Exercise Testing & Prescription for Asthma and Cystic Fibrosis PDF

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Warning This material has been produced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the copyright act (Act). The material in this communication may by subject to copyright under the act. Any further reproduction or communication of this material by you may be the subject of copyright protection under this act. Do not remove this notice  Final lecture Exercise testing and prescription for asthma and cystic fibrosis Week 13 Part b Learning Outcomes be able to outline the risk factors, complications and co-morbidities that must be accounted for when applying exercise interventions to individuals with asthma and cystic fibrosis; be able to explain the diagnostic techniques and treatment procedures used in the treatment of asthma and cystic fibrosis; be able to demonstrate the ability to conduct exercise/fitness/functional tests on individuals with asthma and cystic fibrosis; be able to prescribe exercise as a therapeutic modality for individuals with asthma and cystic fibrosis. Lecture Overview 1. Considerations Asthma 2. Exercise testing CF 3. Exercise prescription Asthma 5  Exercise Testing Not generally required, unless exercise tolerance reduced disproportional to symptoms or air-flow limitations When this is evident, symptom-limited incremental test is completed Include assessments of oxyhemoglobin saturation and ECG Optional: respiratory gas analysis and anaerobic threshold Contraindications to consider Acute bronchospasm Chest discomfort Increased SoB above what is usually experiences Severe deconditioning or co-morbidities 8  Exercise-induced Bronchospasm (EIB or EIA) Pathophysiology related to consequences heating and humidifying large volumes of air during exercise Hyperosmolar environment → mast cell degranulation → eosinophil activation, cellular mediators of inflammation → bronchoconstriction → airflow limitation The development of EIB is related more to the water content, rather than temperature Symptoms → dyspnoea, cough, tightness in the chest, wheezing, sputum production Typically experience bronchodilation for initial 10min of exercise, followed by a progressive bronchoconstriction (spasm) at 10 min post-exercise Resolves within approx. 60 min post-exercise 9  Exercise-induced Bronchospasm cont. Diagnosis requires bronchoprovocation challenge with pre and post spirometry testing Exercise test to symptom-limited maximum Protocol involves rapid increase in intensity of 2-4min (VE >21 x FEV1), breathing dry air ( 10% in FEV1 = EIB Two most important determinants of EIB is the sustained high-level ventilation during exercise, and water content Pre-exercise warm-up important to reduce risk of EIB → 15min duration < 60% VO2max (trained); lower intensities for untrained/clinical populations Bronchodilator, anti-inflammatory or leukotriene modifier therapy. SABA should be delivered 15 min prior to exercise 10  Exercise Prescription Variety of exercise prescription will reflect the vast range of symptoms, severity and limitations to airflow. Mode and intensity should reflect training status, interests, goals Exposure to cold air, low humidity and air pollutants should be minimised GXT performed, exercise start below VT 50-85% HHR (HRmax – RHR) No GXT, intensity based on perceived dyspnoea (Borg scale) If maximal test was completed, initial exercise intensity should be just below AT 11  ACSM recommendations Avoidance of triggers resulting in bronchoconstriction, adequate warm-up, use of bronchodilators prior to exercise EIB is less likely if asthma is well-controlled Exercise prescription recommendations outlined for COPD can be directly applicable to clients with asthma when airway obstruction is adequately managed 12 Cystic Fibrosis 13  Exercise Testing Testing is important in CF: monitoring and management of the client’s clinical status pre-transplant assessment counselling and education (exercise/activity) identify new of recurrent symptoms. Designed to optimise overall well-being, physical and psychological health Work with a wide range of allied health professionals and parents Development of goals and an achievable exercise program to improve QoL 14  Exercise Testing Testing should include a standardised GXT to maximum using treadmill or cycle ergometer Monitor data pre, during and post GXT Utilise ECG and pulse oximetry Completion of the protocol without desaturation (70% function, young children approach maximum HRR >70% helps childhood ensure airway clearance Resistance Young children: emphasis on 2-3d/wk 10 to 12 reps of 10-20 min Work total body; Increase whole- body weight activities body weight progress when 10 body strength; activities to 12 reps are no assist in increasing Children: body weight and age- longer body mass and appropriate weight training challenging appropriate growth Flexibility Normal movement activities Daily 10 to 30 s for 5-10 min Natural Reduce risk of Stretching to maintain chest wall each stretch, pain progression as injury; maintain or mobility free needed enhance chest wall mobility DAILY PHYSICAL ACTIVITY Young children: 60min/day of activities appropriate for normal SPECIAL CONSIDERATIONS development AEROBIC: Retest yearly Children: 60min/d of enjoyable activities that are peer or family RESISTANCE: Progress gradually to reduce risk of injury based FLEXIBILITY: similar issues with flexibility as the general population 31  Teens (13-19 years) and Adults (>20years) Mode Frequency Intensity Duration Progression Goals Aerobic Teens: enjoyable activities and Daily Moderate to 30 - 60 min No more than 10% Airway clearance, sports vigorous exercise in any given 2 wk emphasize (>70% HRR) to period coughing and Adults: walking, hiking, ensure increases in huffing swimming, jogging ventilation and shear forces within the lungs Resistance BW activities 2-3d/wk 1 to 3 sets 20 - 40 min Mild progression; Increase strength; 8 to 12 reps maintain high reps increase Formal Resistance training 70-80% 1RM respiratory strength; improve performance of tasks of daily living Flexibility Stretching, yoga, Pilates Daily 10-30 s for each 10 to 15 min Natural Maintain or stretch, pain free progression as enhance chest flexibility improves wall mobility in advancing disease DAILY PHYSICAL ACTIVITY SPECIAL CONSIDERATIONS Teens: 60min/d of sport or recreation that is driven AEROBIC: Formal pulmonary rehab may be best suited for clinical gains in severe by social interactions and family patients. Children: 150-300min/wk of enjoyed activities RESISTANCE: Standard measures of strength assessment. Avoid Valsalva maneuver FLEXIBILITY: Exercise prescription should be an adjunct to regular CF treatments. 32  Benefits of Aerobic Exercise Training Static pulmonary pressure – mixed results Improvements in FEV1 when aerobic and resistance training utilised Improved FVC, FEV, FEF25-75 and peak expiratory flow following 17 d exercise camp Less likely to see improvements in static lung function following exercise, but slow the rate of deterioration Dynamic lung function – improvements with exercise training Lower RHR, increased Hrmax, improved VO2max, increased work capacity, VT and maximum VE Exercise training during hospitalisations also useful with chest physiotherapy and bronchial drainage Greater training effects with higher intensity programs, 33  Benefits of Muscular Strength and Endurance Benefits of anaerobic function have mixed results Resistance training + home cycling (with sport participation) has been shown to increase muscular strength vertical jump, flexibility and balance without specific increases in strength Muscle limitations including decreased muscle size and metabolic abnormities that lead to reduced strength (and strength gain) Longer rest periods may be required Muscle wastage due to medications for CF clients post-lung transplant 34  Benefits for Body Composition, Nutrition and Mental Health Exercise limitations occur independent of nutritional concerns Energy expenditure, sodium/chloride imbalance through increased sweat rates, CF-related diabetes and muscle mass Children undertaking regular exercise can increase body mass independent of caloric needs Nutritional supplementation can support improved aerobic capacity and tolerance and respiratory muscle strength Exe long term psychological benefits (Quality of well-being scale correlate with exercise capacity) Exercise can improve wellbeing, reduce rates of depression and anxiety 35 Watch ✓ Week 13 Lecture ENGAGE ✓ Week 13 Tutorial – Case study analysis READ ✓ Ehrman Chapters 20 (Asthma) and 21 (CF) ✓ Exercise testing for CF clients reading (Interact2) Revision/drop-in session next week (highly recommended) might not be recorded (usual tutorial time) Exam and Intensive School details are available on the Interact2 site Please complete the Subject Evaluation (please be courteous and constructive) 36