ACSMs Exercise Management for persons with Chronic Diseases

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ACSMs Exercise Management for persons with
Chronic Diseases Disabilities

• MI Patients
• Recommendations for Exercise Testing
• Recommendations for Exercise Programming
• Intensity of exercise
• 40 - 85 of maximal heart rate reserve,
• Rating of perceived exertion (RPE) 11 16
• is used as an adjunct to heart rate as an
  intensity guide.
• Frequency of exercise at least 3 days/ week.
• Duration of training 20- 40 min of continuous
  or interval exercise, preceded and following by
  warm-up and cool-down periods of about 10 minutes.

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Medication MI patients

• Medications
• Appendix A Pp. 241-247 (Table A.1 A.2)
• Beta blockers No major effect on exercise
  trainability in cardiac patients.
• Antiadrengergic agents
• Nitrates Nitroglycerin
• Calcium channel blockers No major effect on
  exercise trainability in cardiac patients
• Diuretics
• Peripheral vasodilators
• ACE inhibitors
• Antiarrhythmic agents Class I, II, II IV
• Sympathomimetic agents Antihyerlipidemic agents

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Coronary Artery Bypass Graft Surgery (CABGS)
Angioplasty

• CABGS Angioplasty
• Effects on the Exercise Response
• Effects on Exercise Training
• Management and Medications
• Recommendations for Exercise Testing

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CABGS Angioplasty (cont)

• Recommendations for Exercise Programming
• Begin impatient exercise rehabilitation sooner
• Progress at a more accelerated rate devote more
  attention to upper extremity range-of-motion
  exercises
• Upper body ergometry or resistive exercises
  should be avoided until the healing of the
  sternal incision is complete (generally 4 - 8
  weeks after CABG)
• Subjects may begin to resume normal activities,
  including light to moderate exercise such as
  brisk walking, within 24 to 48 hours after
  rehabilitation (Phase II) provides close
  monitoring supervision in which failures
  (restenosis) can be detected early.

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Medications

• Medications
• See chapter 3 programming table and appendix A.
• Beta blockers No major effect on exercise
  trainability in cardiac patients.
• Calcium channel blockers No major effect on
  exercise trainability in cardiac patients.

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Angina Ischemia

• Effects of Exercise Training
• Recommendations for exercise testing
• Recommendations for Exercise Programming
• Before entry into a cardiac rehabilitation
  program, all people who have experienced angina
  symptoms should have a diagnostic exercise test
  to establish functional capacity and the severity
  of their disease
• If angina occurs during the exercise test, the
  work rate and heart rate at which angina occurred
  are useful for determining the initial upper
  training limits for that person
• Before clients are allowed to exercise, they
  must
• Define angina
• Identify angina symptoms
• Identify their own angina symptoms
• Describe the immediate treatment

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Angina Medications

• Medications
• Appendix A Table A.2, pp. 244-247
• Beta Blockers, Nitrates, Calcium channel
  blockers, vasodilators, etc.
• Most cardiac medications can alter the
  hemodynamic responses to exercise and possibly
  reduce the sensitivity to the test,
• i.e., increase or decrease HR, BP, exercise
  capacity, change of ECG at rest during
  exercise

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Hypertension
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Hypertension (cont )

• Recommendations for Exercise Testing
• Recommendations for Exercise Programming
• It is recommended that people with more marked
  elevations in BP (180/110) add endurance
  training to their treatment regimen only after
  initiating drug therapy
• Exercise RX
• The mode (large muscle, aerobic activities)
• frequency (3-7 days per wk),
• duration (20-60 min) and
• intensity of exercise (50-85 of maximal oxygen
  consumption)
• The above recommendations for persons with
  hypertension are similar to those for healthy
  adults.

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Exercise Testing Recommendations
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Exercise Programming Recommendations
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Medications

• Beta blockers
• Attenuate HR by about 30 contractions per min
• These medications may cause post-exertional
  hypertension
• Alpha 1 blockers
• alpha 2 blockers
• calcium channel blockers
• vasodilators

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Recommendations for Exercise Testing

• Primary objectives of a treadmill test for
  clients with PAD are to
• Obtain reliable measures of claudication pain
  times
• Obtain reliable measures of ankle pressure
  following exercise
• Assess whether coronary artery disease is present.

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Recommendations for Exercise Programming

• Designed with a goal of improving claudication
  pain symptoms and reducing cardiovascular risk
  factors
• Most persons should do interval walking or stair
  climbing 3 times a week, at an intensity that
  causes pain of a score of 3 on a 4-point scale
• This type of program may start with 20 minutes of
  exercise per session at 40 of heart rate
  reserve, and gradually progress to 40 min. at 70
  of heart rate reserve, over a period of about 6
  months
• Non-weight bearing tasks may be used for warming
  up and cooling down

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Exercise Programming (cont)

• Exercise training should not be performed until
  medical clearance, based on a physical exam,
  blood screening and graded exercise test (GXT)
  results, has been completed
• Exercise should not be performed when there are
  concomitant co-morbidities that may limit
  exercise tolerance.

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Peripheral Arterial Disease (PAD)
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Peripheral Arterial Disease
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Peripheral Arterial Disease (cont)
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PAD (cont)
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Medications

• Pentoxyphylline, dipyridamole, aspirin, and
  warfarin May improve time to claudication
• Beta blockers May decrease time to claudication

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Effect of Medications on

• Exercise Response Exercise Training
• i.e., HR, BP, ECG Exercise Capacity
• Recommendations for Exercise Training
• Recommendations for Exercise Programming

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Diabetes Exercise Training
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Intensity/Frequency/Duration

• 50-90 peak HR
• 4-7 days/ week
• 20-60 min session
• 4-6 month

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Obesity Patient

• Health Status
• Mild Obesity
• Morbid Obesity
• Effects of Exercise Response
• Effects of Exercise Training

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Obesity Exercise Testing
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Obesity Patient

• Recommendations for Exercise Programming
• In obesity exercise programming, it is
  recommended that there be 2 sessions a day at
  20-30 minutes each.