Term
| exercise is prescribed based on |
|
Definition
Condition
• Individual characteristics
• Goals |
|
|
Term
|
Definition
Frequency--how often
• Intensity
• Physiological--HR, RR, RPE, SpO2
• Physical--speed, incline, absolute or relative mass
• Time--duration of exercise bout
• Type of activity (walking, skiing, knitting, playing cello)
• Falls into overlapping categories of aerobic, endurance,
anaerobic, strength, power, flexibility, neuromuscular, functional |
|
|
Term
| categories for exercise testing and prescription |
|
Definition
Aerobic--maximum oxidative metabolism
• Endurance--ability to sustain submax aerobic activity
• Anaerobic--ability to sustain short-term, high intensity exercise
• Strength--max force developed against high load, irrespective of time
• Power--ability to generate force rapidly
• Flexibility--ability to move joints through ROM (extensibility)
• Neuromuscular--ability to perform tasks requiring coordination & skill
• Functional--ability to specific physical activity, usually ADL/IADL |
|
|
Term
|
Definition
• VO2 max, VO2 peak, max steady state VO2, lactate
threshold
• Athletes
• Ventilatory measures: RR, breathlessness tools
• RPE
• METs
• Time to exhaustion |
|
|
Term
|
Definition
Capacity for oxygen debt
• Peak lactate
• 30s peak power output
• Time trials
• Almost always reserved for athletes |
|
|
Term
|
Definition
6MWT (12, 3)
• 1 mile walk
• Time to exhaustion
• RPE at constant work load
• Max # of repetitions |
|
|
Term
|
Definition
Max # repetitions
• Isokinetic work, peak torque
• Max voluntary contraction
• Peak power output
• 1 RM on specific exercises
• Squat vs clean |
|
|
Term
|
Definition
Sit & reach
• Goniometry
• Muscle length tests |
|
|
Term
| neuromuscular and functional tests |
|
Definition
Gait, balance, hand-eye coordination, rxn
time
• Timed up and go, etc. |
|
|
Term
|
Definition
| gold standard aerobic testfor healthy athletes, limited by O2 supply, chronic disease, symptom limited exhaustion, and other factors |
|
|
Term
|
Definition
Important for those with chronic disease
• Functional level may improve without change
in VO2 max
• Improvements may reduce need for
HH or institutionalization |
|
|
Term
|
Definition
Related to strength in healthy individuals
• Short periods of higher intensity
• Activities that might be trivial for healthy person
• Cooking, cleaning, self-care
• Why do we consider such activities to be “trivial?”
• Correlated with VO2 max in chronic disease |
|
|
Term
|
Definition
Difficult to perform with low functional level
• Lack of endurance may limit testing
• Limited availability of isokinetic equipment
• Increased strength decreases CV stress for a
given load, even with IADLs |
|
|
Term
|
Definition
May limit performance of functional tasks
• May increase difficulty of functional tasks,
including CVP response |
|
|
Term
| developing exercise prescrition without testing |
|
Definition
necessary on occasion
• Use measure of physiologic response as intensity
• HR, RPE, RR, SpO2
• Does not allow one to determine what the limiting
aspect of exercise is
• Need to be creative in developing test as part of
exercise prescription |
|
|
Term
| normal cardiorespiratory response to acute aerobic exercise |
|
Definition
Linear increases in CO, HR, SV, SBP
• Steady or decreasing DBP
• Difference between SBP and DBP
should increase
• RR increasing linearly until
anaerobic threshold
• Effect of heavy resistance is different
• SBP and HR rise in proportion to
% maximum voluntary contraction |
|
|
Term
| abnormal cardiorespiratory response to acute aerobic exercise |
|
Definition
Low VO2 max--Anaerobic threshold
during ADL
• EKG responses to exercise testing
• Chronotropic incompetence--Failure
of HR to rise as predicted
• Exertional hypotension--Failure of SBP
to rise as expected [6-10mmHg/MET]
• Exertional hypertension
• Rising DBP |
|
|
Term
|
Definition
Determine risk factors
under controlled conditions
• Abnormal hemodynamic
responses
• Abnormal EKG
• Development of symptoms
of CAD under controlled
condition |
|
|
Term
| risks of vigorous exercise |
|
Definition
Increased BP and HR
• Increase myocardial oxygen demand
• Shortened diastolic time
• Shortens coronary perfusion time
• Decreased CVP immediately post-ex
• Need for cool-down period
• Principle is used to increase sensitivity
to testing
• Increased catecholamine secretion
• Increased risk of arrhythmia
55 |
|
|
Term
| risk factors for heart disease |
|
Definition
Clinical status
• How one
participates in
exercise training
• Exercise test data
• Other factors |
|
|
Term
|
Definition
Screening tool for presumably healthy general population
• Seven questions related to:
• Cardiovascular disease
• Neuromusculoskeletal conditions
• Unspecified other causes |
|
|
Term
| risk factors for CV exercise |
|
Definition
History: MI, CABG, pacemaker, CHF, congenital HD,
etc
• Symptoms: angina, SOB, dizziness, heart meds
• Other: DM, lung dz, claudication, musculoskeletal,
concerns about safety, prescription meds, pregnancy
2 or more fails screening for simple fitness program
• Man older than 45
• Woman older than 55, had a hysterectomy, or is
post-menopausal
• Smokes or quit smoking within 6 months
• Blood pressure > 140/90
• Does not know BP
• Takes BP meds
• Blood cholesterol > 200 mg/dL
• Do not know cholesterol level
• Relative with MI or CABG before 55 (M) or 65 (F)
• Physically inactive
• > 20 # overweight
Age: men ≥ 45, women ≥ 55
• Family history of heart disease
• Cigarette smoking
• Sedentary lifestyle
• Obesity
• Dyslipidemia
• Total > 200 mg/dL
• LDL > 130
• HDL < 35
• Using lipid-lowering medication
• HDL > 60 considered negative risk factor
• Prediabetes: fasting BG 100-126, impaired glucose tolerance (OGTT 140-200 p 2 hr) |
|
|
Term
| signs and symptoms of CV pulm or metabolic disease |
|
Definition
Angina
• SOB at rest or during exertion
• Dizziness or syncope
• Orthopnea or paroxysmal nocturnal dyspnea
• Ankle edema
• Palpitations or tachycardia
• Intermittent claudication
• Known heart murmur
• Unusual fatigue or SOB with usual activities
(anginal equivalent) |
|
|
Term
|
Definition
Asymptomatic men and women
• No major signs of CV, pulm, metabolic dz
(Table 2.2)
• No more than one risk factor from Table 2.3
• Suitable for exercise without medical exam
and clearance |
|
|
Term
|
Definition
Asymptomatic men or women with two or more
risk factors from ACSM Table 2.3
• No major signs of CV, pulm, metabolic dz
• Ok for low or moderate intensity exercise
without medical exam & clearance
• GXT and medical exam/ clearance for vigorous
exercise |
|
|
Term
|
Definition
Known cardiovascular, pulmonary, or metabolic
disease
• Cardiac, peripheral arterial, or cerebrovascular dz
• COPD, asthma, interstitial lung dz, CF
• DM, thyroid, renal, or liver disease
• GXT and thorough medical examination
• Should be in a medically supervised rehab program |
|
|
Term
|
Definition
Disease involving defect in a specific type of chloride ion
channel (cystic fibrosis transmembrane conductance regulator)
• Morbidity due to multiple effects caused by inability to transport
Cl ions across cell membranes
• Median life expectancy > 37 years
• Commonly associated with lung disease and pancreatic
insufficiency
• Affects reabsorption of ions from sweat, exocrine glands,
reproductive tracts |
|
|
Term
High levels of NaCl in sweat;
sweat test used to diagnose
CF (analyze salt content of
evoked sweat)
• CF may be suspected due
to:
• Malnourishment
• Salty skin
• Presence of CF in families
of parents |
|
Definition
| diagnosis of cystic fibrosis |
|
|
Term
Large number of mutations
can be involved
• Autosomal recessive
disease
• Defective gene is carried by
1/29 Caucasian individuals
• Delta F508 most common
• Incidence: 1/2000 live
births, primarily Caucasian |
|
Definition
| genetics of Cystic fibrosis |
|
|
Term
|
Definition
Frame shift mutation
• Affects single amino acid
• Prevents the trafficking of
CFTR through endoplasmic
reticulum
• This type of Cl- channel not
placed in membrane
• As many as 200 other
mutations may exist |
|
|
Term
| homozygous for delta 508 cystic fibrosis |
|
Definition
produces most
severe disease |
|
|
Term
Obstruction with purulent exudate
• Presence of mucus provides suitable home for:
• Pseudomonas aeruginosa
• Staphylococcus aureus
• Burkholderia (formerly Pseudomonas) cepacia
• Impaired localized immunity of the lungs (defensins)
• Altered phospholipid metabolism with increased arachidonic acid
production
• Chronic inflammation with increased mucus production |
|
Definition
| pathophysiology of lung involvement in CF |
|
|
Term
|
Definition
Aimed at breaking the cycle
of mucus, inflammation,
infection
• Chest PT
• Mucolytic drugs and
hypertonic saline
• Antiinflammatory drugs
• Infection control
• Exercise |
|
|
Term
Diabetes due to
pancreatic injury
• Osteoporosis
• Urinary incontinence
• Likely all girls by lateteens
• Postural syndromes
(variable) |
|
Definition
| secondary problems with increased survival of CF |
|
|
Term
Innervation of the lungs/airways
• Sensory receptors cause cough
and vagal reflexes
• Presence of material in airways
evokes coughing proportional to
number of receptors stimulated
• Coughing can be suppressed to
some degree, but can overwhelm
conscious control
• Coughing is a poor means of
clearing distal airways; only works
well for large airways |
|
Definition
| Why does ellie (CF) cough so much? |
|
|
Term
|
Definition
Indiscriminate activation of vagal
targets, particularly heart
• Airway obstruction can lead to
bradycardia and syncope
• Parasympathetic stimulation of
airways produces bronchoconstriction
and glandular secretion
• Activation of beta2 receptors in
airways produces bronchodilation and
decreased glandular secretion |
|
|
Term
|
Definition
Shared space with alimentary canal—
both food and air move through these
spaces
• Functions:
• Warm and humidify air
• Remove larger particles from air
• Lose effectiveness with:
• Increased ventilatory rate
• Mouth breathing
• Use of artificial airways bypass these
functions; they need to be replaced
to avoid injuring lungs |
|
|
Term
|
Definition
Below epiglottis—
only air should pass
through them |
|
|
Term
|
Definition
First ~16 generations of branching
• From trachea to left and right main bronchi
• To lobar and segmental bronchi,
subsegmental and respiratory and terminal
bronchioles
• Terminal bronchioles: most distal airways
without capacity for exchanging gases
• Air moves by bulk flow from high to low
pressure
• Largest airways have cartilage rings
preventing collapse with high transmural
pressure
• Smaller airways in conducting zone subject
to collapse that can occur with coughing |
|
|
Term
|
Definition
Remaining 6-7
generations
• Gas exchange between
alveoli and blood
• Either airways lined with
alveoli or passageways
within clusters of alveoli
• Respiratory bronchioles,
alveolar ducts and alveoli |
|
|
Term
|
Definition
final clearance technique for
proximal airways with cartilage rings
• Coordinate closing of glottis, isometric
contraction of abdominal muscles and
rapid opening of glottis
• Double _____ used to increase
effectiveness
• may be improved with trunk
flexion
• generates very high airflow,
but ineffective for distal airways
• High intrathoracic pressure
produced collapses distal airways |
|
|
Term
|
Definition
Pts unable to
produce forceful
cough
• Spinal cord injury
• Other NM or MS
dz/injury |
|
|
Term
| passive airway clearance/postural drainage |
|
Definition
Positions used to promote
drainage of a given segment in
either or both lungs
• Several variations in positions
exist in the literature; we will use
the CF Foundation’s positions
• Passive: maintain up to 20
minutes
• If done with active chest PT, 2-5
minutes per position is a
reasonable starting point |
|
|
Term
|
Definition
Divided for convenience
into bilateral apical, anterior,
and posterior segments
• Geometry is NOT
symmetric, but the
positioning is considered to
be bilateral in the CF
Foundation scheme
• Other schemes may have
different positioning for left
and right |
|
|
Term
|
Definition
Sitting leaning
slightly backwards
(30 degrees)
• Strike between
upper traps and
clavicle |
|
|
Term
|
Definition
Lying supine
• Strike inferior to
clavicle |
|
|
Term
|
Definition
Sitting leaning
forward (30 degrees)
• Strike superior to
spine of scapula |
|
|
Term
|
Definition
Treated the same way in CF
Foundation positions
• Head down 15 degrees; strike at
level ~ 4th intercostal space
• Lingula (left-sided equivalent for
ACT)
• 3/4 supine with left side elevated
• Right middle lobe
• 3/4 supine with right side
elevated |
|
|
Term
|
Definition
Divided into:
• Bilateral superior
segments
• Three sets of bilateral
basal segments
• Superior segment airways
directed horizontally
• Basal segments directed
more vertically |
|
|
Term
| superior segments (lower lobes) |
|
Definition
Prone, flat with two
pillows under belly
• No tilt except what
pillows do
• Strike between scapulae
between spine and
inferior angle
• Can be done bilaterally
simultaneously |
|
|
Term
| basal segments (lower lobes) |
|
Definition
Strike just inferior to scapula for all three sets of
bilateral segments
• Names are somewhat off: posterior is posterior,
but anterior is mainly lateral, and lateral is in
between
• Three positions all with the head down 30 degrees
• Anterior
• Sidelying--can only do right or left side, then
turn if needed
• Lateral
• 3/4 prone--can only do right or left side, then
turn if needed
• Posterior
• Prone--can do both sides simultaneously |
|
|
Term
Pulmonary edema
• CHF
• HTN
• Intracranial
pressure
• SOB
40
Obesity
• Distention
• Hiatial hernia
• Nausea
• Full stomach |
|
Definition
| postural drainage contraindications |
|
|
Term
anything that increases risk of bleeding or fracture
• Hemoptysis
• Increased bleeding time
• Thrombocytopenia
• Fractured ribs
• Osteopenia
• Pt does not tolerate |
|
Definition
| precautions for precussion and shaking |
|
|
Term
| positive expiratory pressure devices |
|
Definition
Valved devices allow free
inspiration, but expiration
occurs at a prescribed
pressure
• Maintain positive pressure
within airways, creating flow
acceleration behind secretions
• Allow air to get behind
secretions so huffing and
coughing can clear them
• Portable and easy to use |
|
|
Term
|
Definition
Consists of a mouthpiece and weighted ball
with a cap over the weighted ball
• Weighted ball seals the orifice producing PEP,
but the ball’s weight causes it to fall back over
the orifice
• Pressure builds causing the ball to rise again
and gravity causes it to fall
• Results in an oscillatory PEP as the ball rises
and falls as well as flow acceleration each
time the ball lifts up
• Cycle of PEP and flow acceleration is an
improvement over plain PEP devices
• Portable and easy to use
• Angle that the device is held changes the
PEP and the frequency of oscillation |
|
|
Term
|
Definition
Pneumatic device featuring a
vest with air chambers
• Rapidly alternates inflation
pressure similar to manual
percussion
• Pt can do most activities
while the device is running in
spite of noticeable shaking
• Portable enough to be taken
on trips |
|
|
Term
|
Definition
Self-administered intrapulmonary technique
• Does not require any equipment or other person to help after initial training
• Training may be difficult and some may not be able to learn
• 3 phases to unstick, collect, and evacuate, representing A&P of distal, mid-sized, and
larger airways.
• Deep inspiration to get air behind secretions
• Series of low volume ventilations near residual volume to “unstick” secretions
• Series of mid-lung volume ventilations to “collect” secretions in the mid-sized airways
• Series of mid-to-high volume ventilations to evacuation with huffing to remove
secretions
• Huffing and coughing to clear |
|
|
Term
Pulled outwardly by
muscles of inspiration
• Linkage of the lungs to
the chest wall by the
pleura
• Lungs are pulled outward
• Creates negative pressure
inside the chest that
produces inspiration |
|
Definition
| dynamics of chest wall movement |
|
|
