals with COPD have a non-fully reversible airflow limitation (FEV1/FVC < 0.7) measured by spirometry.

    <p>False (B)</p> Signup and view all the answers

    What are the major risk factors for COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)?

    <p>Exposure to noxious particles or gases, genetic syndromes, abnormal lung development, and oxidative stress-induced accelerated ageing.</p> Signup and view all the answers

    The diagnosis of COPD is based on the presence of non-fully reversible airflow limitation, measured by _______________________.

    <p>spirometry</p> Signup and view all the answers

    Match the following symptoms with their characteristic feature in COPD:

    <p>Dyspnoea = Shortness of breath Wheezing = High-pitched whistling sound Chest tightness = Feeling of constriction in the chest Cough = With or without sputum production</p> Signup and view all the answers

    What is the goal of ventilatory muscle training for COPD patients?

    <p>All of the above (D)</p> Signup and view all the answers

    Inspiratory Resistive Loading is a technique used in ventilatory muscle training.

    <p>True (A)</p> Signup and view all the answers

    What is the purpose of Voluntary Isocapnic Hyperpnea in ventilatory muscle training?

    <p>To breathe at the highest sustainable level of minute ventilation for 10 to 15 minutes.</p> Signup and view all the answers

    Inspiratory Threshold Loading devices permit air to flow through them only after a critical ___________ pressure has been reached.

    <p>inspiratory</p> Signup and view all the answers

    Match the following ventilatory muscle training techniques with their descriptions:

    <p>Voluntary Isocapnic Hyperpnea = Breathe at highest sustainable level of minute ventilation for 10 to 15 minutes Inspiratory Resistive Loading = Breathe through inspiratory orifices of smaller and smaller diameter while attempting to maintain a normal breathing pattern Inspiratory Threshold Loading = Breathe through a device that permits air to flow through it only after a critical inspiratory pressure has been reached</p> Signup and view all the answers

    What is the primary goal of exercise interventions for individuals with pulmonary conditions?

    <p>To reduce symptoms of dyspnoea (B)</p> Signup and view all the answers

    The diaphragm descends during inspiration.

    <p>True (A)</p> Signup and view all the answers

    What is the significance of a 1-2 kg increase in body mass compared to previous few days in clients with CHF?

    <p>Fluid retention</p> Signup and view all the answers

    The _______________________ muscles are activated during exercise in clients with pulmonary conditions.

    <p>Diaphragm + accessory muscles of inspiration</p> Signup and view all the answers

    Match the following components of resistance training with their goals:

    <p>Free weights = Increase respiratory muscle strength Machines = Improve functional activities Functional activities = Increase strength and endurance High reps, low resistance = Improve exercise capacity</p> Signup and view all the answers

    What is the primary method used to establish an initial diagnosis of COPD?

    <p>Spirometry (B)</p> Signup and view all the answers

    In clients with COPD, exercise testing is only important for those with severe disease.

    <p>False (B)</p> Signup and view all the answers

    What are some common signs and symptoms of COPD?

    <p>Dyspnoea, cough, sputum production, wheezing, chest tightness, occasional fever</p> Signup and view all the answers

    The ______ barked

    <p>dog</p> Signup and view all the answers

    Match the following components of the diagnostic process for COPD with their descriptions:

    <p>Medical history = Comprehensive medical history, including medical history, family history of COPD, other chronic lung disease, pattern of symptom development, exacerbation history, hospitalisations, co-morbidities, impact on QoL, social and family support and potential risk factors Physical examination = Completion of physical exam by doctor Spirometry = Forced expiratory volume in one second (FEV1) and forced vital capacity ratio of less than 0.7 confirming the presence of persistent airflow obstruction Laboratory results = Confirmatory tests, such as CT scan and x-ray</p> Signup and view all the answers

    What is the purpose of exercise testing in clients with COPD?

    <p>All of the above (D)</p> Signup and view all the answers

    Arm ergometer testing results in decreased dyspnea in clients with COPD.

    <p>False (B)</p> Signup and view all the answers

    What is the name of the test used to assess the exercise capacity of clients with COPD?

    <p>Treadmill or cycle ergometer test</p> Signup and view all the answers

    In clients with COPD, reduced exercise capacity is due to reduced _______________________ capacity compared to demand.

    <p>ventilatory</p> Signup and view all the answers

    Match the following exercise tests with their characteristics:

    <p>Treadmill test = Constant work rate protocols with incremental increases in workload and slow progression Cycle ergometer test = Unloaded cycling for 3 minutes, followed by a ramped protocol 6-minute walk test = Field walking test that can be self-paced or externally paced and conducted over a predetermined time or distance</p> Signup and view all the answers

    What is the recommended intensity of the training load for ventilatory muscle training according to ACSM?

    <p>≥30% MIP (A)</p> Signup and view all the answers

    There is a demonstrated superiority of one method of inspiratory muscle training over another.

    <p>False (B)</p> Signup and view all the answers

    What is the frequency of inspiratory muscle training recommended by AACVPR?

    <p>4-5 d/wk</p> Signup and view all the answers

    The AACVPR recommends inspiratory muscle training sessions of two 15 min sessions per day or one ______________ min session per day.

    <p>30</p> Signup and view all the answers

    Match the following types of inspiratory muscle training with their descriptions:

    <p>Inspiratory resistance training = Training that uses resistance to strengthen the inspiratory muscles Threshold loading = Training that uses a specific threshold to load the inspiratory muscles Normocapnic hyperventilation = Training that uses hyperventilation to improve inspiratory muscle function</p> Signup and view all the answers

    What is the primary contributing factor to asthma?

    <p>Airway inflammation (A)</p> Signup and view all the answers

    Inflammation in asthma is primarily in the small sized bronchi.

    <p>False (B)</p> Signup and view all the answers

    What is the percentage of adults with recently diagnosed asthma who may experience clinical remission within 5 years?

    <p>16%</p> Signup and view all the answers

    Inflammation in asthma promotes ______________ and structural changes in the airways.

    <p>oedema</p> Signup and view all the answers

    Match the following factors with their relationship to asthma:

    <p>Genetics = Host factor Pollens = Environmental factor Obesity = Host factor Mites = Environmental factor</p> Signup and view all the answers

    What percentage of CF patients have exocrine pancreatic insufficiency?

    <p>85% (C)</p> Signup and view all the answers

    Malnutrition is a rare issue for CF patients.

    <p>False (B)</p> Signup and view all the answers

    What is the correlation between ideal body mass and the effects on the respiratory system?

    <p>There is a correlation between ideal body mass and the effects on the respiratory system.</p> Signup and view all the answers

    CF-related diabetes is more common in adults over ______ years.

    <p>35</p> Signup and view all the answers

    Match the following effects on the body with their corresponding systems:

    <p>Bronchiectasis = Respiratory System Exocrine pancreatic insufficiency = Gastrointestinal System Cystic-fibrosis-related diabetes = Metabolic System Malnutrition = Gastrointestinal System</p> Signup and view all the answers

    What is the primary characteristic of asthma?

    <p>Chronic airway inflammation (D)</p> Signup and view all the answers

    Asthma is a homogeneous disease.

    <p>False (B)</p> Signup and view all the answers

    What is the typical pattern of symptoms in individuals with asthma?

    <p>Symptoms typically resolve (transient) with experiences of flare-ups.</p> Signup and view all the answers

    Asthma is defined by the history of respiratory symptoms, such as _______________________, that vary over time and in intensity.

    <p>wheeze, shortness of breath, chest tightness, and cough</p> Signup and view all the answers

    Match the following characteristics of asthma with their definitions:

    <p>Hyperresponsiveness = Airway response to direct and indirect stimuli Chronic inflammation = Involves chronic inflammation</p> Signup and view all the answers

    What percentage of Australians had asthma in 2020-21 according to the ABS?

    <p>11% (D)</p> Signup and view all the answers

    Pathology may be present even when symptoms are present.

    <p>False (B)</p> Signup and view all the answers

    What is the name of the asthma phenotype that is particularly common in women who present for the first time in adulthood?

    <p>Adult-onset (late-onset) asthma</p> Signup and view all the answers

    First Nations people were ______________ times as likely to report having asthma as non-Indigenous Australians.

    <p>1.6</p> Signup and view all the answers

    Match the following asthma phenotypes with their characteristics:

    <p>Allergic asthma = easily recognised, often commences in childhood, associated with a past and/or family history of allergic disease Non-allergic asthma = the cellular profile of the sputum of these patients may be neutrophilic, eosinophilic or contain only a few inflammatory cells Asthma with persistent airflow limitation = some with long-standing asthma develop airflow limitation that is persistent or incompletely reversible</p> Signup and view all the answers

    What is the characteristic of lung function in individuals with asthma?

    <p>Variable expiratory airflow limitation (B)</p> Signup and view all the answers

    Allergy tests are specific for asthma and are present in all phenotypes.

    <p>False (B)</p> Signup and view all the answers

    What is the significance of a reduced FEV1/FVC ratio in diagnosing asthma?

    <p>A reduced FEV1/FVC ratio, compared with the lower limit of normal, indicates expiratory airflow limitation.</p> Signup and view all the answers

    Inhaled ____________ are used in bronchial provocation tests to diagnose asthma.

    <p>methacholine or histamine</p> Signup and view all the answers

    Match the following tests with their purposes in diagnosing asthma:

    <p>Spirometry = To document variable expiratory airflow limitation Bronchial provocation tests = To assess sensitivity of the airways Allergy tests = To identify atopy</p> Signup and view all the answers

    What is the primary goal of exercise interventions for individuals with pulmonary conditions?

    <p>To improve respiratory function (B)</p> Signup and view all the answers

    Clients with stable CHF can undergo symptom-limited maximum cardiopulmonary exercise testing without medical clearance.

    <p>False (B)</p> Signup and view all the answers

    What is the purpose of conducting exercise/fitness/functional tests on individuals with asthma and cystic fibrosis?

    <p>To assess their exercise tolerance and develop a personalized exercise program</p> Signup and view all the answers

    According to Boyle's Law, the volume of a gas is directly proportional to its _______________________ temperature.

    <p>inverse</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Diaphragm = The primary muscle of inspiration. Intrapleural pressure = The pressure between the lungs and chest cavity. Pacemaker = A device that regulates heart rhythm. Alveoli = The site of gas exchange in the lungs.</p> Signup and view all the answers

    What is the primary goal of exercise interventions for individuals with pulmonary conditions?

    <p>Improve airway clearance (B)</p> Signup and view all the answers

    Teens with pulmonary conditions should undergo 60 minutes of daily physical activity.

    <p>True (A)</p> Signup and view all the answers

    What is the recommended frequency for aerobic exercise in individuals with pulmonary conditions?

    <p>Daily</p> Signup and view all the answers

    Young children with pulmonary conditions should engage in __________ minutes of physical activity per day.

    <p>60</p> Signup and view all the answers

    Match the following age groups with their recommended exercise frequency and duration:

    <p>Young children = 2-3 days/week, 10-20 minutes Children = Daily, 60 minutes Teens = Daily, 60 minutes Adults = 2-3 days/week, 20-40 minutes</p> Signup and view all the answers

    What is the primary reason for conducting an exercise test in clients with asthma?

    <p>To assess exercise tolerance (C)</p> Signup and view all the answers

    Clients with asthma should avoid exercise if they experience acute bronchospasm.

    <p>True (A)</p> Signup and view all the answers

    What is the typical duration of bronchoconstriction after exercise in clients with exercise-induced bronchospasm?

    <p>approximately 60 minutes</p> Signup and view all the answers

    Exercise-induced bronchospasm is related more to the ______________________ of air during exercise.

    <p>water content</p> Signup and view all the answers

    Match the following symptoms with exercise-induced bronchospasm:

    <p>Dyspnoea = Symptom of exercise-induced bronchospasm Chest discomfort = Contraindication for exercise Wheezing = Symptom of exercise-induced bronchospasm Sputum production = Symptom of exercise-induced bronchospasm</p> Signup and view all the answers

    What is the recommended weekly duration of enjoyed activities for children with cystic fibrosis?

    <p>150-300 min/wk (C)</p> Signup and view all the answers

    Resistance training can improve muscular strength and endurance in clients with cystic fibrosis.

    <p>True (A)</p> Signup and view all the answers

    What is the benefit of exercise training on dynamic lung function in clients with cystic fibrosis?

    <p>Improvements in FEV1, FVC, FEV, FEF25-75, and peak expiratory flow.</p> Signup and view all the answers

    Exercise training can improve ______________ in clients with cystic fibrosis.

    <p>VO2max</p> Signup and view all the answers

    Match the following benefits of exercise training with their descriptions:

    <p>Improved body composition = Increase in body mass independent of caloric needs. Reduced rates of depression and anxiety = Long-term psychological benefits. Improved nutrition = Nutritional supplementation can support improved aerobic capacity. Improved respiratory muscle strength = Exercise can improve wellbeing.</p> Signup and view all the answers

    What is the primary purpose of bronchoprovocation challenge with pre and post spirometry testing?

    <p>To diagnose exercise-induced bronchoconstriction (EIB) (D)</p> Signup and view all the answers

    According to the ACSM recommendations, avoidance of triggers resulting in bronchoconstriction is not necessary for clients with asthma.

    <p>False (B)</p> Signup and view all the answers

    What is the significance of a 15-minute pre-exercise warm-up in reducing the risk of EIB?

    <p>To reduce the risk of EIB by allowing the airways to adapt to the increased ventilation during exercise.</p> Signup and view all the answers

    The protocol for exercise testing in clients with cystic fibrosis involves monitoring and management of the client's _______________________.

    <p>clinical status</p> Signup and view all the answers

    Match the following components with their purposes in managing exercise-induced bronchoconstriction (EIB):

    <p>Bronchodilator = To relax the airway muscles Anti-inflammatory = To reduce inflammation in the airways Leukotriene modifier = To modify the immune response Pre-exercise warm-up = To reduce the risk of EIB</p> Signup and view all the answers

    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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    Related Documents

    EHR519 202430 Week 9 Revascularisation CHF Testing & Prescription PDF
    Week 10 Pacemakers and Internal Defibrillators PDF
    EHR519 2024-30 Week 11a Intro to the Pulmonary System PDF
    Prevalence and Treatment of Pulmonary Diseases - Week 11b - Charles Sturt University 2024
    EHR519 2024 Week 12a COPD Pathophysiology, Medications, & Considerations PDF
    EHR519 2024-30 Week 12b Exercise Testing and Prescription for COPD PDF
    EHR519 2024 Week 13a Patho, Meds, Considerations Asthma and CF PDF
    Exercise Testing & Prescription for Asthma and Cystic Fibrosis PDF

    Description

    This quiz covers considerations and contraindications of exercise testing and prescription, specifically focusing on Week 9 of the EHR519 course.

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