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Clinical Exercise Physiology for Cancer, Cardiovascular, and Pulmonary Rehabilitation

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Many forms of the disease. Degenerative heart disease. Coronary artery disease. Arteriosclerosis ... calcium in coronary arteries. CARDIAC DISEASE ASSESSMENT ... – PowerPoint PPT presentation

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Title: Clinical Exercise Physiology for Cancer, Cardiovascular, and Pulmonary Rehabilitation


1
Chapter 32
  • Clinical Exercise Physiology for Cancer,
    Cardiovascular, and Pulmonary Rehabilitation

2
Clinical Exercise Physiologist in the Clinical
Setting
  • Outcomes of disease
  • Handicap
  • Disability
  • Functional limitations
  • Impairment
  • Disease
  • Vital link between sports medicine and exercise
    physiology

3
Training and Certification Programs for Exercise
Physiologists
  • ACSM certifications
  • Clinical track
  • Program director (PD)
  • Exercise specialist (ES)
  • Health/Fitness track
  • Health/fitness director (HFD)
  • Health/fitness instructor (HFI)
  • Exercise leader (EL)

4
Clinical Applications of Exercise Physiology to
Oncology
  • Cancer statistics
  • Second leading cause of death in USA
  • Lung cancer causes most deaths
  • Men get prostate cancer most frequently, followed
    by lung, colon, then bladder
  • Women get breast cancer most frequently, followed
    by lung, colorectal, and uterine

5
Clinical Applications of Exercise Physiology to
Oncology
  • Cancer exercise
  • Strong inverse relationship between activity
    all cancer
  • Cancer rehabilitation through exercise
    prescription
  • Several shorter length moderate to low intensity
    sessions
  • Helps patients regain strength following therapy
  • Helps patient psychologically

6
Clinical Applications of Exercise Physiology to
Oncology
  • Nutrition and cancer
  • 1/3 of cancer deaths are related to diet
  • Food factors influencing cancer risk
  • Type
  • Preparation
  • Portion size
  • Overall energy balance

7
Clinical Application of Exercise Physiology to
Cardiovascular Diseases
  • Overview and scope of cardiovascular diseases
  • Many forms of the disease
  • Degenerative heart disease
  • Coronary artery disease
  • Arteriosclerosis
  • Coronary heart disease

8
Blood Pressure-Classification and Risk
Stratification
  • Mild hypertension
  • 140 159 mmHg systolic
  • 90 99 mmHg diastolic
  • Moderate hypertension
  • 160 179 mmHg systolic
  • 100 109 mmHg diastolic

9
Exercise Training and Hypertension
  • Chronic resistance training effects on blood
    pressure
  • Reductions in blood pressure of 6-10 mmHg
  • Reductions most apparent in those with mild
    hypertension
  • Effects are transient- need to continue training

10
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11
Diseases of the Myocardium
  • Angina pectoris
  • Chest pain indicating inadequate oxygen supply
  • Myocardial infarction
  • Congestive heart failure
  • Heart fails to pump required volume of blood
  • Aneurysm
  • Abnormally dilated wall of a blood vessel
  • Creates a weak spot

12
Diseases of the Myocardium
  • Heart valve disease
  • Stenosis narrowing or constriction
  • Insufficiency fails to close properly resulting
    in regurgitation
  • Prolapse enlarged valve leaflets bulge back
    into left ventricle

13
Diseases of the Myocardium
  • Inflammation conditions
  • Endocarditis
  • Pericarditis
  • Congenital malformations
  • Septal defects
  • Shunts between aorta pulmonary artery
  • Cardiac nervous system diseases
  • Dysrhythmias
  • Bradycardia, tachycardia, or PVCs

14
Cardiac Disease Assessment
  • Purpose of health screening and risk
    stratification-identifies persons
  • With medical contraindications
  • Needing in-depth medical evaluation
  • With clinically significant disease who need
    medical supervision when exercising
  • Patient history

15
Cardiac Disease Assessment
  • Physical examination
  • Heart auscultation
  • Laboratory tests
  • Noninvasive physiologic tests
  • Echocardiography
  • Graded exercise stress test
  • Ultrafast CT scan
  • Electronic beam detects calcium in coronary
    arteries

16
Cardiac Disease Assessment
  • Invasive physiologic tests
  • Radionucleotide studies
  • Thallium imaging
  • Nuclear ventriculography
  • Pharmacologic stress testing
  • Cardiac catheterization
  • Coronary angiography

17
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18
Cardiac Rehabilitation
  • Inpatient programs
  • Medical surveillance
  • Identification of significant impairments
  • Patient return to daily activities
  • Optimize recovery through preparation of family
    and patient

19
Cardiac Rehabilitation
  • Outpatient programs
  • Monitoring patient to detect changes in clinical
    status
  • Return to premorbid activities
  • Assisting patient implement at-home, unsupervised
    exercise program
  • Providing family support and education

20
Exercise Stress Testing
  • Reasons for stress testing
  • Diagnosis heart disease
  • Assess exercise-related chest symptoms
  • Screen for entry into preventive and cardiac
    rehabilitative exercise programs
  • Uncovers abnormal blood pressure responses
  • Monitors effectiveness of therapeutic
    interventions
  • Quantifies and evaluates functional aerobic
    capacity

21
Exercise Stress Testing
  • Guidelines for determining who requires stress
    testing have been established by the ACSM AMA
  • Informed consent
  • Tells patient risks benefits
  • Establishes confidentiality, voluntary nature of
    tests and allows for asking questions

22
Exercise Stress Testing
  • Stress testing absolute contraindications
  • Resting ECG suggesting acute cardiac disease
  • Recent complicated MI
  • Unstable angina pectoris
  • Uncontrolled arrhythmias
  • Third degree AV block without pacemaker
  • Acute CHF
  • Severe aortic stenosis
  • Active or suspected myocarditis or pericarditis
  • Recent systemic or pulmonary embolism
  • Acute infections
  • Acute emotional distress

23
Exercise Stress Testing
  • Stress testing relative contraindications
  • Resting diastolic BP gt 115 or systolic gt 200
  • Moderate valvular disease
  • Electrolyte abnormalities
  • Frequent ventricular ectopy
  • Ventricular aneurysm
  • Uncontrolled metabolic disorders
  • Chronic infectious diseases
  • Neuromuscular or musculoskeletal disorders
  • Pregnancy
  • Anxiety

24
Exercise Stress Testing
  • GXT termination
  • Signs or symptoms of heart disease
  • Abnormal BP response
  • Physical distress of subject
  • Nausea, dizziness etc.
  • Equipment failure
  • ECG indicated arrhythmias
  • Patient requests termination

25
Exercise Stress Test
  • Stress test outcomes
  • True positive
  • Test shows CHD they do have CHD
  • True negative
  • Test shows they do not have CHD they dont
  • False positive
  • Test shows CHD they do not have CHD
  • False negative
  • Test shows they do not have CHD they do

26
Exercise Stress Test
  • Exercise-induced indicators of CHD
  • Angina pectoris
  • Electrocardiographic abnormalities
  • ST segment elevation or depression
  • Significant Q waves
  • Prolonged PR interval

27
Exercise Stress Test
  • Exercise-induced indicators of CHD
  • Cardiac rhythm abnormalities
  • PVCs
  • Flutter or fibrillation
  • Bradycardia
  • AV blocks
  • Bundle branch blocks

28
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29
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30
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31
Exercise Stress Test
  • Exercise-induced indicators of CHD
  • Hypertensive exercise response
  • Hypotensive exercise response
  • Heart rate response

32
Stress Test Protocols
  • Bruce and Balke treadmill tests
  • Bicycle ergometer tests
  • Arm-crank ergometer tests
  • Stress testing safety
  • Pre-screening is critical
  • Follow guidelines to determine who may be tested
    without a physicians presence

33
Prescribing Exercise
  • Improvements in CHD patients
  • Cardiac workload
  • Physiologic adaptations
  • The program
  • Supervision level
  • Determined by health status risks
  • Resistance exercise provides benefits

34
Prescribing Exercise
  • Cardiac medications and exercise response
  • Medications alter heart rate response
  • Physician supervision / permission for exercise
    prescription is recommended

35
Pulmonary Diseases
  • Restrictive lung function
  • Pneumonia
  • Pulmonary edema
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic bronchitis
  • Emphysema
  • Cystic fibrosis

36
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37
Pulmonary Diseases
  • Pulmonary assessments
  • X-ray
  • Computed tomography

38
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39
Pulmonary Diseases
  • Pulmonary rehabilitation and exercise
    prescription
  • Improve health status
  • Improve respiratory symptoms
  • Recognizing early signs that require medical
    attention
  • Decreasing frequency and severity of respiratory
    problems

40
Pulmonary Rehabilitation and Exercise Prescription
  • Benefits
  • Maximizing arterial O2 saturation and CO2
    elimination
  • Enhancing daily functional capacity
  • Modifying body composition
  • Optimizing nutritional status

41
Exercise and Asthma
  • Sensitivity to thermal gradients and fluid loss
  • Environmental impact
  • Cool, dry air dehydrates bronchial tissues
  • Warm, moist air inhibits bronchospasms
  • Pollutants irritate bronchial tissues
  • Irritations may trigger EIA

42
Exercise and Asthma
  • Benefits of warm-up and medication
  • Refractory period
  • 15 30 minutes of light to moderate warm-up
    induces a refractory period, where bronchospasms
    are not likely to be induced by exercise
  • Medications
  • Relax smooth muscles of airways
  • Blunt inflammatory response
  • Suppress asthmatic symptoms

43
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44
Health/Fitness Promotion at the Work Site
  • Behavior changes/health outcomes
  • Healthier behaviors
  • Reduced risk factors for CHD
  • Reduced health care costs
  • Increased employee productivity

45
Health/Fitness Promotion at the Work Site
  • Decreased employee absenteeism
  • Employer cost benefits
  • Monetary benefits from improved employee
    productivity decreased absenteeism
  • Improved work environment from psychological
    emotional benefits
  • Employees feel better physically psychologically
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