Special Considerations

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Chapter 9

• Special Considerations

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Older Populations gt 65

• Decreased Referrals
• Increased disease severity
• Decreased functional status

• Financial barriers
• Transportation barriers
• Increased Psychosocial concerns
• Figure 9.1

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Comorbidities

• Diabetes Mellitus
• PVD
• COPD
• Obesity
• Arthritis
• Congestive Heart Failure

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Physiological Changes

• Body Fat Increases
• Decreased Fast Twitch
• Muscle Mass Decreases
• Diminished Glycogen Stores

• Decreased of neurons
• Loss of elasticity to connective tissue
• Lungs less able to supply O2
• Diminished stress adaptation

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Special Considerations

• Safety
• Functional Independence
• Modify Routines
• Alternative Learning Approaches
• Long-term exercise options

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Risk Factors gt Older Adults

• Smoking Cessation 20-70
• Hypertension gt 65
• Dyslipidemia Higher, difficult to manage
• Obesity Clustering of RF increases rates
• Diabetes Body mass relationships
• Psychosocial support, depression, sensory
• Physical Inactivity longer participation

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Young Adults

• Return to Work
• Anxiety, Denial, Anger
• Time Pressures
• Promoting Self-Management
• Compliance

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Women

• Atypical CP
• CAD 1 Killer
• Fewer women in CR
• Menopausal Status

• Increased Depression
• Increased Body Fat
• Functional Status
• Fewer Social Support

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Different Programming

• Womens Support Group
• Family Involvement
• Mall Walking

• Buddy System
• Womens Hour of Exercise
• One-on-one Orientation

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Diversity

• CAD Most common deaths among all races
• Black Americans Hypertension
• Native Americans Increased Smoking
• Black American Women Increased Mod. Risk Factors

• Asian/Pacific Islander Women Lowest Risk
• Socioeconomic Status
• Language Communications
• Social Issues
• Transportation

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RevascularizationCABG Valve

• Decreased risk of ischemia
• Increased mental depression
• Infection Rates
• Physical Function
• http//www.sts.org/doc/3705 - 4

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Valve

• Anticoagulant Medication
• Low Resistance Training
• Aortic Semilunar Valve, Bicuspid Valve
• Mechanical Valves, Pig Valves, and Cow Valves
• Coumadin Management
• http//health.allrefer.com/health/heart-valve-surg
  ery-heart-valves-anterior-view.html

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MIDCAB

• Avoidance of Sternotomy
• IMA Radial Artery
• Quicker Recovery
• http//www.heartsurgery-usa.com/What_s_New/MIDCAB/
  body_midcab.html

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PTCA/Stent

• Secondary Prevention
• Revascularization
• Plavix Blood Thinners
• Perclose
• Coated Stents
• Brachytherapy
• Re-Stenosis Rates
• http//www.heartsite.com/html/ptca.html

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Atrial/Ventricular Arrhythmias,Pacemakers,
AICDs

• Safety
• Symptoms
• Exercise Tolerance
• http//www.heartpoint.com/pacemakers.html

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Atrial Fibrillation

• Uncontrolled Contraindication
• Coumadin Diet Bleeding
• Digitalis Can cause ST depression
• Use wider range for Target Heart Rate
• Low Level Therapy Initially
• Reduce Caffeine intake nicotine
• http//www.aboutatrialfibrillation.com/

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Pacemakers AICDs

• No lifting over 10 lbs.
• Avoid Contact Activity
• Clean Incisions
• Fever?
• Drainage
• ID Card
• Maintain MD appointments

• Avoid Strong Magnetic Fields (MRI devices,
  Welders, Airports)
• Cough CPR
• Inform Dentists
• AICDs Shock can be felt
• TTR 10-15 below Shock Rate

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Congestive Heart Failure

• Poor Exercise Tolerance
• Volume Overload
• 1 admission for pts over 65
• Sodium Restriction

• Daily Weighing
• Medication Use
• Exertional Hypotension
• Increased LV Pressures

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LVAD

• End Stage CHF
• Transplants
• http//www.chfpatients.com/implants/lvads.htm

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Transplant Patients

• 3,000 per year
• Immunosuppressants
• RHR 95-115
• EKG May have 2 distinct P Waves
• RPB typically Higher

• VO2 increase 25 - 2-6 months
• Increased HR
• Increased Exercise Endurance
• Increased Symptoms
• Increased peak BP

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Diabetics

• Type I Type II
• Normalization of BS Levels
• Minimize Diabetic Complications
• Management of Weight

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COPD

• Smoking
• Medication Use
• O2
• Rest Periods
• Pursed Lip Breathing
• Disease Management

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Peripheral Arterial Disease - PVD

• Intermittent Claudication
• Rest Periods
• Peripheral Pulses ( Doppler studies Peripheral
  Pulses )
• Smoking Cessation
• Skin Foot Assessment
• Entry Level 50 Functional Capacity

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Heart Anatomy

• http//www.gwc.maricopa.edu/class/bio202/cyberhear
  t/hartint0.htm