phase 3

Question 1

Mx

Answer 1

• Group effect is important
• Refer to community groups
• Give precautions regarding exercise
• Establish energy involved in normal occupation & housework
• Establish MET level
• Discuss activity patient prefers
• Give ceiling pulse pre, post, 2 min

Question 2

Precautions – Safe Exercises

Answer 2

• Care with hills
• Don’t exercise in heat of day
• > 28C or humidity – low intensity
• > 2 hours after meals
• Don’t exercise if sick
• Resume > 2 days after illness resolves
• Learn to take pulse – know limits

Question 3

Exercise in Obesity & Diabetes

Answer 3

¬ Low intensity > 40-70% of MHR
¬ Long duration > endurance
¬ Intermittent at first > 2-3 x 10 minute walk/bicycle
¬ Non-weight-bearing > cycling, hydrotherapy
¬ Aerobic & resisted

¬ Monitor:
o Haemodynamic response (blood pressure)
o Blood glucose

Question 4

Contraindications for Stress Test or Exercisev

Answer 4

• Unstable or at rest angina
• Dangerous arrhythmias
• Third degree AV heart block
• Uncontrolled LVF
• Moderate severe aortic stenosis
• Suspected dissection aortic aneurysm
• Myocarditis
• Recent embolism
• Uncontrolled hypertension
• Pregnancy
• Resting SBP >200mHg or DBP > 100mmHg
• Orthostatic BP drop > 20mmHg
• Acute illness, fever
• Acute pericarditis or myocarditis

Question 5

Relative Contraindications/Special Precautions

Answer 5

• Diabetes – uncontrolled
• Pulmonary hypertension
• Cardiac enlargement
• Conduction disturbances
• Severe anaemia
• Renal, hepatic disease
• Pulmonary disease

Question 6

Reasons for Stress Test

Answer 6

• Diagnostic – IHD, Respiratory/Cardiac cause
• Rhythm disturbances
• Prior to exercise programme
• Comparison at end of programme
• Estimate LV function
• Prognosis