3. A cool-down phase lasting about 10 minutes which consisted of seated exercises that allowed the heart rate to fall in a controlled manner. (Owen & Croucher, 2000) Arthritis Patients with arthritis can also participate in exercise programs to reduce symptoms. Patients should focus on improving functionality through cross-training and functional exercises, including sit to stand, and stair climbing should be included to improve functional ability (McDermott & Mernitz, 2006). People with arthritis should start with short bouts of low-intensity exercise every day while progressively increasing the duration. They should make sure that when exercising affected joints, they only perform pain-free range-of-motion and flexibility training (McDermott & Mernitz, 2006). Progressive resistance training (PRT) should begin using the patient’s pain threshold as a guide for intensity beginning with as little as two or three repetitions and working up to 10 to 12 repetitions two to three days per week (McDermott & Mernitz, 2006). Initially, cardiovascular exercise should be brief, starting at 10 minutes and adding five Diabetes Patients with diabetes can also benefit from exercise, but special considerations are needed for this patient population. Progressive resistance training should include lower resistance and lower intensity; major muscle groups should be incorporated into exercise; repetition goals should be 15 to 20; and it is important to focus on proper form and breathing to avoid the Valsalva maneuver (McDermott & Mernitz, 2006). It is important for this patient population to undergo a medical evaluation or pre-screening to assess cardiovascular, nervous, renal and visual systems, as well as the risk of diabetic complications (McDermott & Mernitz, 2006). Contraindications to exercise for patients with diabetes include: ● Intense progressive resistance training may cause an acute hyperglycemic effect and basic progressive resistance Hypertension Patients with hypertension also require special considerations when beginning an exercise program. Focus on aerobic activities that incorporate large muscle groups; patients should exercise 30 to 60 minutes, three to seven days per week to effectively lower blood pressure (McDermott & Mernitz, 2006). Daily exercise may be most effective for patients with hypertension (McDermott & Mernitz, 2006). Progressive resistance training should be combined with aerobic activity using lower resistance and more repetition. Patients also need ensure they are Obesity Patients with obesity should focus on daily activities that utilize large muscle groups to increase total energy expenditure (McDermott & Mernitz, 2006). Patients with this chronic disease condition should exercise 45 to 60 minutes, five to seven days per week (McDermott & Mernitz H, 2006), at an intensity of 40 to 60 percent VO2 reserve with an emphasis on increased duration and frequency. The patient should then be progressed to 50 to 75 percent VO2 reserve to help them expend calories faster; a vigorous program may not be necessary if moderate activity, such as walking, is preferred and will improve compliance (McDermott & Mernitz, 2006). Osteoporosis Patients with osteoporosis require special consideration due to increased risk of fractures secondary to low bone density and stability. This patient population should focus on improving balance and functionality (McDermott & Mernitz, 2006). Frequency should include weight-bearing activities four days per
Subjects also measured their pulse rate and were advised not to exceed 70 percent of their age-predicted maximum heart rate (Owen & Croucher, 2000). The results of this study demonstrated that elderly patients with heart failure can benefit from an appropriately designed exercise program (Owen & Croucher, 2000). minutes per session until reaching 30 minutes (McDermott & Mernitz, 2006). Cardiovascular exercises may be weight-bearing (walking) or non-weight-bearing (cycling or hydrotherapy) (McDermott & Mernitz, 2006). While it is safe for patients with arthritis to exercise, some contraindications must be considered, including: ● Avoiding vigorous repetitive exercises that are performed at unstable joints; overstretching and morning exercises if rheumatoid arthritis-related stiffness is present. ● Avoiding exercise during flare-ups and discontinue exercise if the patient has unusual or persistent fatigue, increased weakness, decreased range of motion, or if joint swelling or pain lasts for more than one hour after exercise. (McDermott & Mernitz, 2006) training may cause post-exercise hypoglycemia, especially in patients taking insulin or oral hypoglycemic agents. ● Patients with diabetes and concomitant retinopathy and overt nephropathy may have reduced exercise capacity. ● Peripheral neuropathy may be associated with gait and balance abnormalities; consider limited weight-bearing exercises and addressing patient foot care. ● With autonomic neuropathy, emphasize the Borg Rate of Perceived Exertion Scale, monitor patient for heart rate and blood pressure response to exercise, thermoregulation, signs of silent ischemia, and post-exercise plasma glucose levels. ● Polyuria may contribute to dehydration and compromised thermoregulation. (McDermott & Mernitz, 2006) following proper form and breathing to prevent the Valsalva maneuver (McDermott & Mernitz, 2006). Contraindications to exercise for patients with hypertension include: ● Beta blockers may attenuate heart rate response and reduce exercise capacity while other medications may impair thermoregulation. Patients should cool down gradually after exercise to prevent hypotension. (McDermott & Mernitz, 2006) Contraindications to exercise for patients with obesity include: ● To prevent orthopedic injury, aerobic intensity and duration may be maintained at or below usual recommendations and modified as needed. ● Non-weight-bearing aerobic activities or frequent rotation of modalities may be required. ● Equipment modifications may be required, because treadmills have weight limits and cycle or rowing seats may be too small. Free weights may be used instead of weight machines if necessary. ● Because the risk of hyperthermia during exercise is increased in obese patients, emphasize hydration and proper attire. (McDermott & Mernitz, 2006) week; progressive resistance training two to three days per week; and flexibility exercises five to seven days per week. Patients should also perform functional exercises (McDermott & Mernitz H, 2006). Intensity of exercise for patients with osteoporosis should be 40 to 70 percent VO2 reserve for aerobic activities
Page 86
Book Code: PTNY3622B
EliteLearning.com/Physical-Therapy
Powered by FlippingBook