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Part II: Applied Science of Exercise and Techniques
Chapter 7
Principles of Aerobic Exercise
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Key Terms and Concepts
Physical Activity Exercise Physical Fitness Maximum Oxygen
Consumption Endurance
Aerobic Exercise Training (Conditioning)
Adaptation Myocardial Oxygen
Consumption Deconditioning
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Energy Systems– Phosphagen, or ATP-PC system– Anaerobic glycolytic system– Aerobic system– Recruitment of motor units– Functional implications
Energy Systems, Energy Expenditure, and Efficiency
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Energy Expenditure– Quantification of energy expenditure– Classification of activities
Efficiency
Energy Systems, Energy Expenditure, and Efficiency (cont'd)
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Cardiovascular Response to Exercise– Exercise pressor response– Cardiac effects– Peripheral effects• Net reduction in total peripheral resistance• Increased cardiac output• Increase in systolic blood pressure
Physiological Response to Aerobic Exercise
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Respiratory Response to Exercise Responses Providing Additional Oxygen to
Muscle– Increased blood flow– Increased oxygen extraction– Oxygen consumption
Physiological Response to Aerobic Exercise (cont'd)
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Signs & Symptoms of Excessive Effort Persistent dyspnea Dizziness/confusion Pain Severe leg claudication Excessive fatigue Pallor, cold sweat Ataxia Pulmonary rales
Lack of SBP increase Hypertensive BP >
200/110 Progressive fall in SBP by
10-15mmHg Change in rhythmDelayed Responses:Prolonged fatigueInsomniaSudden weight gain due to
fluid
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Fitness Testing of Healthy Subjects Stress Testing for Convalescing Individuals and
Individuals at Risk– Principles of stress testing– Purpose of stress testing– Preparation for stress testing– Termination of stress testing
Multistage Testing
Testing as a Basis for Exercise Programs
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Frequency Intensity– Overload principle– Individuals at risk– Variables– Specificity principle
Time (Duration) Type (Mode)– Reversibility principle
Determinants of an Exercise Program
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ACSM, AHA, CDC, Surgeon General– Children: Age 6–17– Adults: Age 18–65– Older adults: Age 65 or older– Adults age 50–65 with chronic health conditions
General Recommendations for Aerobic Physical Activity
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Warm-Up Period Aerobic Exercise Period– Continuous training– Interval training– Circuit training– Circuit-interval training
Cool-Down Period Application
Exercise Program
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Cardiovascular Respiratory Metabolic Other Systems
Physiological Changes That Occur With Training
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For the Patient With Coronary Disease– Inpatient phase (Phase I)– Outpatient phase (Phase II)– Outpatient program (Phase III)– Special considerations– Adaptive changes
Application of Principles of an Aerobic Conditioning Program
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For the Deconditioned Individual and the Patient With Chronic Illness– Deconditioning– Reversal of deconditioning– Adaptations for participation restrictions
(disabilities), activity restrictions (functional limitations), and deconditioning
– Impairments, goals, and plan of care
Applications of Aerobic Training
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Age Differences
Children Young Adults Older Adults
Heart Rate Stroke Volume Cardiac Output Arteriovenous Oxygen
Difference Maximum Oxygen Uptake Blood Pressure Respiration Muscle Mass and Strength Anaerobic Ability
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Hypertension
Prehypertensive Stage I
Stage II
Stage II
SBP 120-130; DBP 80-89 SBP 130-140; DBP 90-
100 SBP 140-160; DBP 100-
110 SBP > 160; DBP >110
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General Goals of PT intervention– Increase aerobic capacity– Increase ability to perform physical tasks related to self
care, home management, community & work integration & leisure activities
– Improve physiological response to increased O2 demand
– Increased strength, power & endurance– Decreased symptoms associated with increased O2
demand
PT Intervention for Pts with CAD
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Increase ability to recognize recurrence & intervention is sought sooner
Reduce risk of recurrence Acquire behaviors that foster healthy habits,
wellness, & prevention Enhance decision making regarding health,
use of health care resources by pt, family, caregivers, etc.
PT Intervention - continued
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Unstable Angina Symptomatic heart failure Uncontrolled arrythmias Moderate to severe aortic stenosis Uncontrolled diabetes Acute systemic illness/fever Uncontrolled tachycarida (HR >100 bpm) Resting SBP > 200 mmHG; DBP >110 mmHg Thromophlebitis
Contraindications to Aerobic Exercise
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Chest pressure Dyspnea Fatigue Syncope Palpitations Edema – pulmonary/Peripheral – CHF Fluid weight gain – CHF S3 Heart Sound – CHF Renal dysfunction - CHF
Clinical Signs & Symptoms CAD/CHF
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Improve physiological reponse to increased O2 demand
Improvement of self management of symptoms Increased ability to perform physical tasks Acquire behaviors that foster healthy habits, wellness
& prevention Reduction of disability associated with acute or chronic
illness Reduction of secondary impairments Improved awareness & use of community resources Increased performance of & independence with ADL’s
PT Intervention for CHF - Goals
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Activity Guidelines Self Monitoring – pulse; RPE Symptom recognition & response Nutrition Medications – prescription & OTC Lifestyle issues Psychological/Social Issues Other
Pt Education for Pts with CHD