Cardiorespiratory Module Wrap Up PDF

Cardiorespiratory Module – Wrap up PT 6606 SPRING Definitions Your patient reports walking his dog 2 miles 5 days a week. He says it takes him between ~35min. This is best classified as A. Physical Activity B. Physical Fitness C. Physical Function D. Physical Exercise The Dog Walking is best...

Cardiorespiratory Module – Wrap up PT 6606 SPRING Definitions Your patient reports walking his dog 2 miles 5 days a week. He says it takes him between ~35min. This is best classified as A. Physical Activity B. Physical Fitness C. Physical Function D. Physical Exercise The Dog Walking is best classified as Exercise because A. It is structured B. It is repetitive C. It is recreational D. It is progressive Key Points Exercise is Planned Purposeful and Repetitive It can be progressive IF the purpose is to improve fitness It does not have to be progressive IF the purpose is to maintain fitness The Dog Walking is also Physical Activity because A. It is a leisure activity B. It increases energy expenditure C. It is not timed D. It does cause one to sweat Key Points Physical Activity encompasses Exercise So, there are some semantics – All exercise is physical activity – some of the difference lies in the intent Not all physical activity is exercise --- remember it must be planned, structured, repetitive Our Dog Walker (DW) also reports that his loop has a 5% grade for ~1 mile. He does not get SOB and has plenty of energy at the end. Would you say he is reasonably physically fit? (remember the loop is completed in ~35 min) A. Yes B. No C. It depends Tell me Why? Oh Why?? Consider the METs for Activities What do you know about DW’s overall pace? What don’t we know about DW in general? Foundational Principles Of the following what is the key ingredient to causing a physiologic change with exercise? A. Match the exercise to the desired activity B. Overload the system/structure being trained C. Consider a person’s unique situation and condition D. Exercise for at least 6 weeks  Remember it is like Goldilocks Overload should be just right….. Right amount; right frequency; right recovery time So although those other items are true, they aren’t the Key ingredient for a physiologic change Cunanan et al. Sports Med. 2018;48:787-797 Of the following, what is the key ingredient to improving sport specific performance? A. Be prescriptive with the volume of exercise B. Use periodization C. Be specific with the training stimulus D. Use a variety of modes to avoid overtraining DW wants to do a 50-mile bike ride, what would you need to know to start your Ex Rx? Essential components to Ex Rx somewhat depends on the purpose of the exercise Outcome(s) & health – related priorities: ◦ Improved cardiorespiratory and/or musculoskeletal fitness? Or function? ◦ Generalized improvement in health ◦ Function for return to work or play ◦ Event-specific training ◦ Changes in body mass or composition, weight loss, joint unloading ◦ Cardioprotection or reduced chronic disease risk Be aware when looking at research – what is the outcome?  Making sure DW bikes for his training is applying the concept of Rank Responses Keywords: Specificity Correct Response: 0  As DW progresses, You have him/her do intervals on Monday, longer distance on Wednesday, and high RPM on Fridays. This is an example of Rank Responses Keywords: variation Correct Response: 0 Mastering Exercise Prescription Specificity Volume effect Progressive overload Variation Individuality Reversibility  As DW improves in fitness from your excellent Ex Rx, which of the following should occur if DW maintains a set RPE or HR during the workout? A. MET level of exercise bout will increase B. HR during exercise bout will decrease C. Blood pressure at rest will increase slightly D. Stroke volume at rest will stay the same METs / HR / RPE / VO2??? Let’s integrate…… Of the following, what is best to use to set the level of intensity for Ex Rx? A. Range for HR B. METs C. Total Time D. Work load Is 4 METs Moderate Intensity? A. Yes B. No C. It depends Tell me Why? Oh Why?? How does a person’s Maximum MET capacity come into play? What is a standard concept and the amount of METs for ADLs? On initial testing, DW was at 75% of max HR when performing 7 METs. After training, what should be expected when exercising at 7 METs? A. % of max HR should be lower B. % of max HR will be the same C. VO2 will be greater D. VO2 will be less Let’s look another way You instruct a patient to exercise at a moderate intensity with an RPE around 6, after training for 6 weeks, what will change for that moderate intensity? A. % of max HR should be lower B. % of max HR will be the same C. VO2 will be greater D. VO2 will be less Relationships RPE and % HR reflect the same concept/physiologic measure (% of Max HR ish – yes there is also the lactate threshold….. But go with me) METs and %VO2 reflect the same concept/physiologic measure (workload) With training, your ability to perform work at a lower % of max is the key change ◦ (along with raising the lactate threshold ) Ex Rx Set intensity by % HR or RPE METs are listed as light; moderate; or vigorous but it all depends on the condition of the patient/client METs directly reflect the VO2 capacity required METs are a measure of workload Don’t get METs and RPE confused  You have a patient whose Max MET load is 10. Which of the following Ex Rx will get the desired health benefits of >500 MET min / week most efficiently and be of moderate intensity A. Perform 35 min of exercise at 8 METs 2X / week B. Perform 30 min of exercise at 6 METs 3X / week C. Perform 30 min of exercise at 3 METs 5X / week D. All of the above will work Translation to clinic If a person walks a mile in 20 minutes and reports an RPE of between 4-6, What amount of walking would you prescribe to accumulate 800 MET min / week? Risks and Benefits Benefits of Exercise Outweigh Risk Remember – the risk of exercises is minute compared to the risk of being sedentary Cardiovascular health Reduction of CVD risk factors Decreased Morbidity and Mortality Other Benefits Remember the Algorithm The reason we start with Active Subject Vs. Sedentary Then add in: Known CVD/Metabolic/Renal Major Signs/Symptoms ◦ Name them - 9 What is Medical Clearance??? Does it require a graded exercise test? NOPE – “Approval from a health care professional to engage in exercise” So…. What about risk factors for CVD?? Why do you care? How can they inform your decision regarding exercise? What are the risk factors? ◦ Name them - 8 (plus a (–) one) How might the person’s risk inform your choice of testing? Compare and contrast the: ◦ 6MWT Which allows the patient to choose their own pace? Why might that be desirable? ◦ 1 mile walk (or other variation) ◦ Standardize Step tests (Queen’s/ YMCA) Which allows for easiest monitoring of HR/BP? ◦ Step (March) test Why might that be desirable? ◦ Progressive TM or Cycle test ◦ Simple Gait Velocity Which have a controlled Workload? Why might that be desirable? ◦ Simple distance over time walking General Rule of Thumb Start light – check tolerance – monitor, monitor, monitor ◦ Remember – beginning, during, and at the end/recovery Build endurance / distance Then build intensity Lab Cases and MET Application CASE 1: 52 year old apparently healthy but sedentary female who upon interview indicates an inability to sustain household activities (vacuuming, weeding and raking leaves, for example) for any length of time before becoming tired. Has never been very active but has been encouraged to join a walking club at the local mall. She denies any major signs/symptoms of CVD. Lab Cases and MET Application CASE 2: 48 year old apparently healthy male is currently exercising on a home treadmill; able to walk for 15 minutes twice daily at an average speed of 3MPH, 5% grade. He would like an assessment to better target an appropriate exercise intensity to improve fitness to keep up with Case 3 this summer. Lab Cases and MET Application CASE 3: 63 year old apparently healthy female who is recovering from knee surgery (12 weeks ago). Last summer she participated in a summer fun run series. She jogs the 5K route and usually finishes in 42-45 minutes depending on the terrain. She would like to restore her fitness level so she is ready to participate again this summer. Lab Cases and MET Application CASE 4: 25 year old apparently healthy but overweight male (BMI – 29, weight 195 lbs) can currently bike outside on the level for 30 minutes. He rides a 6 mile loop around a lake. Since he doesn’t check his pulse, but is willing albeit kind of hard to do on a bike, he would like some feedback about his fitness and some parameters to use to progress his program to be able to ride a 16 mile loop in one hour. Lab Cases and MET Application CASE 5: 42 year old apparently healthy female, weight 155 is currently exercising on regular basis but wants to make sure she’ll be ready for the Little Red Riding Hood 100 mile bike ride. Last year she completed the ride between 6 - 7 hours. She would like to know she has the fitness needed to participate with vigor!  Warm-Ups and Cool-Downs Very important for the cardiovascular system ◦ Gives the heart and vasculature time to slowly increase and decrease heart rate and blood pressure ◦ Remember the muscle pump for venous return? Don’t focus on warm-ups and cool-downs to prevent musculoskeletal injuries with your patients/clients, focus on the cardiovascular system Guy --- FITT-VP Can you use his 6MWT to determine his CV condition? Why? / Why not? Without a test, you could use the simple 220 – Age and use the low end of light/moderate intensity. BUT…… please use his GXT which is in the folder