freq: at least 3 days per week

intensity: to a position of mild discomfort

Duration: 10-30 seconds per stretch

repetitions: 3-5 per stretch

type: dynamic followed by static, with major emphasis on lower back and thigh area

a typical exercise session should include: warm-up, endurance (aerobic) activity, strength training activity, and a cool-down

*what is the recommended duration for each?

warm-up: 5-10 minutes(longer warm-ups necesary for a.m. workouts)

endurance: 15-60 minutes

RT: 20-40 minutes

cool-down: 5-10 minutes (longer cool down with harder workout)

the warm-up period is designed to gradually increase the metabolic rate from the resting MET level to the MET level required for conditioning. 

*what is the resting MET level?

concentric

eccentric

leg extension

don't fully lock knees out

single leg curl

• don't permit the lower back and hips to twist
• complete reps on one leg b4 switching legs

leg press

• knees joint should be slightly tighter than 90 degrees
• feet hip width apart, toes angled slightly outward, ankles in line with knees
• don't fully lock out knees

calf raises

squats

• feet parallel to each other
• squat down with back flat, elbows high, chest up and out
• continue lowering into squat until thighs are parallel to floor

hip and knee flexion(squat down)

followed by

hipe and knee ext. (standing up)

bench press

don't lock elbows

shoulder press

• maintain 5 point body position (head, shoulders, PSIS, both feet)
• do not lock out elbows upon full extension

lat pulldown

• extend elbows fully
• feet flat on floor
• tilt torso slightly backward
• pull bar down & toward upper chest
• touch bar to chest, return to start position

chin-ups

• stand erect then lower body to fully extend arms
• pull yourself up until chin is to handgrip height
• slowly return to start, repeat

tricep pushdown

• stand erect, feet shoulder width apart, facing away from machine
• lean back against pad, pull bar down until upper arms are against sides of torso
• push the bar down until the elbows are fully extended, slowly return to start, repeat

parallel dips

• lean forward slightly and lower  body until back of upper arms are parallel to floor
• push up to full elbow ext., repeat

bicep curl

• flex elbows until palms of hands are within 4-6 inches of anterior deltoids
• slowly return bar to near full extension, repeat

crunches

• press lower back into the floor and curl the torso toward the thighs until the scapula raise off floor

health hx

rheumatic heart disease

strep infection that gets into the lungs

• is accompanied by some or all of the joints
• affects heart valves

health hx

rheumatic heart disease

what to ask?

did you have joint inflammation or stiffness?

when did it occur?

how long did it occur?

health hx

heart murmur

is it functional or not?

have your activities ever been restricted by a physician b/c of the murmur?

health hx

high blood pressure

how long have they had it?

what does it normally run?

is it controlled with medication?

what medicines do you take?

health hx

gout

alcohol >s ____ acid

uric

fluid in the joint (uric acid)

(looks like shards of glass under microscope)

can't ex. with active gout..will tear up joint

health hx

varicose veins

blown out veins

where are they? do they cause pain or do any of them bother person?

health hx

injuries to back, neck, etc.

where is the pain at and does it travel? (ex. down the leg, down both legs, etc.)

are they taking any meds for pain?

if so, what kind

health hx

lung disease

asthma

chronic bronchitis

asthma-exercise induced?

taking inhaler?

c.b.-bad cough, most have emphezema

health hx

piriformis syndrome

feet angled outward

(duck walk)

health hx

epilepsy

what kind of seizures do they have;

petite mal or grand mal?

are seizures controlled with meds?

what meds are they taking?

when was last episode?

health hx

epilepsy

*if this condition is not controlled with meds you should do their exercise tests on what?

health hx

diabetes

*what to ask

what kind of diabetes?

how long have they had it?

what is latest hemoglobin A1c?

how long ago was last eye exam(any retinopathy), foot exam(any neuropathy, pain in feet), visit to endocrinologist?

do you get hypo/hyperglycemic and what are your normal symptoms?(what level do they become symptomatic?)

what meds are they taking?

if they have hx of exercise, how has their b.s. responded to the exercise?

health hx

reactive hypoglycemia

sign of insulin insensitivity

intake lots of sugar, body kicks out insulin, sugar drops, end up pushing out more insulin than needed

precursor to diabetes

health hx

diabetes

*what should fasting blood glucose range be?

*what is a good HbA1c number?

below 99 and above 60

below 6 is good

health hx

heart disease

mitral valve prolapse

*what to ask

m.v.p.-40% of W have it

what kind of heart disease? how long ago were they diagnosed? has their doctor ever limited their activity from it? do they get angina pectoris? if so, what provokes symptoms? what are their symptoms?(if px had MI what were Sx during the attack?) what meds do they take for their heart? have they had heart surgery? 

health hx

heart disease

CABG x3

PTCA + stent x 2

health hx

heart surgery

health hx

kidney disease

stones

infection

what kind of disease? when were they diagnosed? are they on any medications? if so, what are they? have their activities ever been restricted because of their disease?

have they ever had kidney stones?

infx-if you get a kidney infx, it is damaged forever

health hx

stomach ulcers

*what to ask

have you ever had bleeding ulcers?

how long ago?

are they having any current stomach problems?

are they taking any medications for stomach and if so, what?

health hx

arthritis

 osteoarthritis

rheumatoid arthritis

*what to ask

what kind do they have? what joints are affected? are they on any medications? what are they?

osteoart.-wear and tear at joint. where is it? will it hurt during exercise?

r.a.-can't exercise with it; it will grind up joint

health hx

cardiac catheterization

*what to ask

health hx

strokes

aphysia and agraphia 

TIA

how long ago did they have their stroke or TIA? what area was affected? do you have any difficulty with activity? are they   on any meds related to their stroke?

aphysia-know what they want to say but can't

agraphia-can see words but can't read

health hx

thyroid problems

are they hypo or hyper thyroid?

 hypo-heavier set

what meds are they taking?

health hx

dizziness or fainting spells

(normally related to cardiac problem)

health hx

nervous or emotional problems

health hx

allergies

health hx

phlebitis

how long ago?

are you still on any meds for it?

clots, they become inflammed

health hx

cardiac arrest

how long ago did it happen?

what were they doing?

do you have any problems as a result?

health hx

hospitalizations

overnighters

health hx

have you recently had means?

health hx

irregular heartbeat

or any

fast heartbeats or flutters

does it bring on any sx?

health hx

shortness of breath

exercise induced asthma

cough on exertion?

health hx

back pain

if it is b/t the shoulder blades it is a sign of angina

where is it and what typically brings it on? sharp or dull pain? does it travel?

health hx

difficulty sleeping

orthpnea

pnd 

bypap machine

difficulty getting to sleep or staying asleep?

do you sleep on one or more pillows?

orthpnea-one, two or three pillow orthpnea

pnd- people that get up and run to the window

tell you they sleep in a chair?

bypap machine-sleep apnea

health hx

fatigue means

health hx

calf pain when exercising is normally caused from?

blood clots

cloticatication?

the larger systemic arteries (>10mm diameter) are generally of ______ composition

the smaller systemic arteries (0.1-10mm) tend to be of ______ composition

elastic

muscular

the distensible aorta "stores" a portion of the blood, creating _____ within the entire arterial system

causes a ____ wave--->pulse

Pressure

Pressure

all arteries, with the exception of the _____ and _____ arteries, carry oxygenated blood

_____ -thick walled, high P tubing that conducts oxygenated blood

______-smaller branched arteries, circular layers of connective tissue

(they constrict or relax, thus changing the resistance to blood flow)

arteries

arterioles

arterioles AKA ______ vessels

-help regulate blood pressure by the variable contraction of the smooth muscle of their walls

-deliver blood to capillaries

a single layer of _____ cells line the capillary wall

-at rest, more capillaries are available than are open

-dormant capillaries open during exercise from increased P and local metabolites

___-small veins that collect deoxygenated blood from capillaries

___-thin walled, lower pressure

venules

veins

the capacitance vessels are the small veins and large veins and they hold __% of blood at rest

...blood reservoir

venous return of blood to the heart

-has one way ___s

-skeletal muscle acts as a ____
-alternate ____ and ____ "milk" blood back to the heart

-smooth muscle layer

valves

pump

compression and relaxation

VCO2/VO2=?

measured from expired air

RER

respiratory exchange ratio

VCO2/VO2=? 

for the cell

RQ

respiratory quotient

it is AKA regular sinus rhythm (RSR) or normal sinus rhythm (NSR)

• is the most common adult rhythm with rates b/t 60-100 bpm
• QRS is most often narrow with upright P waves in lead II

athletes may routinely be in this due to an optimal cardiac stroke volume that requires less HR to yield acceptable cardiac output.

• may be produced by vagal stimulation or due to sick sinus syndrome
• narrow QRS
• upright P wave in lead II
• rate=

most often results from increased sympathetic stimulation (ex. due to pain, fever, increased O2 demand, and/or hypovolemia)

• usually narrow QRS
• rate=100-150

most often a benign rhythm

• common in children and less common with older adults
• the irregular pattern of this rhythm fluctuates with inspiration (HR increases) and expiration (HR decreases)
• narrow QRS
• upright P wave in lead II
• rate=

results from blocked sinus impulses-impulses not getting through to depolarize the atria

• the sinus is firing on schedule, but the tissue around the SA node is not carrying the impulse
• the seriousness of this dysrhythmia is related to the frequency and duration of the blocks
• each pause is equal to a multiple of previous P-P intervals
• P wave is slightly depressed below baseline
• since the impulse isn't getting through the atria, the heart will pick up a junctional rhythm (40-60 bpm) 

• occurs when the SA node fails to fire
• the resulting pause is often NOT equal to the multiple P-P intervals seen in sinus exit block
• often an escape pacemaker such as the AV junction will assume control of the heart
• AV Junction rate=40-60 bpm 

sinus arrest

aka sinus pause

• result from irritability to the atria resulting in increased automaticity of atrial tissue
•  the atria initiate an impulse earlier than expected from the SA node
• narrow QRS
• flattened, notched, peaked or biphasic P waves
• normal sinus rhythm (60-100bpm)

• ominous rhythm with rates b/t 170-230per min.
• telltale sign of this is the narrow QRS which defines its ___origin and its regular, rapid pattern
• you know that the rhythm is not sinus tachycardia due to its very fast rate (170-230)
• for those at rest, narrow QRS tachycardias over 150/min. are most often this rhythm

SVT

supraventricular tachycardia

supraventricular origin

• chaotic rhythm with recognizable QRS complexes
• the hallmarks of this dysrhythmia are the chaotic rhythm pattern and the absence of P waves
• chaotic baselines aka ___ waves
• atrial kick is lost
• the risk of thrombus formation is particularly significant after 48 hours

atrial fibrillation

fibrillatory

when atrial contraction occurs, the AV valves are open and the rest of the atrial blood is pushed down into the ventricles. This is called the atrial ___

• accounts for ~30% of cardiac output