cardiac output (CO) =
heart rate x stroke volume
with activity, what happens to HR, SV, CO, SBP, DBP
- HR: goes up
- SV: goes up
- CO: goes up
- SBP: goes up
- DBP: stays the same
MABP =
- DBP + 1/3(SBP-DBP)
- usually between 65-110
- average arterial pressure during a single cycle
- in general, need MABP > 60 mmHg to sustain organs
relationship between heart rate and intensity of workload
- fairly linear
heart rate and training
- with a given workload, HR with training will be less than before trianing period
cardiac output will [ ] then [ ]
- increase then plateau
- SV will also increase then plateau while HR is more linear
CO = HR x SV
HR, VO2, and increasing work
- relationship between VO2 and HR allows prediction of VO2 with HR
pathologies affecting the heart
- coronary artery disease
- angina: typically 1-15 minutes - longer can be prelude to HA
- chronic angina: long-lasting, stable, brought on by exercise/stress/heavy meal, regular over months and years
- unstable angina: can happen at rest, most serious - can signal future HA
- angina causes myocardial ischemia, dysrythmias, but less likely to cause a HA in itself because. HA is due to blockage
questions to ask patients with heart pathologies
- ask if they feel better or worse when activity is stopped
- takes 3 nitros in 10 minutes if they take nitroglycerine
- call if no change or call to let dr know about episode if they feel better
double product - relation to anginal threshold
- HR x SBP = “double product” AKA rate-pressure product
- equivalent to heart’s workload or VO2
how many patients will be able to change anginal threshold value
- < 5% - fairly fixed
- but what can we do to improve performance knowing we won’t change where the actual line is drawn?
- we can lower HR and SBP by slowly increasing work and intensity of exercise to allow conditioning
- if HR and SBP don’t go up as much, can shift curve to the right
angina scale
- rating of chest pain
- 3+ warrants stopping exercise
atrial fibrillation
- 5% of adults over 65 have A-fib
- greater risk for throwing clots: will be on coumadin/anticoags to decrease risk
- > 50% of adults > 65 years have dysrhythmias
- pulse rate does not work with pt with dysrhythmia: a-fib (need stethoscope to measure HR)
- uncontrolled a-fib > 100 BPM HR
- controlled a-fib up to 100 BPM HR
more pathologies affecting heart
- congestive heart failure: swelling, difficulty breathing, weight gain (need rest, diet, meds, modified daily activities)
- coronary artery disease
- hypertension
- dysthymians - atrial vs ventricular (more severe and serious)
- valvular insufficiency/stenosis
- myocarditis
- cardiomyoptahy: inflamed heart muscle (1. dilated is most common with enlarged heart cavities 2. hypertrophic 3. restrictive)
assessment of function of the heart as PTs
- HR (drugs)
- BP
- double product (HR x SBP)
- EKG rate/rhythm and ST-level
- angina
- lightheadedness
EKG rate is differential for heart problem
borg dyspnea scale
- want 4-6 or 12-14 target for pulmonary rehab
dyspnea level – objective qualification
i-STRONGER tool kit
- goal: 2-3 sets x 8 to FAILURE
- progress: > 8 reps
- ADLs, transfers, dishwasher loading
- tricep dips, bicep curls, wall push-ups
- weighted vests
3 categories of exercise
- strength training: usually isolated muscle groups
- therapeutic activities and transfers: crossover with OT
- neuromotor training - balance and gait: how can you combine with strength training
strength training LE
therapeutic activities and transfers
functional bridging progression
- supine bridges
- suprine bridges with weights or 5 sec hold at top
- bridges with marching at top
- bridges with marching and weight or 5s hold at the top
- bridges with knee extension
- bridges with knee extension and weight or 5s hold at the top
neuromotr training
neuromotor training balance progression
