What is considered moderate intensity for treadmill and bike in Watts?
Treadmill: 3 mph = 3.0 METs 4.5 mph = 6.0 METs
Cycling: 8-10 mph = 3.0 METs, 14-16 mph = 6.0 METs
What was found in the Journal of American Cardiology and by who?
- 122 007 patients with a median follow up of 8.4 years - deaths in over 13,000
- Elite group had a hazard ratio of 5.04 compared to bottom 25% for all-cause mortality
- Risk adjusted was 80% vs. low and 23% vs. High
- Below vs. Above: 41% reduced risk, Coronary artery disease 29%, Smoking 41% and Diabetes 40%.
- In over 70s elite vs. high performance was 29%
What did Williams 2001 find in Medicine and Science in Sport and Exercise?
- Meta-analysis in 23 cohorts (16 activity, 7 fitness)
- Physical fitness huge drop off as cumulated percentage at initial 25% and decreases linearly - physical fitness about 65% relative risk reduction and physical activity 25%
What information are needed before someone participates in exercise?
a) Informed consent, b) Exercise preparticipation health screening, c) Health history, d) Cardiovascular risk factor analysis
What are the 7 point that should be considered when providing informed consent and how should it be provided?
Informed consent is written and provided verbally
1) Informed of programme with written documentation
2) Purpose of test
3) Attending risks
4) Responsibilities (tell us if something goes wrong
5) Benefits to be expected
6) Inquiries (ask questions please)
7) Medical records kept confidential,
8) Freedom of consent
What is used in pre-screening of patients and what is on it?
- PARQ+
1) Basic info
2) Health history
3) Current medication
4) PA history
5) Risk factors
6) Symptoms
7) Pregnancy
8) Emergency contact
9) Waiverha
What are signs and symptoms suggestive of cardiovascular, metabolic or renal disease
1) Pain: Heavy feeling (constricting, squeezing, burning) substernal or both arm indicative of ischemia - occurs during exercise/stress - not provoked by body motion.
2) Dyspnea - left ventricular dysfunction and COPD
3) Dizziness/Syncope - Can be cardiac disorders stopping rise in cardiac output
4) Orthopnea/Paroxysmal dyspnea: Breathlessness going from recumbent to upright position. Breathlessness while sleep. Indicate left ventricular dysfunction.
5) Edema: Bilateral - heart failure - generalized nephrotic syndrome - one side lymphoedema.
6) Palpitations or tachycardia: Anxiety states, anaemia, underlying CVD
7) Intermittent claudication: Pain with walking - PAD
How might exercise be differentiated for those with and without CVD, renal, or metabolic disease
No previous PA
1) No CV and no sign and symptoms: No clearance needed. Start light to moderate and progress from there
2) Known CV metabolic and renal disease and asymptomatic: Medical clearance needed - light to moderate and progress via guidelines
3) Any signs and symptoms suggestive - Same as above
Previous PA (30 minutes/3 days/week/ 3 months)
1) Moderate or vigorous and progress as needed
2) Medical clearance for moderate PA - medical clearance for vigorous PA in the last 12 months and no change in signs/symptoms
3) Discontinue exercise and seek medical clearance
Describe moderate, vigorous, and light intensity exercise
- Light: 30-39% HRR, 9-11 RPE, slight increase in breathing
- Moderate: 40-59% HRR, 12-13 RPE, noticeable increase in HR and breathing
- Vigorous >60% HRR, >14 RPE, substantial increases in heart rate and breathing
What patients are considered high risk f one the criteria is met?
1) LVEF <40%
2) Survivor of cardiac arrest
3) MI or cardiac surgery with post-intervention ischemia
4) Abnormal hemodynamics with exercise
5) Symptoms of exercise intolerance <5.0 METs
6) Significant silent ischemia (>2mm depression)
7) Clinical depression
8) Functional capacity <5.0 METs
What patients are considered moderate risk?
1) LVEF 40%-15%
2) Signs and symptoms of angina at moderate exertion levels
3) Mild ST depression 1-2mm with exercise or in recovery
What patients are low risk if the following factors are present?
1) LVEF >50%
2) No resting or exercise-induced complex dysrhythmia
3) Uncomplicated MI, CABG, Angioplasty etc
4) Normal haemodynamics
5) Asymptomatic with exercise or in recovery
6) Functional capacity >7.0 METs
7) Absence of depression
What are the 8 risk factors for CVD?
1) Age: >45 Men, >55 Women
2) Family history
3) Cigarette smoking
4) Physical inactivity: Not meeting guidelines
5) BMI: >30 kg/m2 or waist circumference >40 inch men or >38 inch women
6) Blood pressure: >130/>80 (Either)
7) Dyslipidaemia: LDL>130 mg/dL, <50 mg.dL HDL
8) Blood glucose >100 mg.dL (fasting value)
HbA1C >5.7%
