What is the rate of continuation for those who start a cardiac rehab exercise program or any other type of behavioral change, irrespective of initial
... [Show More] health status or type
half or less of
The drop out rate is higher in the first 3 months
What is the biggest predictor for a patient to participate in cardiac rehab?
the fervor of the primary physicians'
recommendation or referring physician appears to be one of the most
powerful predictors of the patient's participation in
exercise, especially if a baseline fitness assessment
and an exercise prescription are provided at the
point of care.
True of False
The amount of exercise needed to improve health is the same as the amount of exercise needed to improve cardio system
False- You actually need more exercise to improve your heart, you can see health benefits from the addition of small amounts of exercise
True or False
lifestyle
intervention, including at least 150 minutes of
physical activity per week, was even more effective
than pharmacologic treatment, in reducing the
incidence of Type 2 diabetes.
TRUE! Diabetes Prevention Study
Name three tools that can be used to encourage the addition of physical activity and exercise into a cardiac rehab participant's lifestyle
Activity Pyramid,
pedometers and accelerometers may assist clients
in tracking their daily activities and facilitate exercise
Besides watts what is another unit that can be used on the bike to determine workload?
kilopond-meters per min−1 (kpm/min)
How should a bike seat be set up?
At the ideal
seat height the knee should be slightly flexed at full
extension.
Physiological responses to
exercise on a cycle ergometer differ from those
obtained on a treadmill. How much lower is the max oxygen uptake?
Physiological responses to
exercise on a cycle ergometer differ from those
obtained on a treadmill. Moreover, maximum oxygen
uptake is 5% to 20% lower than on the treadmill.
How should an arm bike be set up?
seated in the upright position, with
the fulcrum of the handle adjusted at shoulder height
and the arm should be slightly bent at the elbow
during farthest extension movements
What is the range for RPM on the arm bike?
60 - 75
Comparing arm bikes to leg exercises: oxygen uptake, HR & BP response
Oxygen uptake during any equivalent submaximal
level (eg, 50 W) of arm work exceeds that of leg
work. Accordingly, the rates of increase of heart rate
and blood pressure responses during arm ergometry
are more rapid. Other physiological responses to
dynamic arm exercise, eg, stroke volume and
diastolic blood pressure, also differ from those of leg
How often should a treadmill or arm cycle used in stress testing be calibrated?
Monthly or sooner
What is the equation to make sure treadmill MPH displayed are accurate
the actual miles per hour calculated by:
Belt length (inches) x number of revolutions/min divided by
1056
(1056 = conversion of inches per minute to miles per
hour)
How often should treadmills be serviced?
1000 hours of use
How you do check the calibration on a mechanically-braked cycle ergometer?
To check the calibration on a mechanically-braked
cycle ergometer, the belt should be removed from
the wheel. The mark on the pendulum weight should
be set at "0," and a weight that is known to be
accurate should be attached to the belt. The weight
should hang freely. A reading of that weight should
be given accurately on the scale. If all conditions are
met and the scale continues to show an incorrect
reading for the known weight, the adjusting screw
should be turned until the scale reads the correct weight
How is treadmill elevation calibrated?
Treadmill elevation is calibrated by measuring a fixed
distance on the floor and determining the difference
in height of the treadmill over the fixed distance.
Example:
What do you use to adjust the elevation calibration?
carpenter's level to check elevation and adjust potentiometer on the treadmill
What calculation is used to test elevation calibration?
Divide the difference between the two heights by the elevation you set. If the elevation is correct the difference of the two heights should = your grade in decimal format
Proper skin preparation for ECG
• Skin preparation:
- Clip excess hair from application sites
- Gently rub the area with a gauze or dry
washcloth pad to remove dead skin cells and
oily residue
- Cleanse site with mild soap and water
- Dry skin completely before applying electrodes
The quality of the signal received from the
electrodes is a direct result of skin preparation
and lead placement.
True or False
Use an alcohol pad to prepare the skin for the electrode
FALSE
Cleaning with alcohol should be avoided or
limited to situations in which electrode adhesion is
an issue (excessively oily or lotion covered skin),
because alcohol dries out the skin and in turn pulls
the moisture out of the electrode. Without this
moisture the electrode gel can act as a barrier to the
ECG signal. If alcohol is used, allow to dry prior to application
Describe the lead placement in a three lead system for II:
• White (RA) (negative) - infraclavicular fossa
close to right shoulder - below clavicle
• Red (LL) (positive) - on lower edge of rib
cage on left side of abdomen
• Black (LA) (ground) - infraclavicular fossa
close to left shoulder - below clavicle
What is the ground in a three lead system?
Black (LA) is the ground
What is the positive in a three lead system?
Red (LL) positive
What is the negative in a three lead system?
White (RA) negative
Why is cool-down important is cardiac rehab?
The
attenuation of the catecholamine response,
especially in patients with heart disease, may reduce
the likelihood of threatening ventricular
dysrhythmias, which are potential harbingers of
sudden cardiac death.
What are the following examples of?
5 minutes of slower walking or
jogging, cycling and approximately 5 minutes of
stretching exercises, and in some cases, alternate
activities (yoga, tai chi, relaxation training
Types of cool-downs
What are the four parts of an aerobic training session?
Warm-up, Exercise, Cool-down, Stretching
Optional fifth: Recreation Activity Time/Games with modified rules and less of a focus on winning
Benefits of warm-up:
warm-up may reduce the
susceptibility to musculoskeletal injury by increasing
connective tissue extensibility, improving joint range
of motion and function, and enhancing muscular
performance. A preliminary warm-up may also have
preventive value, decreasing the occurrence of
ischemic ST-segment depressions, threatening
ventricular dysrhythmias, and transient global left
ventricular dysfunction following sudden strenuous
exertion.
What is the range of VO2R for the warm-up?
10-30%VO2R
Describe the Exercise component of an aerobic training session:
The stimulus (conditioning) phase includes CR
(endurance), resistance, and flexibility programming.
Depending on the individual's goals or outcomes;
one, two, or all program areas can be included. A
comprehensive program should include all three
conditioning components.
What MET level should CAD patients accomplished before attempting Resistance Training?
It is advisable for CAD patients to have normal or only
slightly reduced left ventricular function (EF > 35%)
and a functional capacity > 5 METs before starting a
RT regimen.
Contraindications for RT
• Unstable angina
• Uncontrolled arrhythmias
• Left ventricular outflow obstruction
• Symptomatic heart failure
• Severe valvular disease
• Uncontrolled hypertension (ie, systolic BP ≥ 160;
diastolic BP ≥ 105 mmHg)
Traditional RT program defined as
lifting ≥ 50% of his/her 1-repetition (RM)
maximum
ACSM and AACVPR guidelines recommend the
following for starting a traditional RT program
• Post-MI and post-surgical patients should defer
traditional RT for at least 5 weeks after their
event/surgery
• Post-PCI (percutaneous coronary intervention =
angioplasty, stent) patients should defer
traditional RT for at least 2-3 weeks after the
revascularization procedure.
• It is recommend that CAD patients complete a
minimal period (ie, 2 weeks for post-PCI and 4
weeks for post-MI/surgery) of supervised CR
endurance training before starting a traditional RT.
• To prevent soreness and minimize the risk of
injury, the initial load should allow 12-15
repetitions comfortably. If a 1RM pretest is used,
this load would be approximately 30-40% 1RM
for the upper body and 50-60% for hips and legs.
Low-risk-stratified, well-trained patients may
progress to higher relative loads depending on
program goals.
• Perform 1 set of 8-10 exercises (major muscle
groups) 2-3 d/week. An additional set may be
added, but additional gains are not proportionate.
Some specific considerations for RT:
- Exercise large muscle groups before small
muscle groups
- Increase loads by 5% when the patient can
comfortably lift 12-15 repetitions
- Raise weights with slow, controlled
movements; emphasize complete extension of
the limbs when lifting
- Avoid straining
- Exhale (blow out) during the exertion phase of
the lift (eg, exhale when pushing a weight
stack overhead and inhale when lowering it)
- Avoid sustained, tight gripping, which may
evoke an excessive BP response to lifting
- An RPE of 11-13 may be used as a subjective
guide to effort.
- Stop exercise if warning signs or symptoms
occur, especially dizziness, dysrhythmias,
unusual shortness of breath, or anginal
discomfort
Reductions in flexibility are
often evident by the ______ decade of life and progress
with aging.
third
_________ __________ involves slowly stretching a muscle to the end of the range of motion (point of tightness without invoking discomfort) and then holding that position for an extended period of time (usually 15 to 30 seconds).
Static stretching involves slowly stretching a muscle
to the end of the range of motion (point of tightness
without invoking discomfort) and then holding that
position for an extended period of time (usually 15 to
30 seconds).
The
optimal number of stretches per muscle group is
_____ to _____
The
optimal number of stretches per muscle group is
2 - 4
Why is static stretching recommended over other forms of flexibility exercises?
The risk of injury is low,
requires little time and assistance, and is quite
effective. For these reasons, static stretching is
recommended.
Guidelines for flexibility in exercise Rx:
• Precede stretching with a warm up to elevate
muscle temperature
• Do a static stretching routine that exercises the
major muscle tendon units that focuses on
muscle groups (joints) that have reduced range of
motion
• Perform a minimum of 2 to 3 d·wk-1, ideally
5-7 d·wk-1
• Stretch to the end of the range of motion at a
point of tightness, without inducing discomfort
• Hold each stretch for 15 to 30 seconds
• 2 to 4 repetitions for each stretch
THR for patients with angina or ECG changes
10 beats per minute
below the ischemic ECG or angina threshold
Special considerations for patients with angina
-longer warm-up (10 to 20 mintues), HR up only 10-15 beats per minute
-non weight bearing exercises at low levels of exertion for very deconditioned patients with angina
-avoid exercises that increase angina higher than a level two on the 1 - 4 angina scale
-if patient still has angina after three nitro are taken and/or exercise has been stopped it is a MEDICAL EMERGENCY
-avoid exercise in cold weather
-caution should be taken when adding in RT exercises or upper body exercises
Special considerations for patients with CABG
• As there is often significant soft tissue and bone
trauma to the thoracic cavity after CABG, range
of motion (ROM) exercise should be undertaken
in the early post-surgical period. ROM should be
performed without feelings of pulling on the
incision or mild pain.
• CABG patients that experience sternal movement
or wound complications should not perform
upper body ergometry or RT until healing is
complete. As described earlier, the CABG patient
should perform 3-4 weeks of CR endurance
exercise before initiating traditional RT.
• Asymptomatic PCI patients can begin RT after 2
weeks of CR endurance exercise training
• Walking is a highly recommended and beneficial
mode of exercise that can be initiated within a few days of the CABG or PCI procedure.
Special considerations for patients with pacemaker/ICD
• The device discharge thresholds must be known
so that heart rate levels during exercise can be
kept safely below this value (~10-20 beats.min-1)
to prevent inappropriate shocks.
• Ratings of perceived exertion should be used in
conjunction with HR to regulate exercise intensity.
• Upper body/should motion should be limited
initially to prevention dislodging of the leads and
traditional RT should not be performed until 4 to 6
weeks post-implantation.
Absolute Contraindications for Exercise
• Recent change in ECG
• Unstable angina
• Uncontrolled cardiac arrhythmias
• Symptomatic severe aortic stenosis or other
valvular disease
• Decompensated symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute noncardiac disorder that may affect
exercise performance or may be aggravated by
exercise (eg, Infection, thyrotoxicosis)
• Acute myocarditis or pericarditis
• Acute thrombophlebitis
• Physical disability that would preclude safe and
adequate exercise performance
Relative Contraindications to Exercise:
• Electrolyte abnormalities
• Tachyarrhythmia or bradyarrhythmias
• High-degree atrioventricular block
• Atrial fibrillation with uncontrolled ventricular rate
• Hypertrophic obstructive cardiomyopathy with
peak resting left ventricular outflow gradient of
> 25 mmHg
• Known aortic dissection
• Severe resting arterial hypertension (systolic [BP]
> 200 mmHg and diastolic BP > 100 mmHg)
• Mental impairment leading to inability to
cooperate with testing
*Contraindications can be superseded if benefits
outweigh risks of exercise
Adverse Responses to Exercise Leading
to Exercise Discontinuation
• Diastolic BP ≥ 110 mmHg
• Decrease in systolic BP > 10 mmHg
• Significant ventricular or atrial dysrhythmias
• Second-or-third-degree heart block
• Signs/symptoms of exercise intolerance,
including angina, marked dyspnea, and
electrocardiogram changes suggestive of
ischemia.
The normal ECG response to exercise includes the
following:
• Minor and insignificant changes in P wave
morphology
• Superimposition of the P and T waves of
successive beats
• Increases in septal Q wave amplitude
• Slight decreases in R wave amplitude
• Increases in T wave amplitude (although wide
variability exists among subjects)
• Minimal shortening of the QRS duration
• Depression of the J point
• Rate-related shortening of the QT interval
A patient exercises has depression of the J point that leads to marked
ST-segment upsloping. Should the patient stop exercising?
Depression of the J point that leads to marked
ST-segment upsloping is due to competition
between normal repolarization and delayed terminal
depolarization forces rather than to ischemia.
Exercise-induced myocardial ischemia may be
manifested by three different types of ST-segment
changes on the ECG. Name them:
-ST segment elevation
-ST segment depression
-ST segment normalization
ST-segment elevation is _____repolarization
ST-segment elevation is early repolarization
Exercise-induced ST-segment elevation in leads
displaying a previous Q wave infarction may be
indicative of _____ _______ _________ or
_______ _______________.
Exercise-induced ST-segment elevation in leads
displaying a previous Q wave infarction may be
indicative of wall motion abnormalities or
ventricular aneurysm.
Exercise-induced ST-segment elevation on an otherwise normal ECG (except in aVR or V1-2)
generally indicates significant __________ ________, and localizes the ischemia to a specific
area of myocardium.
Exercise-induced ST-segment elevation on an otherwise normal ECG (except in aVR or V1-2)
generally indicates significant myocardial
ischemia, and localizes the ischemia to a specific
area of myocardium.
What is the
most common manifestation of exercise-induced
myocardial ischemia.
ST-segment depression (depression of the J point
and the slope at 80 msec past the J point) is the
most common manifestation of exercise-induced
myocardial ischemia.
Name the standard criterion for a ST depression.
The standard criterion for a positive test is
≥ 1.0 mm (1 mV) of horizontal or downsloping ST
segment 80 msec after the J point.
True or False
ST-segment depression does not localize
ischemia to a specific area of myocardium.
True
ST-segment depression does not localize
ischemia to a specific area of myocardium.
The more leads with (apparent) ischemic
ST-segment shifts, the more _______ the disease.
The more leads with (apparent) ischemic
ST-segment shifts, the more severe the disease.
Why is significant ST-segment depression occurring only
in recovery an important diagnostic finding?
Significant ST-segment depression occurring only
in recovery likely represents a true positive
response, and should be considered an important
diagnostic finding.
Slowly _____________ ST-segment depression should
be considered a borderline response, and added
emphasis should be placed on other clinical and
exercise variables.
Slowly upsloping ST-segment depression should
be considered a borderline response, and added
emphasis should be placed on other clinical and
exercise variables.
In right bundle-branch block, exercise-induced
ST-segment depression in the _________ _______ ________ should not be used to
diagnose ischemia
In right bundle-branch block, exercise-induced
ST-segment depression in the anterior precordial
leads (V1, V2, and V3) should not be used to
diagnose ischemia
What leads can show ischemia in a RBBB?
ST segment
changes in the lateral leads (V4, V5, and V6) may
be indicative of ischemia even in the presence of
this conduction abnormality
The _____ _____ is the ratio of the maximal
ST-segment change to the maximal change in HR
from rest to peak exercise. An ST/HR index of
≥ ____ is defined as abnormal.
The ST/HR index is the ratio of the maximal
ST-segment change to the maximal change in HR
from rest to peak exercise. An ST/HR index of
≥ 1.6 is defined as abnormal.
The ______ ______
evaluates the maximal slope relating the amount
of the ST-segment depression to HR during
exercise. An ST/HR slope of > _____ mV/beat/min is
defined as abnormal.
The ST/HR slope
evaluates the maximal slope relating the amount
of the ST-segment depression to HR during
exercise. An ST/HR slope of > 2.4 mV/beat/min is
defined as abnormal.
True or False
Ischemia may be manifested by normalization of
resting ST segments.
True
Ischemia may be manifested by normalization of
resting ST segments. ECG abnormalities at rest,
including T-wave inversion and ST-segment
depression, may return to normal during anginal
symptoms and during exercise in some patients.
Although patients with exercise-induced ST-segment
depression can be asymptomatic, when concomitant
angina occurs, the likelihood that the ECG changes
are due to CAD is significantly ________.
Although patients with exercise-induced ST-segment
depression can be asymptomatic, when concomitant
angina occurs, the likelihood that the ECG changes
are due to CAD is significantly increased.
True or False
Angina pectoris without ischemic ECG changes may
be as predictive of CAD as ST-segment changes
alone.
Angina pectoris without ischemic ECG changes may
be as predictive of CAD as ST-segment changes
alone.
True or False
Exercise-associated dysrhythmias occur in healthy
subjects as well as patients with cardiac disease.
True
Exercise-associated dysrhythmias occur in healthy
subjects as well as patients with cardiac disease.
Increased sympathetic drive and changes in
extracellular and intracellular electrolytes, pH, and
oxygen tension contribute to disturbances in myocardial and conducting tissue automaticity and
reentry, which are major mechanisms of
dysrhythmias.
True or False
Supraventricular Dysrhythmias:
Isolated premature atrial contractions are common
and require no special precautions.
True
What is it called when a patient has > 7
PVCs per minute
frequent ventricular ectopy
Criteria for terminating exercise
based on ventricular ectopy include:
Criteria for terminating exercise
based on ventricular ectopy include sustained
ventricular tachycardia, as well as multifocal PVCs,
and triplets of PVCs. The decision to terminate
exercise should also be influenced by simultaneous
evidence of myocardial ischemia and/or adverse
signs or symptoms.
Isolated premature ventricular complexes or
contractions (PVCs) occur during exercise in ____ to
____ of healthy subjects and in ____ to ____ of
patients with CAD.
Isolated premature ventricular complexes or
contractions (PVCs) occur during exercise in 30 to
40% of healthy subjects and in 50 to 60% of
patients with CAD.
The five components of health-related physical
fitness are:
• Muscular Strength: muscular strength is ability of
a muscle to exert a maximal force through a given
range of motion or at a single given point.
• Muscular Endurance: muscular endurance refers
to the capacity of a muscle to exert a submaximal
force through a given range of motion or at a
single point over a given time.
• Cardiovascular Endurance: cardiovascular
endurance is the ability to continue training the
cardiovascular system for a period longer than
twenty minutes (on average).
• Flexibility: flexibility is the ability of a joint to
move through a full range of motion.
• Body Composition: Body composition is the ratio
of lean body mass to fat body mass.
expression of total body oxygen uptake and one unit = 3.5 ml/kg/min of oxygen consumption
1 MET
Oxygen uptake (VO2)
usually expressed in ml/kg/min (can be converted to METs by dividing by 3.5
Fick Equation where VO2 =
cardiac output x arterio-venous oxygen content difference
What do peak oxygen uptake levels
of less than 14-15 ml/kg/min reflect
Peak oxygen uptake levels
of less than 14-15 ml/kg/min reflect very low
functional capacity and portend a poor prognosis,
particularly in those with heart failure.
Rate Pressure Product (Double
Product)
is estimated by heart rate x systolic blood
pressure (RPP = [HR x SBP]/100) and generally
reflects myocardial demand (MVO2).
Why is RPP important in regards to ischemia?
This measure is
particularly important in patients with myocardial
ischemia as signs and symptoms of ischemia
generally occur at a consistent and reproducible
RPP. Regular exercise training will generally
decrease RPP at a similar submaximal exercise level
which may result in decreased ischemic symptoms
Ejection Fraction
usually measured by
echocardiography or cardiac catheterization, is
calculated by dividing stroke volume (SV) by
end-diastolic volume (EDV).
Normal EF
Normal EF at rest is generally
between 50-60%
A reduced EF (< 50%) is
associated with
left-ventricular systolic dysfunction
and may produce signs and symptoms of heart
failure (eg, HF with a reduced EF). While an EF
≤ 35% represents significant left ventricular
dysfunction, EF can decrease to 10-15% in those
with very poor left ventricular function
HFrEF
Patient with
HF with a reduced EF (HFrEF)
HFpEF
heart failure with a preserved EF
(HFpEF)
HFpEF is more common in what populations?
This condition is particularly common in
older adults, and is more common in women,
diabetics, and hypertensive patients.
Acute response to exercise
What happens to HR, SV, Cardiac Output, SBP, DBP, Double Product
- Rapid increase in HR, SV, cardiac output
- SBP increases with increasing work rate
- DBP remains the same or slightly decreases
- Double product (HR x SBP) increases linearly
with exercise intensity and reflects the work of
the heart (myocardial oxygen consumption
= MVO2)
- Heart rate and cardiac output increase linearly
with increasing work rate and reaches plateau
at 100% VO2max
True or False
True
Do not place AED electrode over transdermal
medication patch (nicotine, nitroglycerine)
Name two calcium channel blockers will likely decrease heart rate at rest and during exercise.
calcium channel blockers Diltiazem and Verapamil
Adaptations to Exercise (Resting HR, Exercise HR, Max HR, AVO2, SV, Q, BP at rest, VO2Max, VE)
• Resting HR decreases
• Exercise HR at submax levels decrease
• Maximal HR stays the same or may decrease
slightly
• Arterial Venous Oxygen content (AVO2)
differences increases
• Stroke volume increases
• Cardiac output (Q) increases
• Blood volume at rest increases
• Resting SBP stays the same or slightly increases
• VO2 max increases
• Maximum ventilation (VE) increases
Name the three main purposes of an individualized exercise prescription:
(1) enhance some facet of
physical fitness (eg, CR endurance, muscular
strength/endurance)
(2) promote health by
modification of chronic disease risk factors (eg,
decrease excess body fat, normalize blood lipids or
blood pressure)
(3) ensure safety during
exercise participation (ie, decrease incidence of
cardiovascular complications and/or musculoskeletal
MHRR or VO2R exercise prescription range
40%/50% - 80%
List abnormal signs and symptoms
for which an upper limit for exercise intensity should
be set, regardless of the calculated MHRR or VO2R:
• Onset of angina or other symptoms of
cardiovascular insufficiency
• Plateau or decrease in systolic blood pressure,
systolic blood pressure of > 250 mmHg (or
diastolic blood pressure of > 115 mmHg)
• ≥ 1 mm ST-segment depression, horizontal or
downsloping
• Radionuclide evidence of left ventricular
dysfunction or onset of moderate-to-severe wall
motion abnormalities during exertion
• Increased frequency of ventricular dysrhythmias
• Other significant ECG disturbances (eg, 2º or 3º
AV block, atrial fibrillation, supraventricular
tachycardia, complex ventricular ectopy, etc.)
• Other signs/symptoms of intolerance to exercise
The peak exercise heart rate should generally be at
least ____ below for problems
The peak exercise heart rate should generally be at
least 10 beats·min-1 below the heart rate associated
with any of the above-referenced criteria.
RPE
The 15-point (6-20) RPE scale is
typically used for this purpose with RPE values of 11
to 13 being recommended for the early outpatient
exercise sessions, whereas a range of 12 to 15 is
recommended for the higher training intensities
during subsequent exercise training sessions.
RPE ragne for early outpatient exercise sessions
RPE values of 11
to 13 being recommended for the early outpatient
HIT
High intensity interval training, AACVPR states more research needed
True or False
Calculating exercise heart rate
ranges based on age-predicting maximal heart rate
formulae (ie, 220-age) is appropriate for CAD
FALSE
DON'T DO IT
Ways to establish intensity of exercise prescription without GTT:
RPE, resting HR plus an
arbitrary value (generally 20 bpm for post-MI or
post-CABG patients on beta blockers or 30 bpm for
non-beta blocked patients), Talk Test, 6 Minute Walk, Submax Exercise Test (use HR or METS from test to establish ranges)
Can you use Pharmacologic stress tests for exercise prescription?
does NOT
provide an assessment of functional capacity,
hemodynamic responses to progressive exercise, or
an indication of the ischemic "threshold".
Consequently, data from these tests are of little value
in the determination of appropriate CR exercise
training intensity.
dobutamine
increases myocardial demand
dipyridamole or adenosine
reduce
myocardial supply
standard recommendation for duration.
standard
recommendation is to have the patient start with a
light to moderate exercise intensity and increase
duration until the desired level (30-40+ minutes) is
attained before increasing intensity.
Frequency Recommendations:
Most CAD patients can achieve improvements in functional capacity with two to three sessions per week, provided that the intensity and duration of these sessions are adequate. However, patients in need of aggressive risk factor intervention (ie, to decrease obesity or hypertension, normalize blood lipids, improve glucose tolerance, etc.) will likely benefit from a greater frequency of cardiorespiratory exercise. Increasing the number of sessions per week (to four to five) will help to modify these risk factors over time; however, the exercise professional should be able to recognize that there is a direct relationship between the frequency of exercise and the risk of orthopedic injury.
patients should be able to achieve
duration of ____ to _____ minutes of continuous CR
exercise before increasing the intensity.
patients should be able to achieve
duration of ≥ 20 to 30 minutes of continuous CR
exercise before increasing the intensity. [Show Less]