Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 79
○ Physical Activity Scale for the Elderly (PASE) is a self-report questionnaire that assesses leisure, household and occupational activities in adults: ■ Has been used in CHF populations, those with pulmonary disease, and with coronary heart disease ■ The PASE is correlated with strength, resting heart rate, systolic BP, peak oxygen uptake and quality of life • Disease specific instruments : ○ Seattle Angina Questionnaire ○ Minnesota Living with Heart Failure Questionnaire ○ Kansas City Cardiomyopathy Questionnaire Aerobic Exercise Contraindications Absolute Contraindications for Aerobic Exercise : • Unstable angina • Uncontrolled cardiac dysrhythmias • Uncontrolled symptomatic heart failure • Acute or suspected major cardiovascular events • Acute systemic infection • Recent significant change in resting ECG Absolute Indications for Terminating Exercise : • Drop in SBP of >10 mmHg from baseline despite an increase in workload • Moderately severe angina • Increase nervous system symptoms • Signs of poor perfusion • Subject’s desire to stop • Technical difficulty with monitoring equipment • Sustained ventricular tachycardia • ST elevation Relative : • Known significant cardiac disease • Severe arterial hypertension at rest • Tachydysrhythmia or bradydysrhythmia • Electrolyte abnormalities • Uncontrolled metabolic disease • Chronic infectious disease • Mental or physical impairment leading to inability to exercise safely Relative indications for terminating exercise : • Drop in SBP of >10mm Hg from baseline despite • Increasing chest pain • Hypertensive response • Fatigue, shortness of breathing/wheezing, leg cramps or claudication • ST or QRS changes • Arrhythmias other than sustained ventricular tachycardia • Development of bundle-branch block or intraventricular conduction delay
ANGINA SCALE Class I
Ordinary activity does not cause angina; angina with strenuous or rapid or prolonged exertion only Slight limitation of ordinary activity; angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, in cold weather, when under emotional stress, or only during the first few hours after awakening Marked limitation of ordinary physical activity; angina on walking one or two blocks level surface or one flight of stairs at a normal pace or under normal conditions
Class II
Class III
Class IV Inability to carry out any physical activity without discomfort or angina at rest Patient symptoms can also provide details regarding central or peripheral perfusion: • Central perfusion = syncope, lightheadedness, change in mental status • Peripheral perfusion = extremity tingling, numbness or coldness Graded Exercise Testing Used to assess aerobic capacity objectively. • Benefits : ○ Diagnose cardiovascular disease and/or pulmonary disease ○ Determine disease severity or risk stratification ○ Evaluate functional abilities ○ Establish baseline for exercise prescription or disease progress ○ Evaluate intervention effectiveness • Examples :
○ Leg cycle ergometry ○ Arm cycle ergometry ○ Stair stepping ○ Treadmill walking ○ Treadmill running
Self-Report Measures : require patients to answer questions and rate statements regarding personal perceptions of conditions or functional abilities. They are often used for depression, pain, and functioning in home or community environments. • Generic health-related quality of life instruments : ○ The Medical Outcomes Study Short Form 36 Health Survey (SF-36) or RAND 36-items Health Survey are commonly used to assess quality of life in older adults
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