Safety with Exercise Training and Testing Patients and Clients PDF

Safety with Exercise Training and Testing Patients and Clients Objectives What should you worry about when your patients are exercising? Who’s at risk while exercising? (remember stratify and..) Who shouldn’t exercise? When do you stop exercise? What do you need to know and do to...

Safety with Exercise Training and Testing Patients and Clients Objectives What should you worry about when your patients are exercising? Who’s at risk while exercising? (remember stratify and..) Who shouldn’t exercise? When do you stop exercise? What do you need to know and do to keep your patients safe? For This Presentation: When you see a reference to exercise testing, change it in your mind to aerobic exercise training (or submax testing) Exercise Testing = Exercise Training Apply the safety principles from exercise testing to your application of aerobic exercise training This is most important during your first couple of sessions with your patient/client particularly in the outpatient setting Know Your Patient’s Medical History  Absolute Contraindications Acute myocardial infarction within 2 d Who should not Ongoing unstable angina Uncontrolled cardiac arrhythmia with hemodynamic compromise Test or Exercise? Active endocarditis Symptomatic severe aortic stenosis Box 4.1 in Decompensated heart failure 11th ed. Pg Acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis 116; e-book Acute myocarditis or pericarditis pg 45 Acute aortic dissection From ACSM 11th ed Physical disability that precludes safe and adequate testing Relative Contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain relationship to symptoms Tachyarrhythmias with uncontrolled ventricular rates Acquired advanced or complete heart block Recent stroke or transient ischemia attack Mental impairment with limited ability to cooperate Resting hypertension with systolic >200 mm Hg or diastolic >110 mm Hg Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism Key Principles If you see something from Box 4.1 make sure your patient’s physician has cleared them for participation in exercise before you challenge your patient Many times you will receive complex patients and the physician is counting on you to treat the patient despite them having conditions in Box 4.1 More to come on this Key Principles Direct access has saddled PTs with a greater burden of being able to appropriately identify patients/clients who need to see a physician first before starting PT Some people may not be seeing a physician on a regular basis, so you are their first point of contact with the medical system Know who is likely safe, and who should see a physician first! Remember your Risk Stratification In addition consider: Who To Watch Out For Risk in Athletes One reason why any Major Sign or Symptom of CVD in a regular exerciser is a Automatic referral for medical clearance Don’t forget the Sedentary Risk and the need to start slowly! Key Principles You need to monitor the cardiovascular system before, during and after your exercise intervention Blood pressure Heart rate EKG in some cases Oxygen saturation (if needed) Rate of perceived exertion Before During After Key Principles You need to monitor the cardiovascular system before, during and after your exercise intervention Cognition Can they understand what you are saying and respond appropriately? Subjective symptoms Dizziness/lightheadedness Dyspnea=shortness of breath Other signs Loss of limb coordination Slurred speech  Figure 4.3 in 11th ed These scales will be applied in CV&P Course sequence. Rate of Perceived Exertion Figure 4.3 11th When Should You Stop Exercising? = Box 4.3 in 11th ed 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 Professionalism Know your limits – recognize your practice setting TAKE VITALS! Watch closely Ask questions